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The association between testosterone and depression in postmenopausal women: A systematic review of observational studies

  • Chandima Hemachandra
    Affiliations
    Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 1, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
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  • Rakibul M. Islam
    Affiliations
    Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 1, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
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  • Robin J. Bell
    Affiliations
    Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 1, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
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  • Farhana Sultana
    Affiliations
    Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 1, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
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  • Susan R. Davis
    Correspondence
    Corresponding author at: Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.
    Affiliations
    Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 1, 553 St Kilda Road, Melbourne, Victoria 3004, Australia

    Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Vic 3004, Australia
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      Highlights

      • Interpretation of data from studies that have explored a possible association between depression and testosterone is limited by methodological heterogeneity.
      • Studies that have measured testosterone by liquid/gas chromatography with tandem mass spectrometry are lacking.
      • The available data does not support an association between testosterone and depression in postmenopausal women.

      Abstract

      Objective

      The contribution of testosterone to depression in older women is uncertain. This review was conducted to investigate the association between endogenous testosterone blood concentrations and depression in postmenopausal women.

      Methods

      We searched Ovid MEDLINE, EMBASE, PsycINFO, and Web of Science databases for observational studies with at least 100 community-dwelling participants. The results were categorised by study design, and the reporting of total, bioavailable and free testosterone findings is narrative.

      Results

      The search strategy retrieved 28 articles for full-text review, of which eight met the criteria for inclusion; these described 6 cross-sectional and 2 longitudinal studies. Testosterone was measured by immunoassay in all of the included studies. No association was seen between total testosterone or free testosterone and depression in either the cross-sectional or the longitudinal studies. A significant association between bioavailable testosterone and incident depressive symptoms was limited to women at least 21 years postmenopause in one study. Most of the cross-sectional studies were not representative of national populations and lacked random selection.

      Conclusions

      This systematic review does not support an association between testosterone and depression in postmenopausal women. However, as the included studies had substantial methodological limitations, studies of community-based samples, employing validated instruments for depression and precise measurement of blood testosterone, are needed to address this knowledge gap.

      Keywords

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