A decline in hypothalamic-pituitary-gonadal (HPG) axis function is often seen in elderly men, and dysthymic disorder is common. Symptoms of both HPG axis hypofunction and dysthymic disorder include dysphoria, fatigue, and low libido. Total testosterone levels were measured in 32 men meeting criteria for dysthymic disorder and 175 in a comparison group who had scored below the median on a validated depression scale in a male aging study. Median testosterone level of 295 ng/dl in those with dysthymia was significantly lower than levels of 423 mg/dl in those with no depression.
Seidman SN, Araujo AB, Roose SP et al. Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry 2002 Mar; 159(3):456-9
COMMENT: Total testosterone levels were lower in elderly men with dysthymia than in men without depressive symptoms. Dysthymic disorder in elderly men may be related to HPG axis hypofunction. Few will find this conclusion a surprise. In dysthymic men, behavioral approaches need to be included in the treatment plan. Antidepressants may lift mood but adversely affect libido and potency. When patients are fully informed about the ramifications of different choices, they will often engage the will to make the harder choice, the one requiring more effort and work outlay, when the dots are connected with the greater possibilities.
Robert Anderson is a retired family physician. In mid-career, his practice took a holistic turn as decades passed. He has authored five major books, Stress Power!, Wellness Medicine, The Complete Self-Care Guide to Holistic Medicine (co-author), Clinician's Guide to Holistic Medicine (McGraw Hill, 2001), and The Scientific Basis for Holistic Medicine, (6th edition 2004), now available from American Health Press, email@example.com. Anderson was the founding president of the American Board of Holistic Medicine, past president of the AHMA, former Assistant Clinical Professor of Family Medicine at the University of Washington and currently Adjunct Instructor in Family Medicine at Bastyr University.
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