Effects of hypogonadism and testosterone administration on depression indices in HIV-infected men

Hypogonadism is prevalent among human immunodeficiency virus-infected men, in whom significantly reduced quality of life and mood disturbances have be en reported. Previous studies have not investigated the relationship betwee n depression score and gonadal function among such patients. We first compa red depression scores in hypogonadal (n = 52) and eugonadal (n = 10) patien ts with acquired immunodeficiency syndrome (AIDS) wasting, matched for weig ht and disease status, and then investigated the effects of testosterone ad ministration on depression score in a randomized, double-blind, placebo-con trolled study among the group of hypogonadal men with AIDS wasting. The pri mary end point in all comparisons was the Beck Depression Inventory. Hypogo nadal patients demonstrated significantly increased scores on the Beck inve ntory compared with eugonadal-, age-, weight-, and disease status-matched s ubjects (15.5 +/- 1.1 vs. 10.6 +/- 1.4 mean +/- SEM, P = 0.02). Among the c ombined hypogonadal and eugonadal subjects, a significant inverse correlati on was seen between the Beck score and both free (r = -0.41, P < 0.01) and total serum testosterone levels (r = -0.43, P < 0.001). The relationship be tween the Beck score and testosterone levels remained highly significant, c ontrolling for weight, viral load, CD4 count, and anti-depressant use (P < 0.01 for free testosterone, P < 0.001 for total testosterone). Furthermore, when subjects were divided into two groups, based on a Beck score greater than 18 or less than or equal to 18, serum total and free testosterone leve ls were significantly lower in the subjects with a Beck score greater than 18, whereas there were no differences in weight, viral load, CD4 count, or Karnofsky status. End of study data were available in 39 patients who compl eted the randomized, placebo-controlled study. Beck score decreased signifi cantly only in the subjects receiving testosterone (-5.8 +/- 1.3, P < 0.001 ), but not in subjects randomized to placebo (-2.7 +/- 1.3, P > 0.05). In a regression analysis, the change in Beck score was related significantly to change in weight (P < 0.01). These data demonstrate increased depression s core in association with hypogonadism in men with AIDS wasting, independent of weight, virologic status, and other disease factors. In such patients, administration of testosterone results in a significant improvement in depr ession inventory score. This effect may be a direct effect of testosterone or related to positive effects of testosterone on weight and/or other anthr opometric indices. Additional studies are needed to assess the effects of t estosterone on clinical depression indices in human immunodeficiency virus- infected patients.