Senior Citizen Men Get Depressed from Low Free Testosterone Level

Testosterone supplement may contribute to successful treatment

March 3, 2008 – Women have a greater tendency than men to become depressed – at least until the members of both sex become senior citizens. At age 65 men catch up with women and scientists have long suspected it has something to do with testosterone. A new study pins the cause clearly on lower levels of free testosterone.

There were 3,987 men age 71 to 89 years in the study by Osvaldo P. Almeida, M.D., Ph.D., F.R.A.N.Z.C.P., of the University of Western Australia, Perth, and his colleagues.

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Depression affects between two percent and five percent of the population at any given time, according to background information in the article in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Between 2001 and 2004, the men in the study completed a questionnaire reporting information about demographics and health history. They underwent testing for depression and cognitive (thinking, learning and memory) difficulties, and information about physical health conditions was obtained from a short survey and an Australian health database.

The researchers collected blood samples from the participants and recorded levels of total testosterone and free testosterone, which is not bound to proteins.

A total of 203 of the participants (5.1 percent) met criteria for depression; these men had significantly lower total and free testosterone levels then men who were not depressed.

Testosterone is produced in the testes, which also produce sperm. Most of the testosterone binds with protein but some circulates freely in the bloodstream. Men normally produce less testosterone as they age and previous studies have shown that older men have lower levels of this free testosterone than younger men.

After controlling for other factors - such as education level, body mass index and cognitive scores - men in the lowest quintile (20 percent) of free testosterone concentration had three times the odds of having depression compared to men in the highest quintile.

The mechanism by which low hormone levels might affect depression risk has not been identified, but might involve changes in the levels of neurotransmitters or hormones in the brain, the authors note.

“A randomized controlled trial is required to determine whether reducing prolonged exposure to low free testosterone is associated with a reduction in the prevalence of depression in elderly men,” the authors write.

“If so, older men with depression may benefit from systematic screening of free testosterone concentration, and testosterone supplementation may contribute to the successful treatment of hypogonadal [with low hormone levels] older men with depression.”

Editor's Note: This study was supported by project grants from the National Health and Medical Research Council of Australia. Biochemical analyses were funded by a Sylvia and Charles Viertel Charitable Foundation Clinical Investigator Award.