madman
Super Moderator
CONCLUSION: CLINICAL IMPLICATIONS FOR
PSYCHIATRIC OUTPATIENTS
To our knowledge, there have not been any studies designed to determine the prevalence of hypogonadism in treatment resistant major depressive disorder or the prevalence of hypogonadism in the general outpatient psychiatric population. Because hypogonadism and treatment-resistant depression are common conditions, this is likely a large and relatively undiagnosed population. Evidence for testosterone alleviating depressive symptoms in hypogonadal patients is mixed and further study is warranted. There is sufficient evidence to conclude that in some men repletion of testosterone has the potential to have a significant positive effect on mood.
For screening purposes, commonly used questionnaires for hypogonadism have not been validated in psychiatric populations. Even in non-psychiatric settings, the specificity of questionnaires is poor. Because many screening questions overlap with symptoms of depression and other psychiatric disorders, there is good reason to suspect that they would not be useful. For example, Lee et al60 found that the prevalence of a positive St Louis Androgen Deficiency in the Aging Male questionnaire in a sample (N ¼ 176) of psychiatric patients was 93%.
We propose that outpatients presenting with psychiatric complaints of depressed mood and associated neurovegetative symptoms be screened for sexual symptoms. Consistent with the European Aging Male Study guidelines, for those with at least 3 sexual symptoms, we recommend that a morning total testosterone level be obtained. If the total testosterone level is lower than 287 ng/dL (11 pmol/L) and the free testosterone level is lower than 0.225 nmol/L, then the patient should be referred to urology for consideration of testosterone replacement. It is important to keep in mind that testosterone is more likely to be a factor in depressive symptoms when the level is substantially below normal, although some men might have Low Testosterone in Outpatient Psychiatry Clinics.
PSYCHIATRIC OUTPATIENTS
To our knowledge, there have not been any studies designed to determine the prevalence of hypogonadism in treatment resistant major depressive disorder or the prevalence of hypogonadism in the general outpatient psychiatric population. Because hypogonadism and treatment-resistant depression are common conditions, this is likely a large and relatively undiagnosed population. Evidence for testosterone alleviating depressive symptoms in hypogonadal patients is mixed and further study is warranted. There is sufficient evidence to conclude that in some men repletion of testosterone has the potential to have a significant positive effect on mood.
For screening purposes, commonly used questionnaires for hypogonadism have not been validated in psychiatric populations. Even in non-psychiatric settings, the specificity of questionnaires is poor. Because many screening questions overlap with symptoms of depression and other psychiatric disorders, there is good reason to suspect that they would not be useful. For example, Lee et al60 found that the prevalence of a positive St Louis Androgen Deficiency in the Aging Male questionnaire in a sample (N ¼ 176) of psychiatric patients was 93%.
We propose that outpatients presenting with psychiatric complaints of depressed mood and associated neurovegetative symptoms be screened for sexual symptoms. Consistent with the European Aging Male Study guidelines, for those with at least 3 sexual symptoms, we recommend that a morning total testosterone level be obtained. If the total testosterone level is lower than 287 ng/dL (11 pmol/L) and the free testosterone level is lower than 0.225 nmol/L, then the patient should be referred to urology for consideration of testosterone replacement. It is important to keep in mind that testosterone is more likely to be a factor in depressive symptoms when the level is substantially below normal, although some men might have Low Testosterone in Outpatient Psychiatry Clinics.
