plix (imported) wrote: Sun Sep 09, 2007 1:10 pm
Can there be cases where a eunuch with mental health issues may experience improvement with the administration of hormomes?
The question is, what exactly do we mean by "improvement"? Feeling better? More energetic? How about those who consume hashish, ecstasy, heroin, opium, etc., and sometimes report feeling so good (in fact, amazingly good) that they constantly look forward to the next "session"? How about individuals with manic-depressive issues in the manic phase (where some of them claim they feel so great and energetic it is "beyond belief"). People on anti-depressants? Finally, what about certain bodybuilders and their fascination with steroids? Should it be considered an "improvement", or merely a state of an artifically elevated mood due to hypomania/overstimulation/intoxication, etc? And while we
plix (imported) wrote: Mon Sep 10, 2007 8:08 am
are at it, what exactly "mental health" is, anyway?
Although the title is Testosterone May Boost Efficacy of Antidepressants in Men, the article admits that the study could not conclude whether it was the T itself that improved the depression or whether the T and the ADs together did the work. Also, it does not specifically mention SSRIs, but presumably the ADs used were SSRIs, as
that is generally what AD refers to in modern times.
As with this study, the conclusion of most other researchers that I have seen is more on the order of: "It remains unclear whether low bioavailable testosterone may contribute to depression (or vice versa) and whether clinical depression would respond to testosterone."
We should keep in mind that there is some controversy surrounding things like HRT and mental health meds because of significant financial third party interests, leaving a great deal of the available research potentially suspect (this also applies to certain cosmetics, "wonder creams", etc.) All too often, single-blinded studies with lack of a reliable control group have been taken at a face value in many cases of online advertizement and promotional articles in regards to these issues. In particular, so-called research on the anti-depressants has fallen under scrutiny due to concerns of "cooked" research as the result of alledged massive bribes paid to "scientists" by the agents of pharmaceutical companies (most of the accusations center around researchers overstating drug benefits and delibirately omitting the side effects).
Personally, I don't think that testosterone is helpful for the nervous system. Rather, it may cause "addiction" which, in adult men who are castrated, may produce temporary symptoms characterized by increased derpssive symptoms and moodiness, similarly to what occurs in smokers/alcoholics/drug addicts, where there is a certain crave for the substance because it (supposedly) produces temporary and sometimes permanent addiction on a neurochemical level. The idea that testosterone is not required for "mental health" is, I believe, easily evident by observing pre-pubertal indivduals, as well as all the (content/satisfied/happy) non-HRT eunuchs with sufficiently adequate levels of "day to day" functioning (myself included; btw, in my personal anecdotal experience, I do also feel that I am much better off this way psychologically).
Anyway, there is an interesting "all in one" article I'd personally reccomend on the topic of "Testosterone Deficiency, Depression and Sexual Function in Aging Men" (2006), by Stuart N. Seidman, M.D., published in the Psychiatric Times magazine at:
http://www.psychiatrictimes.com/article ... =172900880 , with probably the most relevant stuff located under the "Male HPG Axis and Depression" section.
Some interesting excerpts, with commentary:
There appears to be a clinical consensus among andrologists that testosterone replacement enhances mood in hypogonadal men . The author then notes that this "consensus", however, is based on a few studies which lacked a placebo control group, stating: No placebo controls (or placebo substitutions) were included in these studies, leaving the question open as to whether the reported mood improvements might have been equally detectable in a placebo group of hypogonadal men who thought they might be receiving testosterone. In fact, of all the currently available placebo controlled studies, it is evident that: Indeed, a negative picture emerges from the only two placebo-controlled testosterone replacement studies in which mood was systematically assessed (Sih et al., 1997; Steidle et al., 2003). Neither had a testosterone-placebo difference distinguishable with respect to mood. (in fact, one of the studies had a slightly higher overall response rate to placebo vs. testoterone).
Further below in the article, a double-blinded "counter" study was briefly provided in regards to mood effects of acute testosterone deprivation in otherwise healthy eugonadal men: In a well-designed experiment, Schmidt et al. (2004) examined the mood effects of a one-month suppression of testosterone secretion with Lupron (leuprolide), followed by double-blind, placebo-controlled testosterone replacement in 31 healthy men. They demonstrated that overall, there was a minimal effect of induced testosterone deficiency on mood. . Not mentioned in the article, but still worth emphasizing, is a large recent study
http://archinte.ama-assn.org/cgi/conten ... /166/4/465 wich reported similar results in older healthy men and men with various stages of prostate cancer.
Further in the article, the author notes that there is some correlation between naturally occuring testosterone and depression scores, ie. : In the Rancho Bernardo Study, adult residents of a Southern California community were enrolled in a study of heart disease risk factors (Barrett-Connor et al., 1999). In a 10-year follow-up study that included 82% of the surviving community residents, 856 men ages 50 to 89 (mean age=70) completed the Beck Depression Inventory (BDI) and had a morning blood sample drawn for hormone assays. Multiple linear regression analysis revealed a significant inverse correlation between BDI score and bioavailable, but not total, testosterone levels (p=0.007). That is, men with lower free testosterone levels had higher BDI scores, which is indicative of increased depressive symptoms. However, as is the case with most observational/epidemiological/retrospective studies (this particular study relied on one or maximum two hormone samples for the whole period, as mentioned elsewhere), we can't tell for certain whether testoterone even had anything to do with the BDI outcomes in the frist place. For instance, it is a well-known fact that periods of stress significantly reduce testosterone levels, and that depression itself causes similar effects (so we are here essentially back at the same classic "chicken or the egg" question). The same largely applies to Siedman's and Delhez's studies.
A Veterans' Experience study is quoted to have reached the following intriguing assumption, suggesting that the alledged relationship might not be linear, but in fact quite narrow: a representative sample of Vietnam War veterans (mean age=38) were administered the Diagnostic Interview Schedule (DIS) and provided morning blood samples for testosterone assay (Booth et al., 1999; Dabbs et al., 1990). Booth et al. (1999) demonstrated that the relationship between testosterone level and depression was nonlinear: Below 600 ng/dL, men with lower testosterone levels were more likely to be depressed whereas above 600 ng/dL, men with higher testosterone levels were more likely to be depressed. Thus, this particular study suggest that "high" testosterone men may be equally as prone to depressive episodes as do the naturally "low" group.
When it comes to non-depressed eugonadal men, the author concludes that: In most clinical trials in which exogenous testosterone was administered to nondepressed eugonadal men at physiological and moderately supraphysiological doses, significant effects on mood were not detected. .
However, Administration of supraphysiological doses of testosterone to eugonadal men has been associated with mania in a small proportion of men. , specifically In a double-blind study, Pope et al. (2000) enrolled 66 men (age range=20 to 50) who did not have psychiatric histories to receive testosterone in doses rising to 600 mg per week or matching placebo for six weeks, followed by a six-week no-treatment period, and then cross-over to the alternate treatment. They found that testosterone administration significantly increased the mean manic score on the Young Manic Rating Scale (YMRS) (p=0.002) and on daily diaries (p=0.003), the "like the way I feel" score on daily diaries (p=0.008), and aggressive responses on the Point Subtraction Aggression Paradigm (PSAP) (p=0.03). Notably, two participants became markedly hypomanic (YMRS=20) after testosterone administration.
Consequently, the quesion one might ask, then, is it possible that most of the alledged effects of testsoterone on mood could be accounted for either by (1) self-suggestion, or as a response to increases in physical endurance and sexual function and (2) a "hypomanic" (ie. "non-psychotic") episode (
http://en.wikipedia.org/wiki/Hypomania )?
On the subject of "depressed men", Seidman notes that: Reports from the older psychiatric literature (1935-1960) on the "antidepressant" effects of testosterone suggested that a substantial number of "depressed" men responded immediately and dramatically to hormone replacement therapy and subsequently relapsed when treatment was discontinued (Seidman and Walsh, 1999). However, standardized, syndromal, psychiatric diagnoses were not used in these studies, and baseline testosterone levels were not assessed. Moreover, the lack of a control group prevents considering such results any more than promising. More recent anecdotal reports have suggested that in some hypogonadal men, comorbid MDD remits with testosterone replacement (Ehrenreich et al., 1999; Heuser et al., 1999; Rinieris et al., 1979) or augmentation to partially effective antidepressant treatment (Seidman and Rabkin, 1998) and that in hypogonadal, HIV-infected men, testosterone replacement is associated with improved mood, libido and energy (Grinspoon et al., 2000; Rabkin et al., 2000). Based on such reports, it had been assumed that testosterone replacement in hypogonadal men with MDD would conform to the "hypothyroid" model (i.e., hormone axis normalization as an effective antidepressant). Systematic study suggests that this is not the case.
Finally, Seidman concludes that: Overall, although initial anecdotal reports have been favorable, systematic trials of androgen replacement for depression have provided little support for its efficacy. Currently, treatment of depression with testosterone, either as replacement (i.e., in hypogonadism) or as an antidepressant supplement, should be considered experimental.
