Symptoms of male hypogonadism such as low libido and erectile dysfunction (ED) respond to testosterone (T) replacement. In hypogonadal men with major depressive disorder (MDD), the extent to which T replacement alleviates sexual symptoms of hypogonadism is not known. We conducted 6 week double-blind placebo-controlled clinical trial in men with low and low-normal T levels (i.e., total T <or= 350 ng/dl) and MDD. Men were randomized to receive weekly intramuscular injections of either T enanthate 200 mg or sesame-seed oil (placebo). The primary outcome measure was self-reported sexual functioning. We randomized 30 patients. The mean age was 52(SD +/- 8) years, mean T level 262.5(SD +/- 8) ng/dl, and mean baseline Hamilton Rating Scale for Depression (HAM-D) score 21(SD +/- 8). At baseline, sexual function was low, with the majority reporting having had normal erectile and orgasmic functioning 0-1 time in the preceding month. All patients who received T achieved normalization of their T levels. The HAM-D scores decreased significantly in both T and placebo groups, and there were no significant between-group differences: reduction in mean HAM-D score from baseline to endpoint was 10.1 in patients who received T and 10.5 in those who received placebo. Self-reported sexual functioning improved slightly in both groups; a between-group difference was not detected. Both T replacement and placebo were associated with improvement in sexual function and mood, but differences between T and placebo were not distinguishable.
"These symptoms overlap with disease characteristics of major depression  . Testosterone treatment can enhance several aspects of mood and cognition in hypogonadal men , it normalizes synaptic neurogenesis, and it reduces depressive symptoms . Still, the role of reduced androgens in psychiatric problems, such as mood disorders, remains largely unknown. "
"Emotional functions [24–26], energy and drive functioning [27–29], cognitive functions [30–32], employment [33–35], and relationship with the others [36–38] were the most common psychosocial problems emerging both in the literature and the patients' answers. The frequency of the appearance of PSDs was also comparatively identical. "
[Show abstract][Hide abstract] ABSTRACT: Despite all the knowledge on depression, it is still unclear whether current literature covers all the psychosocial difficulties (PSDs) important for depressed patients. The aim of the present study was to identify the gaps in the recent literature concerning PSDs and their related variables. Psychosocial difficulties were defined according to the World Health Organization International Classification of Functioning, Disability and Health (ICF). A comparative approach between a systematic literature review, a focus group, and individual interviews with depressed patients was used. Literature reported the main psychosocial difficulties almost fully, but not in the same degree of importance as patients' reports. Furthermore, the covered areas were very general and related to symptomatology. Regarding the related variables, literature focused on clinical variables and treatments above all but did not report that many psychosocial difficulties influence other PSDs. This study identified many existing research gaps in recent literature mainly in the area of related variables of PSDs. Future steps in this direction are needed. Moreover, we suggest that clinicians select interventions covering not only symptoms, but also PSDs and their modifiable related variables. Furthermore, identification of interventions for particular psychosocial difficulties and personalisation of therapies according to individuals' PSDs are necessary.
BioMed Research International 06/2014; 2014:319634. DOI:10.1155/2014/319634 · 3.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Descripción: El American College of Physicians desarrolló estas guías clínicas para presentar la evidencia disponible sobre la evaluación hormonal y el tratamiento farmacológico de la disfunción eréctil. Las terapéutica farmacológica actual incluye a los inhibidores de la 5-fosfodiesterasa (PDE-5) como el sildenafil, vardenafil, tadalafil, mirodenafil y udenafil, así como el tratamiento hormonal. Métodos: La literatura publicada sobre este tema fue identificada usando MEDLINE (1966 a mayo del 2007), EMBASE (1980 a la semana 22 del 2007), el Registro Central de Estudios Controlados Cochrane (segunda trimestre del 2007), PsycINFO (1985 a junio del 2007), AMED (1985 a junio del 2007), y SCOPUS (2006). La búsqueda bibligráfica fue actualizada buscando artículos en MEDLINE y EMBASE publicados entre mayo 2007 y abril 2009. Las búsquedas se limitaron a publicaciones en idioma inglés. Esta guía clínica establece el nivel de evidencia y el grado de recomendación utilizando el sistema de graduación de las guías clínicas del American College of Physicians.
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