Testosterone and depression in men with heart failure

Type of funding sources: None.

Low testosterone levels are frequently seen in men with chronic heart failure. Testosterone interacts with neurotransmitters like dopamine, serotonin, and noradrenaline and its levels affect neurobehavioral characteristics such as irritability, emotional tone, and cognitive function. Depression and anxiety are very frequent in patients with heart failure

To evaluate the relationship between testosterone levels and depression severity in a cohort of males with dilated cardiomyopathy and heart failure.

In this cross-sectional single-center study we included 78 Caucasian male patients with dilated cardiomyopathy and chronic heart failure (mean age 58.5 years, range 29 – 80 years old; mean left ventricular ejection fraction 24.54%). All patients were subjected to clinical, biological, and echocardiographic examinations. Depressive symptoms were assessed using the PHQ-9 Depression Test Questionnaire which is a simple 97% sensitivity test used for guiding the diagnosis of depression in high-risk populations including patients with heart failure. Serum total T levels and sex hormone-binding globulin were measured by chemiluminescence assays and free testosterone (FT) levels were calculated. Based on the results from these assays, patients were divided into five groups according to the 5 stages of the PHQ-9 scale (minimal, mild, moderate, moderately severe, and severe).

Patients with high levels of FT (82.83±55.73 pg/mL) didn’t show any features consistent with depression, however patients with lower levels of FT had a proportional increase in the number of signs and symptoms suggestive of depression (67.97±37.12 pg/mL– mild depression, 45.24±28.52 pg/mL - moderate depression, 29.79±20.32 pg/mL – moderately severe depression, 18.56±14.28 pg/mL- severe depression). Patients with depression also had higher levels of higher C-reactive protein, urea, and creatinine (p<0.001).

Lower levels of free testosterone are associated with a proportional increase in depressive symptoms in patients with dilated cardiomyopathy and heart failure.