Higher levels of the hormone testosterone appear to be associated with increased risk of depression in menopausal women.
New research from the University of Pittsburgh shows that women who had higher blood levels of testosterone, the ‘male’ sex hormone, during menopause scored higher on scales measuring levels of depression.
Although testosterone is found in much higher levels in men, and is thought of as the male sex hormone, testosterone also plays a role in healthy women’s biology, albeit at much lower blood levels.
In men, low levels of testosterone have clearly been shown to be a factor in depression, particularly in older men. Recently, this association has been referred to as ‘male menopause,’ or ‘andropause.’ In men with testosterone deficiency, testosterone replacement therapy may provide some relief of depressive symptoms. Testosterone therapy, however, is not without risks; side effects can include acne, fluid retention, increased risk of prostate cancer, and increased risk of heart attack and stroke.
The relationship between depression and testosterone in women has been studied less, and the results are mixed. In some small trials there appears to be no association, and in others, it appears that low testosterone is a risk factor for depression and that there may be a small benefit in treating depressive symptoms with testosterone therapy.
Women with testosterone deficiency can also experience low libido, which is successfully treated with testosterone replacement therapy. Low testosterone levels increase the risk of osteoporosis as well.
Clearly, menopause is a risk factor for depression. During menopause women are three times more likely than the general population to be diagnosed, and even more so if they have a history of depression. Women during menopause are more likely to commit suicide than at any other time in their lives.
It has been thought that decreased levels of estrogen are the explanation for the high levels of depression seen in menopause, but there has not been clear evidence that this is the case. Certainly, fluctuating levels of estrogen play a role in mood changes, but the relationship is not well understood. While animal models suggest that estrogen therapy may help depression, there is not good evidence that treatment with estrogen actually improves depression.
Dr. Joyce T. Bromberger and her research team from the departments of epidemiology and psychiatry at the University of Pittsburgh followed 3,292 woman for 13 years, beginning in 1995. Women of different ethnicities (46.9 percent white, 28.3 percent black, 8.6 percent Hispanic, 8.5 percent Japanese, and 7.5 percent Chinese) from seven different cities were included in the data. All of the women were still menstruating at the beginning of the study.
All participants were interviewed and asked to fill out questionnaires every year of the study. Laboratory tests such as testosterone, estrogen, and other sex hormones, were done at regular intervals. The women gave information regarding their physical and psychological health, lifestyle, and symptoms of menopause such as hot flashes, cold sweats, or night sweats.
The researchers assessed for depression using the Center for Epidemiological Studies Depression Scale (CES-D). A CES-D score of 16 or higher is considered clear evidence of depression.
Of the 3,292 women enrolled in the study, 802 (24.4 percent) had a CES-D score of 16 or higher, indicating definite symptoms of depression. There was a clear association between the level of testosterone in their blood and their CES-D score. Menopausal women were also more likely to have depressive symptoms, even though there was no association between estrogen levels and depression seen in this study.
Other risk factors Bromberger and her colleagues noted in their results were that lower levels of education, Hispanic ethnicity, stressful life events, low social support, and a higher number of physical symptoms such as hot flashes were also associated with a higher risk of depression.
Dr. Bromberger’s team plans to continue to follow the women throughout their postmenopausal years to try to further define the relationship between hormones and depression.
The data from this large-scale trial shows a risk of depression in women from elevated testosterone levels, in contrast to results confirmed in multiple studies in men and suggested in several small studies in women. While no definitive treatment recommendations can be made, further research may help to clarify the relationship between menopause, depression and hormones, hopefully giving some insight into potential treatments.
Source: Archives of General Psychiatry