Low testosterone often masquerades as depression

Russell Haught was tired.

In fact, for the last six years his energy had been deteriorating—so much so that he was barely functional after 3 in the afternoon. It wasn't long before the 52-year-old was forced to take an early retirement from his job at United Parcel Service.

Haught's relationship with his wife also took a downward turn. By evening, he would collapse into his reading chair, often not waking until the next morning.

He had lost the ability to accomplish anything other than the basic functional activities that got him through the day.

"One day I was thinking about my life. I ate well, exercised, took vitamins—I pretty much did everything I could to feel better. But nothing was working. I knew that I needed help—if not just for me, then for her, for my wife."

Haught, of Iowa City, sought a consultation with his physician, who, after hearing his case, determined that Haught most likely was clinically depressed and suggested that he try an antidepressant medication. Haught agreed that he was depressed but only because he was so tired that his quality of life was nearly nonexistent.

Haught decided to get a second opinion from an internist. The internist thought the best course of action was to run a series of laboratory tests, which revealed that Haught was suffering from hypotestosteronemia, or low testosterone, a condition that affects one of every four men over age 30.

And, like Haught, many men suffering from low testosterone levels are inappropriately diagnosed as suffering from clinical depression.

It's easy to understand why.

The most common symptom of low testosterone is fatigue, closely followed by depression, irritability and apathy. Most men complain of a lacking libido. Any one of these signs mimics the typical presentation of clinical depression. And any plurality of complaints nearly precludes other possibilities.

To further complicate the matter, the clinical manifestations of low testosterone are poorly understood by many physicians, so testosterone levels often aren't tested.

Testosterone is one of the most important sex hormones in the male body. At puberty, testosterone stimulates the physical changes that typify the adult male: growth of facial and pubic hair, deepening of the voice, enlargement of the penis, increased muscle mass and strength and increased height.

Throughout adult life, testosterone helps maintain sex drive and vitality, the production of sperm cells, hair patterns, as well as muscle and bone mass.

Testosterone production declines naturally with age. But low testosterone may result from disease or damage to the hypothalamus, pituitary gland or testicles, all of which are involved in normal production of the androgenic hormone. Long-term stress or a serious illness also may cause lower testosterone.

Until recently, testosterone deficiency in the adult male was not considered prevalent. But recent studies published in the Journal of Clinical Endocrinology and Metabolism indicate that 24 percent of men over 30 are deficient in testosterone production, and only about 6 percent show overt signs of deficiency.

Usually, when a person is diagnosed with low testosterone, he is prescribed a form of testosterone replacement, which may be a pill, an injection or a skin cream.

The typical results of treatment are an increase in energy, decreased body fat, increased libido and an improvement in mood. And earlier this year, Harvard Men's Health Watch reported that testosterone replacement may be related to improved mental acuity.

But Kevin McVary, professor of urology at the Northwestern University Feinberg School of Medicine, cautioned that testosterone-replacement therapy remains controversial.

"Potential risks include enlargement of the prostate, problems voiding, acne and hot flashes," McVary explained. "Uncommon, but dangerous, side effects may include stroke or prostate cancer. Also those who suffer from congestive heart failure may notice a worsening of their symptoms."

And recent studies have shown testosterone replacement therapy is not as effective in men over 70.

McVary also noted, however, that there is no evidence to suggest that testosterone-replacement therapy will be wrought with the backlash of cancer and heart disease associated with the federal Women's Health Initiative, which halted a hormone-replacement therapy study involving women in 2005.

And for many men, the risks of not treating low testosterone seem to outweigh the risks of treatment.

Besides a lowered quality of life, sufferers of low testosterone are at least 68 percent more likely to die within the next 41/2 years than those with normal levels, according to recent studies published in the Archives of Internal Medicine.

As for Haught, he now applies a transdermal cream containing 50 milligrams of testosterone that he rubs into his skin once a day.

After undergoing testosterone replacement for about a year, Haught said he feels better than he can remember. He has lost weight, gained muscle, is able to work out, and he has the energy he needs to create quality time with his wife.

"I may be 52, but I have the libido of a 20-year-old—and I've never felt better."



 

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