Testosterone Therapy for Type 2's Affected by Depression

Geoffrey Hackett, MD, of Good Hope Hospital in Sutton Coldfield in the UK, and colleagues reported at the World Meeting on Sexual Medicine that, in a randomized controlled trial, diabetic men who weren't depressed had significant improvements in blood glucose and other metabolic parameters with hormone therapy, but those with depression gained no benefit.

Hackett added that, "All [parameters] improved in the nondepressed group, and there was a worsening of all symptoms in the group with depression."

Men with type 2 diabetes tend to have a high burden of co-occurring hypogonadism and depression, Hackett explained.

To assess whether treatment of low testosterone is affected by depression, the researchers conducted the randomized controlled BLAST Study (an acronym for the towns of Birmingham, Lichfield, Atherstone, Sutton Coldfield, and Tamworth) in 200 men from seven primary care practices who had type 2 diabetes and hypogonadism. The study lasted 30 weeks, with about half the men continuing in a 52-week, open-label follow-up phase.

Participants were given either 1,000 mg testosterone undecanoate (Nebido) or matching placebo at baseline and at weeks 6 and 18.The prevalence of hypogonadism was 50%. Almost a quarter of the population with type 2 diabetes (23%) was depressed, and these men tended to be younger and more obese, Hackett said.

For men who weren't depressed, testosterone therapy significantly reduced HbA1c levels (P=0.045). It was also tied to significant reductions in weight (P=0.038), body mass index (P=0.02), and waist circumference (P=0.02), the researchers reported.

Yet they didn't see similar improvements in any of these parameters for patients who were depressed, Hackett said.

"We saw a highly significant treatment effect in the nondepressed group and in the depressed group there was no response whatsoever," he said during the presentation.

"The take-home message," he continued, "is that it's important to screen for depression when initiating testosterone therapy, as both the metabolic and psychological complications will be affected." "You'll save yourself trouble if you detect those patients early," he said.

He added that clinicians should consider concomitant treatment of patients' depression when they go on hormone therapy, but that this trial would have been underpowered to study that endpoint.

• The study found a high prevalence of hypogonadism in men with type 2 diabetes and also found that response to testosterone in this population was markedly reduced in patients with depression.
• This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Hackett G, et al "Depression significantly reduces the response to testosterone therapy in men with type 2 diabetes and hypogonadism" WMSM 2012; Abstract 166