Research from Harvard Medial School shows that rubbing testosterone gel on the skin can help relieve depression in middle-aged men with low blood testosterone levels. In the 1940s, experiments showed that major depression can be relieved by injecting testosterone into men with low levels. The treatment never caught on because effective antidepressant drugs started coming to market. More recently, however, testosterone patches and gels became available. In June 2000, the United States Food and Drug Administration approved a gel for treating muscle loss, decreased sex drive, lack of energy, and other symptoms of so-called hypogonadism, or underactivity of the testes.
Harrison Pope, A professor of psychiatry are Harvard Medical School wondered if the gel might also help males with the combination of low testosterone and depression not treated successfully with drugs. He received a grant from Unimed Pharmaceuticals Corp., which makes a topical skin testosterone gel called AndroGel. Of the first 56 men screened, Pope and his colleagues found 24 who were both depressed and had low levels of that hormone. More than 40 percent of the men who applied to be admitted to the study suffered from both low testosterone and depression.
Twelve men rubbed 2.5 grams of AndroGel on their skins each night. Another 10 subjects received identical packets containing a placebo. By the end of the experiment, Pope found a significant improvement in mood among those taking testosterone compared with those using the dummy rub. Ten men on the active gel completed the full eight-week study. Three showed almost no improvement, and four experienced only modest relief. However, three enjoyed "striking, dramatic gains."
In any given year, eight percent of American men over 30 years old will experience an episode of major depression. Only a few of these men will get significant help from popular antidepressants. "If this refractory subgroup exhibits a 43 percent prevalence of low testosterone levels, as found in our study," notes Pope's report, "then hundreds of thousands of men in a given year might be candidates for further trials of the teststerone supplements. Normal men who take testosterone usually add muscle and lose fat. That occurred among those in the Harvard study, including subjects whose depression was not reduced. One man, who got no psychiatric benefit at all, gained about 15 pounds of muscle mass and lost about eight pounds of fat. Such results raise the issue of whether the supplements aid only the physical symptoms of depression such as loss of energy, libido, and appetite.
Pope's group found higher moods, less guilt and anxiety, and a decrease of suicidal thoughts. "These analyses suggest that the hormone can cause improvements in both the mind and body," Pope says. Evidence also exists that some women may be helped by testosterone supplements. Other studies hint that postmenopausal women, and those who have had their ovaries removed surgically, may reap some benefits in terms of improved mood and energy. But to avoid excess growth of hair, increased muscle mass, and other masculine side effects, doses would have to be much lower than those given to men. Although there is little evidence that testosterone causes prostate cancer, it can spread an existing prostate cancer. Men who take testosterone must have their prostates checked and get a blood test that screens for prostate cancer called PSA every three months while on the male hormone.
The Archives of Psychiatry, January, 2003
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