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Frontiers | Serum Testosterone Levels and Symptom-Based Depression Subtypes in Men | Psychiatry

Physicians from the Zurich University Hospital of Psychiatry were involved in the procedure of blood sampling. The gonadal hormones were exclusively derived from the blood probes. However, no gonadal hormone assays were taken from 37 subjects. The reasons for this were participants refusing blood sample collection or difficulties during blood sampling e. Of the participants men: After being extensively informed about study procedure and aims both verbally and in writing, the participants gave their written consent.

The validity and reliability of the SPIKE have been established for the assessment of depression and anxiety For the current study, we made use of the three class solution, which had previously been extracted by a data-driven technique latent class analysis, LCA from the SPIKE data of men manifesting depressive symptoms during the past 12 months We excluded the moderate subtype because the investigation of the two clear discriminable melancholic and atypical depression subtypes increased statistical power, which was necessary due to the small sample sizes.

Members of the atypical subtype showed high probabilities of increased appetite and weight gain, whereas the melancholic subtype was characterized by loss of appetite and weight. More detailed information about these depressive subtypes and the entire LCA procedures can be found elsewhere From this group, 39 subjects either matched with the melancholic or the atypical depression subtype of the LCA three class solution A subgroup of 18 controls defined without use of professional help and low overall GSI-scores was included.

Consequently, the present study was dealing with a sample of 57 subjects. Psychosocial Characteristics In order to characterize the depression subtypes, sociodemographic variables such as age, education, urbanicity, and marital status were drawn from the face-to-face interview. Only the diagnosis of neurasthenia was derived from ICD Due to methodological linkage with the Zurich Study 38 , the algorithms of the DSM diagnoses were parallelized.

As a consequence, some diagnoses were based on an older edition of the DSM. Finally, the data concerning the consumption of psychiatric medication were taken from the laboratory day. Biological Measures Hormones. In order to ensure consistency due to diurnal variation 6 and in accordance with the recommendation of an earlier study 55 , the blood sample was drawn in the morning.

The exact time frame of the blood sample collection lay between Blood pressure and BMI. Both systolic and diastolic values were obtained and averaged across the two measurements. First, Chi2-tests and Fisher exact tests two-tailed and non-parametric Kruskal—Wallis tests were performed in order to assess differences of psychosocial characteristics between the depressive subgroups atypical depression, melancholic depression, and controls. Second, unadjusted analyses of variance ANOVAs were performed to evaluate the between-group differences on metric dependent variables.

The values of T were log transformed natural logarithm, ln due to the non-normally distributed residuals of the control group. In the ANOVAs, the depressive subgroup served as independent variable and the biological characteristics were treated as the dependent variable. In addition, a non-parametric median test was carried out on the T data. Finally, an analysis of covariance ANCOVA considering the influence of the covariates age, smoking, alcohol use, and psychopharmacological medication was computed.

Third, the subgroup differences were further examined by generalized linear regression models GLMs using logistic regression. GLMs enable the use of robust estimators in order to minimize the effects of outliers and influential observations T was entered as independent variable and the subgroups served as dependent variable.

Results Psychosocial Characteristics In Table 1 , the psychosocial characteristics of the LCA-based depressive subtypes and the control sample are displayed. No significant differences in demographic correlates were observed between these subsamples. However, groups differed with regard to some comorbid month diagnoses. As expected, both depressive subtypes had higher frequencies of MDD diagnosis than the controls. The severe atypical subtype revealed a diagnosis of generalized anxiety disorder GAD and simple phobia significantly more often than the controls.

In comparison with the melancholic subtype, agoraphobia occurred significantly more often in the atypical depression subtype. Atypical depression showed significantly more psychosis syndromes and personality disorders than the melancholic depression subtype and the controls.

Antidepressant consumption was significantly associated with the atypical depression subtype versus controls. Finally, in terms of the subjectively rated burden related to health problems, both depressive subtypes showed significantly higher values compared with controls. Biological Characteristics The biological characteristics of the subsamples are summarized in Table 2. The atypical depression subtype differed significantly from the melancholic subtype with regard to lower T levels. The difference with respect to the controls remained on a trend level of significance.

The same subgroup differences were found for SHBG. Furthermore, men manifesting atypical depressive symptom configurations were significantly more prone to a higher BMI than the melancholic depression subgroup and controls, respectively. In an extension of the analyses, the biological factors were categorized in order to validate the results in terms of medically relevant cut-offs: The categorized BMI normal weight: BMI The adjusted means and SEs are visualized in Figure 2.

Generalized linear regression models were carried out by contrasting the three subgroups, while adjusting for age, smoking, alcohol use, and psychopharmacological medication. Discussion This is a preliminary study examining differences of serum T levels in empirically derived symptom-based depression subtypes and a healthy control group in a Swiss community sample of male adults.

The results provided evidence that the atypical depression subtype is discriminable by low serum T levels in men aged between 21 and First, our results support the notion that the inconsistent evidence from previous studies with respect to T levels and MDD may have resulted from the heterogeneity of this diagnosis, while the investigation of more homogeneous symptom-based subtypes provides a more detailed picture. Second, the current analyses confirmed previous findings showing that the melancholic and atypical depressive subtypes were distinguishable by biological correlates 29 , 31 , and expanded this knowledge via the aspect of gonadal hormones.

Our results suggest that the previous findings of low T levels in depressed men 4 , 6 , 8 — 10 might have resulted from the subgroup of atypical depressives. There are several explanations for this specific biological correlate within atypical depressives.

The low T levels in atypical depressives could be explained by the high BMI associated with this subtype; this marked biological characteristic of atypical depression will be discussed further below. A further conceivable analogy can be drawn from studies demonstrating differences in HPA axis regulation between melancholic and atypical depression 31 , Melancholic depression was characterized by hypercortisolism while atypical depression was associated with hypocortisolism In combination with the evidence concerning the interactive nature in which the HPA and the HPG axes operate 33 this opens up interesting perspectives.

A fairly recent community study on a sample of men showed a positive correlation between endogenous evening saliva T and overall depression scores, as well as evening cortisol HPA axis 34 , This relation was explained by the effect of cortisol modifying the gonadotropin-releasing hormone GnRH from the hypothalamus, by influencing the LH from the pituitary or by alterations in the stimulating effect of gonadotropins or gonads 34 , To return to the depression subtypes, it thus appears plausible that the down-regulated HPA axis is correlated with low T levels, or even hypogonadism, in atypical depressives.

Also, SHBG, which is correlated with T 35 , was significantly lower in the atypical depression subtype compared with the melancholic subtype. In line with this hypothesis, the hypercortisolism-associated melancholic subtype should show the opposite, namely T level alterations. In our study, T levels were actually higher in the melancholic depression subtype compared to both other groups, although they only differed significantly from the atypical group.

Therefore, our two depression subtypes were found at both the lowest and highest areas of T distribution, which would be in line with the parabolic model displaying a curvilinear relationship between T and depression 13 , 15 , However, considering the fact that the T levels of the melancholic subtype were similar to the controls and, moreover, far from significantly differing from the latter whereas the atypical depression subtype did at least on a trend-level , the clinical relevance of the elevated T levels in the current study can be questioned.

Further studies are needed to replicate the findings of diverging T levels between melancholic and atypical depression with larger sample sizes. Beyond the gonadal hormone T characterizing the atypical depression subtype, the effect size was particularly striking for BMI. In fact, it was more than twice as large as that of T. This is in line with previous findings 29 , 36 demonstrating a positive association between BMI and atypical depression. Friedrich Voelcker in Halle im Jahr die sog.

Terence Millin war es vorbehalten im Jahr die erste Serie retropubischer Prostatektomien zu publizieren. Das Stiefkind wurde zum Lieblingskind. Abstract For hardly any other organ can the development of medicine and technical advances in the last years be so clearly illustrated as for the prostate.

The history of radical prostatectomy was initially characterised by the problems in approaching this relatively difficulty accessible organ. In , Theodor Billroth in Vienna performed the first partial prostatectomy via a perineal access. In Germany, Prof. Friedrich Voelcker in Halle in developed the so-called ischiorectal prostatectomy. But it was left to Terence Millin to publish in the first series of retropubic prostatectomies.

In , the sacroperineal approach according to Thiermann and the sacral prostatectomy according to were introduced. Finally, in another new era in prostate surgery started with the first laparoscopic prostatectomy. This development peaked in with the presentation of the laparoscopic DaVinci prostatectomy by Binder. Originally a stepchild of urological surgey that was to be avoided whenever possible due to the fear of serious complications, the prostate has progressed in the course of time to an obscure object of lust.

The stepchild has become the favorite child.

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