TESTOSTERONE REPLACEMENT THERAPY IMPROVES MOOD IN HYPOGONADAL MEN - ACLINICAL RESEARCH-CENTER STUDY

The effect of testosterone (T) replacement on changes in mood was stud ied for 60 days in 51 hypogonadal men. All patients were withdrawn fro m their prior T replacement for at least 6 weeks before enrollment; Of these patients, 18 received T enanthate 200 mg im every 20 days, 16 r eceived sublingual T cyclodextrin (SLT) at a dose of 2.5 mg three time s daily, and 17 received SLT at a dose of 5.0 mg three times daily. Th e total treatment period was 60 days. The patients were asked to respo nd to a questionnaire on 7 consecutive days before the start-of treatm ent and on 7 consecutive days before their visits to the clinic on day s 21, 41, and 60 of treatment. The following mood parameters were asse ssed using a 7-point Likert rating scale: angry, alert, irritable, ful l of pep (energy), sad/blue, tired, friendly, nervous, and well/good. When compared with the baseline period, T replacement led to significa nt decreases in anger (P = 0.0045), irritability (P = 0.0009), sadness (P = 0.0033), tiredness (P = 0.0035), and nervousness (P = 0.0291), a nd significant improvement in energy level (P = 0.0020), friendliness (P = 0.0072), and sense of well-being (P = 0.024) in all subjects as a group. Analyses of the area under the curve (AUC) of baseline serum T levels before T replacement showed significant positive correlations between serum T (AUC) and friendliness (r = 0.29, P < 0.05) and sense of well-being (r = 0.27, P < 0.05), and significant negative correlati ons with nervousness (r = -0.27, P < 0.05), irritability (r = -0.29, P < 0.05) and tiredness (r = -0.28, P < 0.05). Similar correlations wer e found between serum dihydrotestosterone (DHT) and some of the mood p arameters. After T replacement in the hypogonadal men, these correlati ons between AUC of serum T levels and the positive and negative mood s cores disappeared. These results were corroborated in a subsequent stu dy in which 30 hypogonadal men were supplemented with SLT 5 mg three t imes daily for 6 months. The patients were less nervous (P = 0.0025) a nd more alert (P = 0.0004), friendly (P = 0.042), and energetic (P = 0 .0001) during the 6-month treatment period compared with baseline. We conclude that T replacement therapy in hypogonadal men improved their positive mood parameters, such as energy, well/good feelings, and frie ndliness and decreased negative mood parameters including anger, nervo usness, and irritability; and direct correlations between serum T and DHT with mood scores were only observed in the baseline period when se rum androgen levels were below the normal range. The latter observatio n suggests that once a minimally adequate serum T/DHT level was achiev ed by T replacement therapy, further increases in serum T/DHT levels d id not further contribute to the improvement in mood variables.