Effects of serum T and BMI on sexual function and hypogonadal
symptoms
The diagnosis of hypogonadism is made using both clinical
evaluation for hypogonadal symptoms as well as evaluation of
serum TT levels, with a TT of 300 ng dl
±
1
frequently used as the
cutoff between eugonadal and hypogonadal. In order to evaluate
the impact of serum TT levels and BMI on IIEF and qADAM scores,
we grouped men based on a serum TT cutoff of 300 ng dl
±
1
and a
BMI cutoff of 25 and observed lower total qADAM scores in men
with TT
X
300 ng dl
±
1
as well as men with BMI
X
25 kg m
±
2
, but
no signi±cant differences in IIEF scores between these groups
(Table 7). Given that higher qADAM scores were found in
eugonadal men, in contrast to what might be expected, we
examined the frequency of positive ADAM scores in these
subgroups and found that ADAM was positive in 61 of 73
(83.6%) of men in the TT
o
300 group and 90 of 112 (80.4%) men
in the TT
X
300 group (
P
¼
0.815). However, no differences in
qADAM scores were identi±ed between subgroups when strati±ed
based on whether men were on T replacement (data not shown).
DISCUSSION
Current evidence indicates that sexual dysfunction and depression
frequently coexist.
15,25–27
Given that the symptoms of hypo-
gonadism can mimic depressive symptoms, and the presence of
hypogonadism is associated with worse sexual function, one
would expect depression and sexual function to correlate.
13,27
However, the details of the relationship between sexual function
and depression in men have been incompletely elucidated.
We evaluated the relationship between sexual dysfunction and
depression in men by determining the correlations between
validated questionnaires commonly used to assess the severity
of depressive symptoms and sexual function. Our ±ndings
demonstrate a relationship between depressive symptoms and
Table 3.
Comparison of IIEF domain and qADAM scores in patients
with and without depressive symptoms
IIEF domains and qADAM
scores (Mean
±
s.d.)
PHQ 9
score
o
10
PHQ 9
score
X
10
P
-value
IIEF—erectile function
domain
19.1
±
10.4
17.5
±
10.3
0.443
IIEF—orgasmic function
domain
6.4
±
3.4
6.7
±
3.5
0.740
IIEF—sexual desire
domain
6.2
±
2.5
5.2
±
2.3
0.057
IIEF—intercourse
satisfaction domain
7.8
±
5.2
6.8
±
4.8
0.324
IIEF—overall satisfaction
6.1
±
2.7
4.6
±
2.1
0.008
a
qADAM Total score
26.0
±
4.8
19.9
±
4.6
o
0.001
a
Abbreviations: IIEF, The International Index of Erectile Function; PHQ-9,
The Patient Health Questionnaire-9; qADAM, quantitative androgen
de±ciency in the aging male.
P
-value refers to comparison between the PHQ-9
o
10 and PHQ-9
X
10
subgroups.
a
Statistically signi±cant.
Table 4.
Correlations between PHQ-9 score and qADAM scores for all
patients
qADAM question
Spearman’s
rho (
r
)
P
-value
1. How would you rate your libido
(sex drive)?
±
0.337
o
0.001
a
2. How would you rate your energy
level?
±
0.592
o
0.001
a
3. How would you rate your
strength/endurance?
±
0.412
o
0.001
a
4. How would you rate your
enjoyment of life?
±
0.643
o
0.001
a
5. How would you rate your
happiness level?
±
0.648
o
0.001
a
6. How strong are your erections?
±
0.134
0.069
7. How would you rate your work
performance over past 4 weeks?
±
0.494
o
0.001
a
8. How often do you fall asleep after
dinner?
0.110
0.133
9. How would you rate your sports
ability over past 4 weeks?
±
0.410
o
0.001
a
10. How much height have you lost?
±
0.074
0.667
Total qADAM score
±
0.634
o
0.001
a
Abbreviation: qADAM, quantitative androgen de±ciency in the aging male.
a
Statistically signi±cant.
Table 5.
Correlations between individual PHQ-9 questions and total
qADAM scores for all patients
PHQ-9 question
Spearman’s
rho (
r
)
P
-value
Over the last two weeks, how often have you been bothered by any of
the following problems?
1. Little interest or pleasure in
doing things
±
0.649
o
0.001
a
2. Feeling down, depressed or
hopeless
±
0.613
o
0.001
a
3. Trouble falling or staying
asleep or sleeping too much
±
0.311
o
0.001
a
4. Feeling tired or having little
energy
±
0.612
o
0.001
a
5. How would you rate your
happiness level?
±
0.399
o
0.001
a
6. Poor appetite or overeating
±
0.449
o
0.001
a
7. Trouble concentrating on
things
±
0.355
o
0.001
a
8. Moving or speaking so
slowly or being ±dgety or
restless
0.276
o
0.001
a
9. Thoughts that you would
be better of dead or of
hurting yourself
±
0.360
o
0.001
a
Total PHQ-9 score
±
0.634
o
0.001
a
Abbreviations: PHQ-9, The Patient Health Questionnaire-9; qADAM,
quantitative androgen de±ciency in the aging male.
a
Statistically signi±cant.
Table 6.
Comparison between IIEF domain and qADAM scores and
depressive symptoms using DSM IV criteria for depression
Questionnaire (Mean
±
s.d.)
No MDD
(
n
¼
165)
MDD
(
n
¼
20)
P
-value
IIEF—erectile function
domain
19.4
±
10.1
14.1
±
11.3
0.027
a
IIEF—orgasmic function
domain
6.5
±
3.3
6.5
±
3.9
1.000
IIEF—sexual desire
domain
6.2
±
2.4
4.7
±
2.5
0.008
a
IIEF—intercourse
satisfaction domain
8.0
±
5.0
5.1
±
5.1
0.016
IIEF—overall function
domain
6.0
±
1.8
4.1
±
2.7
0.002
a
qADAM total score
26.0
±
4.8
19.9
±
4.6
o
0.001
a
Abbreviations: DSM IV, Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition; IIEF, The International Index of Erectile Function;
MDD, Major Depressive Disorder; qADAM, quantitative androgen de±-
ciency in the aging male.
P
-value refers to comparison between the No MDD and MDD subgroups.
a
Statistically signi±cant.
Depression and sexual dysfunction in men
AW Pastuszak
et al
197
&
2013 Macmillan Publishers Limited
International Journal of Impotence Research (2013), 194 – 199