Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. eCollection 2023.
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.
根据世界卫生组织的估计，全球有 5%的成年人患有抑郁症。除了这种情绪障碍的情感、精神运动和认知症状外，患有抑郁症的男性还经常报告性功能障碍。最常见的性功能表现是性欲减退、勃起功能障碍和性高潮障碍。此外，流行病学研究记录了抑郁症男性的睾丸酮浓度降低，因此抑郁障碍似乎是男性功能性性腺功能减退的一个可能原因。此外，一些广泛使用的抗抑郁药物会导致或加重性功能障碍，因此抑郁症及其治疗方法引发了一些与男性学相关的问题。另一方面，性腺功能减退的男性可能会表现出情绪低落、焦虑、失眠、记忆力减退，如果症状轻微，可能会对睾丸酮替代疗法（TRT）有反应。然而，抑郁症中功能性性腺功能减退的患病率，以及性腺功能减退男性中抑郁症状的患病率尚不清楚。严重的抑郁症状对 TRT 没有反应，而治疗重度抑郁症对功能性性腺功能减退的影响尚未得到研究。总的来说，每种情况对另一种情况的临床相关性，以及它们之间关系的病理生理学基础，仍有待阐明。本综述总结了目前关于睾丸酮对情绪的影响以及抑郁症对下丘脑-垂体-睾丸轴的影响的证据；男性性腺功能减退症与抑郁症之间的临床关联；以及各自治疗方法的相互作用。
