Bhasin S, Seidman S, Travison TG, Pencina KM, Lincoff AM, Nissen SE, Miller MG, Flevaris P, Li X, Wannemuehler K, Pope HG. Depressive Syndromes in Men with Hypogonadism in the TRAVERSE Trial: Response to Testosterone Replacement Therapy.
J Clin Endocrinol Metab 2024:dgae026. [PMID:
38205962 DOI:
10.1210/clinem/dgae026]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/12/2024]
Abstract
CONTEXT
The effect of testosterone on depressive symptoms in men with hypogonadism remains incompletely understood.
OBJECTIVE
We assessed the effects of testosterone replacement therapy (TRT) in improving depressive symptoms in hypogonadal men with and without depressive symptoms enrolled in the TRAVERSE cardiovascular safety trial.
DESIGN
Randomized, placebo-controlled, double-blind.
SETTING
316 trial sites.
PARTICIPANTS
Men, 45 to 80 years, with two fasting testosterone levels <300 ng/dL, one or more hypogonadal symptoms, cardiovascular disease (CVD), or increased risk of CVD. We evaluated three subgroups of participants: 1) men with rigorously defined late-life-onset, low-grade persistent depressive disorder (LG-PDD, previously "dysthymia"); 2) all men with significant depressive symptoms (Patient Health Questionnaire-9 Score >4); and 3) all randomized men.
INTERVENTION
1.62% transdermal testosterone or placebo gel.
OUTCOME MEASURES
Proportions of participants 1) meeting criteria for LG-PDD or 2) with significant depressive symptoms; changes in depressive symptoms, energy, sleep quality, and cognition in testosterone- vs. placebo-treated men in the three subgroups.
RESULTS
Of 5,204 randomized participants, 2,643 (50.8%) had significant depressive symptoms, but only 49 (1.5%) met rigorous criteria for LG-PDD. Among those with LG-PDD, there was no significant difference in any outcome measure between the TRT and placebo groups, possibly reflecting low statistical power. In men with significant depressive symptoms n=2643) and in all randomized participants (n=5204), TRT was associated with modest but significantly greater improvements in mood and energy but not cognition or sleep quality.
CONCLUSIONS
Depressive symptoms are common in middle-aged and older men with hypogonadism, but LG-PDD is uncommon. TRT is associated with small improvements in mood and energy in hypogonadal men with and without significant depressive symptoms.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03518034.
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