Hypotestosteronism and severe mood disorders- More than a comorbidity?

BACKGROUND: The association between testosterone and depression is extensively debated(1). Testosterone being a neuro-active steroid hormone, is responsible for growth and development of male primary sexual organs(2), musculoskeletal system and influencing mood and appetitive behaviour(1). Several lines of research have examined the potential role of testosterone therapy in alleviating depressive symptoms(1). Thus, considering hypo-testosteronism as a differential diagnosis of depressive disorders in males or testosterone supplementation in such cases as treatment for depression is important but not commonly practiced. CASE SERIES: In this case series, we describe two male patients with young onset depression, who did not respond to adequate trials of multiple antidepressants, were evaluated independently elsewhere by endocrinologist,and detected to have low levels of testosterone. The depressive symptoms improved with initiation of testosterone supplementation in both the cases. DISCUSSION & CONCLUSION: This case series provides insight into this clinical phenomenon where low testosterone may be associated with depressive mood symptoms, thus testosterone supplementation being imperative in such cases. Testosterone causes increased serotonin release in the dorsal raphe nuclei and facilitates general and antidepressant-induced neuroplasticity in the hippocampal formation, which can be considered as central mechanisms of action against depression(1). The beneficial role of testosterone use may thus be independent of hypogonal state as well. However, further studies are needed to ascertain the utility of initiating testosterone use in certain patient groups and develop guidelines to assess for hypo-testosteronism in young males with treatment resistant depression. REFERENCE: 1. Walther A, Breidenstein J, Miller R. Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA psychiatry. 2019 Jan 1;76(1):31-40. 2. Ravan JP, Pattnaik JI, Nath S, Kumar S. Intervention Strategy for Amennorhoea, Galactorrhoea, osteopenia and Sexual dysfunction caused by Antipsychotic induced Hyperprolactinemia. In indian journal of psychiatry 2019 jan 1 (vol. 61, no. 9, pp. S443-s443). Wolters kluwer india pvt ltd, a-202, 2nd flr, qube, cts no 1498a-2 village marol, andheri east, mumbai, 400059, india: wolters kluwer medknow publications.