the psychological, as well as physical, domains of sexual function,

indicating that men with depressive symptoms are likely to have

both emotional and physical manifestations of sexual dysfunction.

Furthermore, we show that in men meeting criteria for MDD,

physical symptoms of sexual function are likely to be more severe.

Importantly, the prevalence of MDD, as well as its severity,

in our cohort is similar to that previously reported in male adults

in the US.

When comparing depressive and hypogonadal symptoms using

the PHQ-9 and qADAM questionnaires, we demonstrate signi±-

cant correlations between these conditions, echoing prior ±ndings

in the literature.

2,8,28,29

Furthermore, T replacement has been

shown to improve depressive symptoms in hypogonadal men.

30–

Obesity also affects sexual function and obese men are more

likely to be hypogonadal.

Our data corroborate these ±ndings

overall, indicating that men with higher BMI are more likely to

have both hypogonadal as well as depressive symptoms. When

evaluating sexual function and hypogonadal symptoms using a

common threshold for hypogonadal TT levels, we ±nd that men

with higher TT are more likely to have slightly lower scores on the

qADAM questionnaire than men with lower TT. However,

the difference in scores, while statistically signi±cant, is small

and the clinical signi±cance unclear. In addition, no differences

between the TT groups were observed when comparing ADAM

positivity rates or when men were separated based on whether

they were on T replacement.

Our study is limited by several factors. First, the size of our

cohort is relatively small, encompassing only 186 men. Never-

theless, we were able to demonstrate a signi±cant relationship

between depression and sexual function using this cohort.

Furthermore, we demonstrate a correlation between the physical

aspects of sexual function and depressive symptoms for the ±rst

time, and show that this relationship relates to the severity of

depressive symptoms. Second, our cohort is derived from men

presenting to a urology clinic specializing in male sexual function

and hypogonadism. Despite the ±nding that the rates of

depression in our cohort mimic those of the general male

population, the data from this study may not be generalizable,

considering that 135 of 186 (72.6%) men in the cohort had

hypogonadism and 115 of 186 (61.8%) had ED, rates higher than

those of the general population.

2,34–36

In addition, at the time of

study, patients with ED and hypogonadism were receiving a

variety of treatments for these conditions, which may further

confound our ±ndings (treatment data not reported). Third, we

utilized the qADAM questionnaire, an unvalidated metric, for

assessing hypogonadal symptoms. However, our ±ndings using

the qADAM were in line with those previously described and

correlate appropriately with ADAM responses within the same

cohort. Furthermore, the use of the binary responses ascertained

using the ADAM questionnaire would not have permitted the

±delity attained using a numeric scale. Fourth, we present data for

a single set of questionnaires completed by each subject, which

does not permit trending of symptoms over time. Therefore, we

cannot

evaluate

the

effects

treatment

for

and

hypogonadism in the population on questionnaire responses,

which would further support the ±ndings. It is important to note

that successful ED treatment has been shown to signi±cantly

improve health related quality of life, and the effects of ED

treatment within our cohort are unclear.

Finally, we grouped

men with MDD using criteria available solely from each patient’s

responses on the PHQ-9 questionnaire rather than formal

psychiatric evaluation, which may not reﬂect the true rate of

depression in our cohort. However, as may be expected, men with

more severe depressive symptoms did evidence worse sexual

function.

CONCLUSION

Sexual dysfunction and depression are two common conditions in

men that contribute to decreased quality of life. We demonstrate

that these conditions are correlated, that the presence of

depressive symptoms is related to both the psychological as well

as the physical aspects of sexual function, and that the severity of

depressive symptoms is related to the degree of sexual

dysfunction. Future work will further clarify the relationship

between the various domains of sexual function and depressive

symptoms.

CONFLICT OF INTEREST

The authors declare no conﬂict of interest.

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Table 7.

Comparison between IIEF overall satisfaction and qADAM total scores for T and BMI subgroups

Questionnaire (Mean

s.d.)

BMI

25 (

38)

BMI

25 (

141)

-value

300 (

73)

300 (

112)

-value

qADAM score

26.6

4.4

24.6

5.4

0.045

25.8

5.4

23.8

4.9

0.014

IIEF—erectile function domain

18.6

10.7

20.1

9.1

0.447

18.4

11.0

19.2

10.0

0.625

IIEF—orgasmic function domain

7.1

2.9

6.4

3.6

0.235

5.9

3.9

6.8

3.0

0.084

IIEF—sexual desire domain

6.2

2.4

6.0

2.5

0.699

5.4

2.6

6.4

2.3

0.012

IIEF—intercourse satisfaction domain

8.7

4.7

7.4

5.2

0.140

7.0

5.3

8.1

4.9

0.489

IIEF—overall satisfaction score

6.2

2.7

5.7

2.6

0.283

5.5

2.4

6.0

2.8

0.216

PHQ-9 score

3.5

3.9

5.7

5.5

0.028

5.4

4.8

4.5

5.0

0.222

Abbreviations: BMI, body mass index; IIEF, The International Index of Erectile Function; TT, total testosterone; qADAM, quantitative androgen de±ciency in the

aging male.

-value refers to comparison between the BMI

25 and BMI

25 subgroups.

-value refers to comparison between the TT

300 and TT300 subgroups.

Statistically signi±cant.

Depression and sexual dysfunction in men

AW Pastuszak

et al

198

International Journal of Impotence Research (2013), 194 – 199

2013 Macmillan Publishers Limited