期刊
REVIEWS IN ENDOCRINE & METABOLIC DISORDERS
卷 23, 期 6, 页码 1259-1273出版社
SPRINGER
DOI: 10.1007/s11154-022-09767-0
关键词
Testosterone; Androgen receptor; Hypogonadism; Androgen deprivation therapy; Testosterone replacement therapy; Depression; Major depressive disorder
资金
- Office of Research and Development (ORD) of the US Department of Veterans Affairs [CX001727]
- National Institute of Aging of the National Institutes of Health [NIA RO1 AG050595, NIA RO1 AG05064]
- Center of Excellence for Stress and Mental Health (CESAMH) from ORD of the US Department of Veterans Affairs
Considerable research has shown that low levels of testosterone are associated with increased risk for depression. However, the effectiveness of testosterone replacement therapy in treating depression in men with low testosterone levels remains uncertain and requires further investigation. Important factors to consider include the heterogeneity of major depressive disorder and the potential role of polygenic mechanisms in influencing the interaction between testosterone and depression.
Considerable research has shown that testosterone regulates many physiological systems, modulates clinical disorders, and contributes to health outcome. However, studies on the interaction of testosterone levels with depression and the antidepressant effect of testosterone replacement therapy in hypogonadal men with depression have been inconclusive. Current findings indicate that low circulating levels of total testosterone meeting stringent clinical criteria for hypogonadism and testosterone deficiency induced by androgen deprivation therapy are associated with increased risk for depression and current depressive symptoms. The benefits of testosterone replacement therapy in men with major depressive disorder and low testosterone levels in the clinically defined hypogonadal range remain uncertain and require further investigation. Important considerations going forward are that major depressive disorder is a heterogeneous phenotype with depressed individuals differing in inherited polygenic determinants, onset and clinical course, symptom complexes, and comorbidities that contribute to potential multifactorial differences in pathophysiology. Furthermore, polygenic mechanisms are likely to be critical to the biological heterogeneity that influences testosterone-depression interactions. A genetically informed precision medicine approach using genes regulating testosterone levels and androgen receptor sensitivity will likely be essential in gaining critical insight into the role of testosterone in depression.
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