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Review
. 2023 Aug 10:14:1198437.
doi: 10.3389/fendo.2023.1198437. eCollection 2023.

The association of hypogonadism with depression and its treatments

Rita Indirli  1   2 , Valeria Lanzi  1   2 , Maura Arosio  1   2 , Giovanna Mantovani  1   2 , Emanuele Ferrante  1
Affiliations
Review

The association of hypogonadism with depression and its treatments

Rita Indirli et al. Front Endocrinol (Lausanne). .

Abstract

According to World Health Organization estimates, 5% of the adult population worldwide suffers from depression. In addition to the affective, psychomotor and cognitive symptoms which characterize this mood disorder, sexual dysfunction has been frequently reported among men suffering from depression. The most common sexual manifestations are decreased libido, erectile dysfunction and orgasmic disorder. In addition, epidemiological studies have documented a reduction of testosterone concentrations in men with depression and, for these reasons, depressive disorders appear as one possible cause of male functional hypogonadism. Moreover, some largely used antidepressant medications can cause or worsen sexual complaints, thus depression and its treatments rise several andrological-relevant issues. The other way round, men with hypogonadism can manifest depressed mood, anxiety, insomnia, memory impairment which, if mild, may respond to testosterone replacement therapy (TRT). However, the prevalence of functional hypogonadism in depression, and of depressive symptoms in hypogonadal men, is not known. Severe depressive symptoms do not respond to TRT, while the effect of treating major depression on functional hypogonadism, has not been investigated. Overall, the clinical relevance of each condition to the other, as well as the physiopathological underpinnings of their relationship, are still to be clarified. The present review summarizes current evidence on the influence of testosterone on mood and of depression on the hypothalamic-pituitary-testis axis; the clinical association between male hypogonadism and depression; and the reciprocal effects of respective treatments.

Keywords: antidepressants; depression; male hypogonadism; testosterone; testosterone replacement therapy (TRT).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Physiology of sexual response and effects of antidepressant and antipsychotic drugs. The upper panel shows the four phases of sexual response and the main systems and neurotransmitters involved. The lower panel summarizes the effects of antidepressant and antipsychotic drugs on the different phases of the sexual response cycle: red boxes stand for inhibitory effects, yellow boxes for neutral effect. ↑, increase; ↓, decrease; 5HT, serotonin; 5HT1, serotonin receptor 1; 5HT1A, serotonin receptor 1A; 5HT1B, serotonin receptor 1B; 5HT1D, serotonin receptor 1D; 5HT2, serotonin receptor 2; 5HT3, serotonin receptor 3; 5HT7, serotonin receptor 7; α2, α2 adrenergic receptor; AAPs, atypical antipsychotics; ANS, autonomic nervous system; DA, dopamine; D2, dopamine receptor 2; FSH, follicle stimulating hormone; GnRH, gonadotropin releasing hormone; LH, luteinizing hormone; MAOi, monoamine oxidase inhibitors; NA, norepinephrine; NO, nitric oxide; PRL, prolactin; SNRIs, serotonin/norepinephrine reuptake inhibitors; SSRI, selective serotonin reuptake inhibitors; TCA, tricyclic antidepressants.
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