Testosterone and mood in aging men

Abstract

Men do not experience a sudden cessation of gonadal function comparable to menopause. However, there is a progressive reduction in male hypothalamic–pituitary–gonadal axis function: testosterone levels decline through both central (pituitary) and peripheral (testicular) mechanisms. Age-associated hypothalamic–pituitary–gonadal axis dysfunction, which has been termed ‘andropause’, is thought to be responsible for a variety of symptoms experienced by elderly men, such as reduced muscle and bone mass, fatigue, sexual dysfunction (including erectile dysfunction and loss of libido) and depression. Although it has been difficult to establish correlations between these symptoms and plasma testosterone levels, there is some evidence that testosterone replacement in middle-aged men leads to symptom relief, particularly with respect to muscle strength, bone mineral density and sexual dysfunction. However, there is limited evidence of a link between hypothalamic–pituitary–gonadal axis dysfunction and depressive illness, and exogenous androgens have not been shown to be antidepressant. This article focuses on the relationship between androgens and mood in aging men and highlights clinical issues relevant to the treatment of age-related depression with exogenous testosterone.