qADAM 24.2 in ADAM positive subgroup versus mean qADAM
28.4 in ADAM negative subgroup,
P
o
0.001). As questions 2, 3, 4
and 5 on the qADAM questionnaire assess depressive symptoms
the strong correlation between these individual questions and
PHQ-9 questions is expected. While non-specifc, given the
overall eugonadal status oF our patient population based on
mean serum hormone levels, these data suggest that we were
evaluating depressive symptoms that were less likely to be
related to hormonal status, and more likely to be related to other
causes. OF note, however, 41 oF 73 (56.2%) men in the TT
o
300
and 61 oF 112 (55.3%) oF men in the in TT
X
300 group were
already on T replacement therapy at the time oF questionnaire
completion.
Next, we grouped men using criteria For MDD (see Materials and
methods) and compared IIE± domain and qADAM scores within
these groups in order to evaluate the relationship between sexual
Function and more severe depressive symptoms. We observed
signifcantly lower scores For the erectile Function, sexual desire
and overall satisFaction domains oF the IIE± as well as total qADAM
score in patients with symptoms consistent with MDD (Table 6).
When using more stringent criteria For the presence oF depression,
we observed a greater diFFerence between the MDD and no MDD
subgroups in each IIE± domain except For the intercourse
satisFaction and orgasmic Function domain. ±or example, the
diFFerence in the erectile Function domain scores between MDD
and no MDD subgroups was much more signifcant when
compared with the diFFerence between PHQ-9 score subgroups
(19.1
±
10.4
(PHQ-9
o
10)
versus
17.5
±
10.3
(PHQ-9
X
10)
(
P
¼
0.443) and 19.4
±
10.1 (no MDD) versus 14.1
±
11.3 (MDD)
(
P
¼
0.027)). These data suggest a positive relationship between
the severity oF sexual dysFunction and severity oF depressive
symptoms, and indicate that the physical aspects oF sexual
Function may be more signifcantly impacted with more severe
depressive symptoms.
Table 1.
Subject demographics
Variable
Total
PHQ-9 score
o
10
PHQ-9 score
X
10
P
-value
Number of subjects (
n (%)
)
186
156 (83%)
30 (16%)
Age (years)
Mean
±
s.d.
54
±
12.7
53.8
±
12.1
47
±
11.9
0.005
Interquartile range
44–61
45–63
36–58
BMI (
mean
±
s.d
.)
29.7
±
7.1
29.4
±
6.5
31.3
±
9.7
0.197
Serum hormone levels (mean
±
s.d.)
T (ng dl
±
1
)
429.8
±
239.2
433.2
±
244.8
412.5
±
210.8
0.663
Free T (pg ml
±
1
)
9.7
±
7.5
9.7
±
7
9.9
±
6.7
0.862
Estradiol (pg ml
±
1
)
34.4
±
22.8
34.0
±
22.3
36.4
±
25.1
0.597
Comorbidities (n (%))
Coronary artery disease
7 (3.8)
7 (4.5)
0 (0)
0.248
Hypertension
53 (28.5)
46 (29.5)
7 (23.3)
0.563
Diabetes mellitus
9 (4.8)
7 (4.5)
2 (6.7)
0.611
Hyperlipidemia
57 (30.6)
45 (28.8)
12 (40)
0.312
Smoking
22 (11.8)
16 (10.3)
6 (20)
0.155
Hypogonadism
135 (72.6)
110 (70.5)
25 (83.3)
0.454
ED
115 (61.8)
99 (63.5)
16 (53.3)
0.523
Premature ejaculation
19 (10.2)
17 (10.9)
2 (6.7)
0.495
Benign prostatic hyperplasia
23 (12.4)
20 (12.8)
3 (10)
0.691
Prostate cancer
34 (18.3)
32 (20.5)
2 (6.7)
0.103
Peyronie’s disease
40 (21.5)
34 (21.8)
6 (20)
0.830
PHQ 9 score (
mean
±
s.d.
)
4.9
±
4.9
3.2
±
2.8
13.6
±
3.9
o
0.001
IIEF questionnaire score (
mean
±
s.d.
)
44.9
±
20.4
45.6
±
24.1
40.9
±
22.9
0.250
qADAM score (
mean
±
s.d.
)2
5
±
5.3
26.0
±
4.8
19.9
±
4.6
o
0.001
Abbreviations: BMI, body mass index; ED, erectile dysfunction; IIEF, The International Index of Erectile Function; PHQ-9, The Patient Health
Questionnaire-9; qADAM, quantitative androgen de±ciency in the aging male; T, testosterone.
P
-value refers to comparison between the PHQ-9
o
10 and PHQ-9
X
10 subgroups.
Table 2.
Correlations between PHQ-9 score and IIEF questions for all
patients
IIEF question/domain
Spearman’s
rho (
r
)
P
-value
1. How often able to get erection during
sexual activity?
±
0.084
0.254
2. How often erections hard enough for
penetration?
±
0.067
0.362
3. How often able to penetrate partner?
±
0.084
0.255
4. How often able to maintain erection after
penetration?
±
0.155
0.035
5. How dif±cult to maintain erection to
completion of intercourse?
±
0.201
0.006
a
6. How many times attempted sexual
intercourse?
±
0.256
o
0.001
a
7. How often sexual intercourse
satisfactory?
±
0.245
0.001
a
8. How much have you enjoyed sexual
intercourse?
±
0.282
o
0.001
a
9. How often ejaculate?
±
0.035
0.631
10. How often feeling of orgasm?
±
0.116
0.114
11. How often felt sexual desire?
±
0.226
0.002
a
12. How would you rate sexual desire?
±
0.228
0.003
a
13. How satis±ed with overall sex life?
±
0.358
o
0.001
a
14. How satis±ed with sexual relationship
with partner?
±
0.413
o
0.001
a
15. Con±dence to get and keep erection?
±
0.104
0.156
IIEF—erectile function domain
±
.0128
0.089
IIEF—orgasmic function domain
±
0.062
0.401
IIEF—sexual desire domain
±
0.201
0.006
a
IIEF—intercourse satisfaction domain
±
0.293
o
0.001
a
IIEF—overall satisfaction
±
0.0413
o
0.001
a
Abbreviations: IIEF, The International Index of Erectile Function; PHQ-9, The
Patient Health Questionnaire-9.
a
Statistically signi±cant.
Depression and sexual dysFunction in men
AW Pastuszak
et al
196
International Journal oF Impotence Research (2013), 194 – 199
&
2013 Macmillan Publishers Limited