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<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">HPR</journal-id><journal-title-group><journal-title>Health Psychology Research</journal-title></journal-title-group><issn>TBA</issn><eissn>2420-8124</eissn><publisher><publisher-name>Health Psychology Research</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.52965/001c.38956</article-id><article-categories><subj-group subj-group-type="heading"><subject>General</subject></subj-group></article-categories><title>Testosterone Replacement Therapy in the Treatment of Depression </title><url>https://healthpr.org/journal/HPR/10/4/10.52965/001c.38956</url><author>J. AndersonDanyon,VazirniaParsia,LoehrCatherine,SternfelsWhitney,HasoonJamal,ViswanathOmar,D. KayeAlan,UritsIvan</author><pub-date pub-type="publication-year"><year>2022</year></pub-date><volume>10</volume><issue>4</issue><history><date date-type="pub"><published-time>2022-11-26</published-time></date></history><abstract>Background
Depression is a common disorder that affects millions globally and is linked to reduced quality of life and mortality. Its pathophysiology is complex and there are several forms of treatment proposed in the literature with differing side effect profiles. Many patients do not respond to treatment which warrants augmentation with other treatments and the investigation of novel treatments. One of these treatments includes testosterone therapy which evidence suggests might improve depressed mood in older patients with low levels of testosterone and helps restore physical impairments caused by age-related hormonal changes.
Objective
The objective of this review is to synthesize information regarding clinical depression, its treatment options, and the efficacy and safety of testosterone treatment for the treatment of depression.
Methods
This review utilized comprehensive secondary and tertiary data analysis across many academic databases and published work pertaining to the topic of interest.
Results
Within some subpopulations such as men with dysthymic disorder, treatment resistant depression, or low testosterone levels, testosterone administration yielded positive results in the treatment of depression. Additionally, rodent models have shown that administering testosterone to gonadectomized male animals reduces symptoms of depression. Conversely, some studies have found no difference in depressive symptoms after treatment with testosterone when compared with placebo. It was also noted that over administration of testosterone is associated with multiple adverse effects and complications.
Conclusion
The current evidence provides mixed conclusions on the effectiveness of testosterone therapy for treating depression. More research is needed in adult men to see if declining testosterone levels directly influence the development of depression.</abstract><keywords>testosterone, depression, major depressive disorder, persistent depressive disorder, dysthymia, hypogonadism</keywords></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>1. Brown-Sequard C. TESTOSTERONE AS A HORMONE. 2009;15.&amp;nbsp;2. Amiaz R, Seidman SN. Testosterone and Depression in Men.&amp;nbsp;3. de Wit AE, Giltay EJ, de Boer MK, et al. Plasma androgens and the presence and course of depression in a large cohort of men. Psychoneuroendocrinology. 2021;130:105278. doi:10.1016/j.psyneuen.2021.105278&amp;nbsp;4. Hore BD. Hypogonadism presenting as a psychiatric disorder. Br J Psychiatry. 1969;115(524):863-864. doi:10.1192/bjp.115.524.863-b&amp;nbsp;5. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment with Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31-40. doi:10.1001/jamapsychiatry.2018.2734&amp;nbsp;6. Carrier N, Saland SK, Duclot F, He H, Mercer R, Kabbaj M. The Anxiolytic and Antidepressant-like Effects of Testosterone and Estrogen in Gonadectomized Male Rats. Biological Psychiatry. 2015;78(4):259-269. doi:10.1016/j.biopsych.2014.12.024&amp;nbsp;7. Gould TD, Georgiou P, Brenner LA, et al. Animal models to improve our understanding and treatment of suicidal behavior. Transl Psychiatry. 2017;7(4):e1092. doi:10.1038/tp.2017.50&amp;nbsp;8. Wainwright SR, Workman JL, Tehrani A, et al. Testosterone has antidepressant-like efficacy and facilitates imipramine-induced neuroplasticity in male rats exposed to chronic unpredictable stress. Hormones and Behavior. 2016;79:58-69. doi:10.1016/j.yhbeh.2016.01.001&amp;nbsp;9. Baischer W, Koinig G, Hartmann B, Huber J, Langer G. Hypothalamic-pituitary-gonadal axis in depressed premenopausal women: elevated blood testosterone concentrations compared to normal controls. Psychoneuroendocrinology. 1995;20(5):553-559. doi:10.1016/0306-4530(94)00081-k&amp;nbsp;10. Sigurdsson B, Palsson SP, Aevarsson O, Olafsdottir M, Johannsson M. Saliva testosterone and cortisol in male depressive syndrome, a community study. The Sudurnesjamenn Study. Nordic Journal of Psychiatry. 2014;68(8):579-587. doi:10.3109/08039488.2014.898791&amp;nbsp;11. Peng R, Li Y. Associations between tenascin-c and testosterone deficiency in men with major depressive disorder: A cross-sectional retrospective study. Journal of Inflammation Research. 2021;14:897-905. doi:10.2147/jir.s298270&amp;nbsp;12. Bhasin S, Seidman S. Testosterone Treatment of Depressive Disorders in Men: Too Much Smoke, Not Enough High-Quality Evidence. JAMA Psychiatry. 2019;76(1):9-10. doi:10.1001/jamapsychiatry.2018.2661&amp;nbsp;13. Seidman SN, Araujo AB, Roose SP, et al. Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry. 2002;159(3):456-459. doi:10.1176/appi.ajp.159.3.456&amp;nbsp;14. Markianos M, Tripodianakis J, Sarantidis D, Hatzimanolis J. Plasma testosterone and dehydroepiandrosterone sulfate in male and female patients with dysthymic disorder. Journal of Affective Disorders. 2007;101(1-3):255-258. doi:10.1016/j.jad.2006.11.013&amp;nbsp;15. Shores MM, Kivlahan DR, Sadak TI, Li EJ, Matsumoto AM. A Randomized, Double-Blind, Placebo-Controlled Study of Testosterone Treatment in Hypogonadal Older Men With Subthreshold Depression (Dysthymia or Minor Depression). J Clin Psychiatry. 2009;70(7):1009-1016. doi:10.4088/jcp.08m04478&amp;nbsp;16. Seidman SN, Orr G, Raviv G, et al. Effects of testosterone replacement in middle-aged men with dysthymia: A randomized, placebo-controlled clinical trial. Journal of Clinical Psychopharmacology. 2009;29(3):216-221. doi:10.1097/jcp.0b013e3181a39137&amp;nbsp;17. World Health Organisation. Depression. www.who.int. Published September 13, 2021. https://www.who.int/news-room/fact-sheets/detail/depression&amp;nbsp;18. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990&amp;ndash;2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197-2223. doi:10.1016/s0140-6736(12)61689-4&amp;nbsp;19. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin. 2017;143(8):783-822. doi:10.1037/bul0000102&amp;nbsp;20. Cuijpers P, Quero S, Dowrick C, Arroll B. Psychological Treatment of Depression in Primary Care: Recent Developments. Curr Psychiatry Rep. 2019;21(12). doi:10.1007/s11920-019-1117-x&amp;nbsp;21. Demyttenaere K, Bruffaerts R, Posada-Villa J, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. J Am Med Assoc. 2004;291(21):2581-2590. doi:10.1001/jama.291.21.2581&amp;nbsp;22. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses. Am J Psychiatry. 2014;171(4):453-462. doi:10.1176/appi.ajp.2013.13030325&amp;nbsp;23. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575-1586. doi:10.1016/s0140-6736(13)61611-6&amp;nbsp;24. Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980&amp;ndash;2013. International Journal of Epidemiology. 2014;43(2):476-493. doi:10.1093/ije/dyu038&amp;nbsp;25. Bromet E, Andrade LH, Hwang I, et al. Cross-National Epidemiology of DSM-IV Major Depressive Episode. BMC Med. 2011;9(1). doi:10.1186/1741-7015-9-90&amp;nbsp;26. Twenge JM, Nolen-Hoeksema S. Age, gender, race, socioeconomic status, and birth cohort differences on the children&amp;rsquo;s depression inventory: a meta-analysis. Journal of Abnormal Psychology. 2002;111(4):578-588. doi:10.1037/0021-843x.111.4.578&amp;nbsp;27. Rice F, Riglin L, Lomax T, et al. Adolescent and adult differences in major depression symptom profiles. Journal of Affective Disorders. 2019;243:175-181. doi:10.1016/j.jad.2018.09.015&amp;nbsp;28. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379(9820):1056-1067. doi:10.1016/s0140-6736(11)60871-4&amp;nbsp;29. O&amp;rsquo;Callaghan G, Stringaris A. Reward processing in adolescent depression across neuroimaging modalities: A review. Zeitschrift f&amp;uuml;r Kinder- und Jugendpsychiatrie und Psychotherapie. 2019;47(6):535-541. doi:10.1024/1422-4917/a000663&amp;nbsp;30. Luppa M, Sikorski C, Luck T, et al. Age- and gender-specific prevalence of depression in late-life &amp;ndash; Systematic review and meta-analysis. Journal of Affective Disorders. 2012;136(3):212-221. doi:10.1016/j.jad.2010.11.03331. Jesulola E, Micalos P, Baguley IJ. Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model - are we there yet? Behavioural Brain Research. 2018;341:79-90. doi:10.1016/j.bbr.2017.12.02532. Maletic V, Eramo A, Gwin K, Offord SJ, Duffy RA. The Role of Norepinephrine and its &amp;alpha;-Adrenergic Receptors in the Pathophysiology and Treatment of Major Depressive Disorder and Schizophrenia: A Systematic Review. Front Psychiatry. 2017;8(1). doi:10.3389/fpsyt.2017.0004233. Boku S, Nakagawa S, Toda H, Hishimoto A. Neural basis of major depressive disorder: Beyond monoamine hypothesis. Psychiatry Clin Neurosci. 2017;72(1):3-12. doi:10.1111/pcn.1260434. Spellman T, Liston C. Toward circuit mechanisms of pathophysiology in depression. Am J Psychiatry. 2020;177(5):381-390. doi:10.1176/appi.ajp.2020.2003028035. Brigitta B. Pathophysiology of depression and mechanisms of treatment. Dialogues in Clinical Neuroscience. 2002;4(1):7-20. doi:10.31887/dcns.2002.4.1.bbondy36. Tiger M, Farde L, R&amp;uuml;ck C, et al. Low serotonin1B receptor binding potential in the anterior cingulate cortex in drug-free patients with recurrent major depressive disorder. Psychiatry Research: Neuroimaging. 2016;253:36-42. doi:10.1016/j.pscychresns.2016.04.01637. Sullivan GM, Oquendo MA, Milak M, et al. Positron emission tomography quantification of serotonin1A receptor binding in suicide attempters with major depressive disorder. JAMA Psychiatry. 2015;72(2):169-178. doi:10.1001/jamapsychiatry.2014.240638. Iscan Z, Rakesh G, Rossano S, et al. A positron emission tomography study of the serotonergic system in relation to anxiety in depression. European Neuropsychopharmacology. 2017;27(10):1011-1021. doi:10.1016/j.euroneuro.2017.07.00939. Ananth MR, Delorenzo C, Yang J, Mann JJ, Parsey RV. Decreased Pretreatment Amygdalae Serotonin Transporter Binding in Unipolar Depression Remitters: A Prospective PET Study. J Nucl Med. 2018;59(4):665-670. doi:10.2967/jnumed.117.18965440. Rajkowska G, Miguel-Hidalgo JJ. Gliogenesis and Glial Pathology in Depression. CNS &amp;amp; Neurological Disorders - Drug Targets. 2007;6(3):219-233. doi:10.2178/18715270778061932641. Maciag D, Hughes J, O&amp;rsquo;Dwyer G, et al. Reduced Density of Calbindin Immunoreactive GABAergic Neurons in the Occipital Cortex in Major Depression: Relevance to Neuroimaging Studies. Biological Psychiatry. 2010;67(5):465-470. doi:10.1016/j.biopsych.2009.10.02742. Rajkowska G, O&amp;rsquo;Dwyer G, Teleki Z, Stockmeier CA, Miguel-Hidalgo JJ. GABAergic neurons immunoreactive for calcium binding proteins are reduced in the prefrontal cortex in major depression. Neuropsychopharmacol. 2007;32(2):471-482. doi:10.1038/sj.npp.130123443. Duman RS, Sanacora G, Krystal JH. Altered Connectivity in Depression: GABA and Glutamate Neurotransmitter Deficits and Reversal by Novel Treatments. Neuron. 2019;102(1):75-90. doi:10.1016/j.neuron.2019.03.01344. Kaiser RH, Andrews-Hanna JR, Wager TD, Pizzagalli DA. Large-Scale Network Dysfunction in Major Depressive Disorder: A Meta-analysis of Resting-State Functional Connectivity Original Investigation. JAMA Psychiatry. 2015;72(6):603-611. doi:10.1001/jamapsychiatry.2015.007145. Buckner RL, Andrews-Hanna JR, Schacter DL. The brain&amp;rsquo;s default network: Anatomy, function, and relevance to disease. Ann N Y Acad Sci. 2008;1124(1):1-38. doi:10.1196/annals.1440.01146. Cullen KR, Westlund MK, Klimes-Dougan B, et al. Abnormal Amygdala Resting-State Functional Connectivity in Adolescent Depression. JAMA Psychiatry. 2014;71(10):1138-1147. doi:10.1001/jamapsychiatry.2014.108747. Price JL, Drevets WC. Neurocircuitry of Mood Disorders. Neuropsychopharmacol. 2010;35(1):192-216. doi:10.1038/npp.2009.10448. Drevets WC. Prefrontal Cortical-Amygdalar Metabolism in Major Depression. Annals NY Acad Sci. 1999;877(1):614-637. doi:10.1111/j.1749-6632.1999.tb09292.x49. Yatham MS, Yatham KS, Ravindran AV, Sullivan F. Do statins have an effect on depressive symptoms? A systematic review and meta-analysis. Journal of Affective Disorders. 2019;257:55-63. doi:10.1016/j.jad.2019.07.00250. L&amp;oacute;pez Le&amp;oacute;n S, Croes EA, Sayed-Tabatabaei FA, Claes S, van Broeckhoven C, van Duijn CM. The dopamine D4 receptor gene 48-base-pair-repeat polymorphism and mood disorders: A meta-analysis. Biological Psychiatry. 2005;57(9):999-1003. doi:10.1016/j.biopsych.2005.01.03051. Dong C, Wong ML, Licinio J. Sequence variations of ABCB1, SLC6A2, SLC6A3, SLC6A4, CREB1, CRHR1 and NTRK2: Association with major depression and antidepressant response in Mexican-Americans. Mol Psychiatry. 2009;14(12):1105-1118. doi:10.1038/mp.2009.9252. Irie F, Masaki KH, Petrovitch H, et al. Apolipoprotein E &amp;epsilon;4 allele genotype and the effect of depressive symptoms on the risk of dementia in men: The Honolulu-Asia aging study. Arch Gen Psychiatry. 2008;65(8):906-912. doi:10.1001/archpsyc.65.8.90653. L&amp;oacute;pez-Le&amp;oacute;n S, Janssens ACJW, Gonz&amp;aacute;lez-Zuloeta Ladd AM, et al. Meta-analyses of genetic studies on major depressive disorder. Mol Psychiatry. 2008;13(8):772-785. doi:10.1038/sj.mp.400208854. Kendler KS, Gatz M, Gardner CO, Pedersen NL. A Swedish National Twin Study of Lifetime Major Depression. Am J Psychiatry. 2006;163(1):109-114. doi:10.1176/appi.ajp.163.1.10955. Sullivan PF, Neale MC, Kendler KS. Genetic Epidemiology of Major Depression: Review and Meta-Analysis. Am J Psychiatry. 2000;157(10):1552-1562. doi:10.1176/appi.ajp.157.10.155256. Kendler KS, Ohlsson H, Sundquist K, Sundquist J. Sources of Parent-Offspring Resemblance for Major Depression in a National Swedish Extended Adoption Study. JAMA Psychiatry. 2018;75(2):194-200. doi:10.001/jamapsychiatry.2017.382857. Keller MC, Neale MC, Kendler KS. Association of Different Adverse Life Events With Distinct Patterns of Depressive Symptoms. Am J Psychiatry. 2007;164(10):1521-1529. doi:10.1176/appi.ajp.2007.0609156458. Kendler KS, Gardner CO. Monozygotic twins discordant for major depression: A preliminary exploration of the role of environmental experiences in the aetiology and course of illness. Psychol Med. 2001;31(3):411-423. doi:10.1017/s003329170100362259. Dalton VS, Kolshus E, McLoughlin DM. Epigenetics and depression: Return of the repressed. Journal of Affective Disorders. 2014;155(1):1-12. doi:10.1016/j.jad.2013.10.02860. Nestler EJ. Epigenetic mechanisms of depression. JAMA Psychiatry. 2014;71(4):454-456. doi:10.1001/jamapsychiatry.2013.429161. Vreeburg SA, Hoogendijk WJG, van Pelt J, et al. Major Depressive Disorder and Hypothalamic-Pituitary-Adrenal Axis Activity: Results From a Large Cohort Study. Arch Gen Psychiatry. 2009;66(6):617. doi:10.1001/archgenpsychiatry.2009.5062. Sher L, Oquendo MA, Burke AK, Cooper TB, John Mann J. Combined dexamethasone suppression&amp;ndash;corticotrophin-releasing hormone stimulation test in medication-free major depression and healthy volunteers. Journal of Affective Disorders. 2013;151(3):1108-1112. doi:10.1016/j.jad.2013.06.04963. Juruena MF. Early-life stress and HPA axis trigger recurrent adulthood depression. Epilepsy &amp;amp; Behavior. 2014;38:148-159. doi:10.1016/j.yebeh.2013.10.02064. Sheline YI, Gado MH, Kraemer HC. Untreated Depression and Hippocampal Volume Loss. Am J Psychiatry. 2003;160(8):1516-1518. doi:10.1176/appi.ajp.160.8.151665. Teo AR, Choi H, Valenstein M. Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study. PLoS ONE. 2013;8(4):e62396. doi:10.1371/journal.pone.006239666. Rosenquist JN, Fowler JH, Christakis NA. Social network determinants of depression. Mol Psychiatry. 2011;16(3):273-281. doi:10.1038/mp.2010.1367. Mcgrath JJ, Saha S, Al-Hamzawi A, et al. The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders. Am J Psychiatry. 2016;173(10):997-1006. doi:10.1176/appi.ajp.2016.1510129368. Beck AT. The Current State of Cognitive Therapy A 40-Year Retrospective.&amp;nbsp;69. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review. 2006;26(1):17-31. doi:10.1016/j.cpr.2005.07.00370. Amick HR, Gartlehner G, Gaynes BN, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ. Published online December 8, 2015:h6019. doi:10.1136/bmj.h601971. Cuijpers P, van Straten A, Warmerdam L, Andersson G. PSYCHOTHERAPY VERSUS THE COMBINATION OF PSYCHOTHERAPY AND PHARMACOTHERAPY IN THE TREATMENT OF DEPRESSION: A META-ANALYSIS. Depress Anxiety. 2009;26(3):279-288. doi:10.1002/da.2051972. Cuijpers P, Dekker J, Hollon SD, Andersson G. Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: A meta-analysis. J Clin Psychiatry. 2009;70(9):1219-1229. doi:10.4088/jcp.09r0502173. Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020;19(1):92-107. doi:10.1002/wps.2070174. Gartlehner G, Gaynes BN, Amick HR, et al. Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression: An evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):331. doi:10.7326/m15-181375. Karyotaki E, Smit Y, Holdt Henningsen K, et al. Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects. Journal of Affective Disorders. 2016;194:144-152. doi:10.1016/j.jad.2016.10103676. Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. 2013;3(4):e002542. doi:10.1136/bmjopen-2012-00254277. Parikh SV, Segal ZV, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. Journal of Affective Disorders. 2009;117(SUPPL. 1):S15-S25. doi:10.1016/j.jad.2009.06.04278. Greenberg J, Tesfazion AA, Robinson CS. Screening, Diagnosis, and Treatment of Depression. Mil Med. 2012;177(8S):60-66. doi:10.7205/milmed-d-12-0010279. Wimbiscus M, Kostenko O, Malone D. MAO inhibitors: Risks, benefits, and lore. Cleveland Clinic Journal of Medicine. 2010;77(12):859-882. doi:10.3949/ccjm.77a.0910380. Bauer M, Pfennig A, Severus E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders. The World Journal of Biological Psychiatry. 2013;14(5):334-385. doi:10.3109/15622975.2013.80419581. Gillman K. &amp;ldquo;Much ado about nothing&amp;rdquo;: monoamine oxidase inhibitors, drug interactions, and dietary tyramine. CNS Spectr. 2017;22(5):385-387. doi:10.1017/s109285291600065182. Thase ME. The Role of Monoamine Oxidase Inhibitors in Depression Treatment Guidelines. J Clin Psychiatry. 2012;73(suppl 1):10-16. doi:10.4088/jcp.11096su1c.0283. Flockhart DA. Dietary Restrictions and Drug Interactions With Monoamine Oxidase Inhibitors: An Update. J Clin Psychiatry. 2012;73(suppl 1):17-24. doi:10.4088/jcp.11096su1c.0384. Lehmann HE, Cahn CH, De Verteuil RL. The Treatment of Depressive Conditions with Imipramine (G 22355). Canadian Psychiatric Association Journal. 1958;3(4):155-164. doi:10.1177/07067437580030040185. Mojtabai R, Olfson M. National Patterns in Antidepressant Treatment by Psychiatrists and General Medical Providers. J Clin Psychiatry. 2008;69(7):1064-1074. doi:10.4088/jcp.v69n070486. Marcus SC, Olfson M. National Trends in the Treatment for Depression From 1998 to 2007. Arch Gen Psychiatry. 2010;67(12):1265. doi:10.1001/archgenpsychiatry.2010.15187. Spijker J, Nolen WA. An algorithm for the pharmacological treatment of depression. Acta Psychiatrica Scandinavica. 2010;121(3):180-189. doi:10.1111/j.1600-0447.2009.01492.x88. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. Journal of Clinical Psychopharmacology. 2009;29(3):259-266. doi:10.1097/jcp.0b013e3181a5233f89. Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database of Systematic Reviews. 2013;(5). doi:10.1002/14651858.cd003382.pub390. Watanabe N, Omori IM, Nakagawa A, et al. Mirtazapine versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews. 2011;(12). doi:10.1002/14651858.cd006528.pub291. Alemi F, Min H, Yousefi M, et al. Effectiveness of common antidepressants: a post market release study. eClinicalMedicine. 2021;41:101171. doi:10.1016/j.eclinm.2021.10117192. Akil H, Gordon J, Hen R, et al. Treatment resistant depression: A multi-scale, systems biology approach. Neuroscience &amp;amp; Biobehavioral Reviews. 2018;84:272-288. doi:10.1016/j.neubiorev.2017.08.01993. Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety. 2010;27(10):891-932. doi:10.1002/da.2074194. Khan A, Faucett J, Lichtenberg P, Kirsch I, Brown WA. A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression. Holscher C, ed. PLoS ONE. 2012;7(7):e41778. doi:10.1371/journal.pone.004177895. Lampe L, Coulston CM, Berk L. Psychological management of unipolar depression. Acta Psychiatr Scand. 2013;127:24-37. doi:10.1111/acps.1212396. Kanter JW, Baruch DE, Gaynor ST. Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison. Behav Analyst. 2006;29(2):161-185. doi:10.1007/bf0339212997. Brakemeier EL, Frase L. Interpersonal Psychotherapy (IPT) in Major Depressive Disorder. Eur Arch Psychiatry Clin Neurosci. 2012;262(S2):117-121. doi:10.1007/s00406-012-0357-098. Ign&amp;aacute;cio ZM, Calixto AV, da Silva RH, Quevedo J, R&amp;eacute;us GZ. The use of quetiapine in the treatment of major depressive disorder: Evidence from clinical and experimental studies. Neuroscience &amp;amp; Biobehavioral Reviews. 2018;86:36-50. doi:10.1016/j.neubiorev.2017.12.01299. Cheer SM, Wagstaff AJ. Quetiapine. CNS Drugs. 2004;18(3):173-199. doi:10.2165/00023210-200418030-00004100. Nelson JC, Papakostas GI. Atypical Antipsychotic Augmentation in Major Depressive Disorder: A Meta-Analysis of Placebo-Controlled Randomized Trials. Am J Psychiatry. 2009;166(9):980-991. doi:10.1176/appi.ajp.2009.09030312101. Valenstein M, McCarthy JF, Austin KL, Greden JF, Young EA, Blow FC. What Happened to Lithium? Antidepressant Augmentation in Clinical Settings. Am J Psychiatry. 2006;163(7):1219-1225. doi:10.1176/ajp.2006.163.7.1219102. Nemeroff CB. Use of atypical antipsychotics in refractory depression and anxiety. The Journal of Clinical Psychiatry. 2005;66(Suppl 8):13-21. Accessed July 20, 2022. https://pubmed.ncbi.nlm.nih.gov/1636032/103. Sapkota A, Khurshid H, Qureshi IA, et al. Efficacy and Safety of Intranasal Esketamine in Treatment-Resistant Depression in Adults: A Systematic Review. Cureus. 2021;21. doi:10.7759/cureus.17352104. Swainson J, Thomas RK, Archer S, et al. Esketamine for treatment resistant depression. Expert Review of Neurotherapeutics. 2019;19(10):899-911. doi:10.1080/14737175.2019.1640604105. Yavi M, Lee H, Henter ID, Park LT, Zarate CA Jr. Ketamine treatment for depression: a review. Discov Ment Health. 2022;2(1). doi:10.1007/s44192-022-00012-3106. Kalmoe MC, Janski AM, Zorumski CF, Nagele P, Palanca BJ, Conway CR. Ketamine and nitrous oxide: The evolution of NMDA receptor antagonists as antidepressant agents. Journal of the Neurological Sciences. 2020;412:116778. doi:10.1016/j.jns.2020.116778107. Powell JG, Garland S, Preston K, Piszczatoski C. Brexanolone (Zulresso): Finally, an FDA-Approved Treatment for Postpartum Depression. Ann Pharmacother. 2019;54(2):157-163. doi:10.1177/1060028019873312108. Gunduz-Bruce H, Silber C, Kaul I, et al. Trial of SAGE-217 in Patients with Major Depressive Disorder. N Engl J Med. 2019;381(10):903-911. doi:10.1056/nejmoa1815981109. Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs. 2019;33(3):265-282. doi:10.1007/s40263-019-00605-7110. Leader LD, O&amp;rsquo;Connell M, VandenBerg A. Brexanolone for Postpartum Depression: Clinical Evidence and Practical Considerations. Pharmacotherapy. 2019;39(11):1105-1112. doi:10.1002/phar.2331111. Lavretsky H, Reinlieb M, St. Cyr N, Siddarth P, Ercoli LM, Senturk D. Citalopram, Methylphenidate, or Their Combination in Geriatric Depression: A Randomized, Double-Blind, Placebo-Controlled Trial. Am J Psychiatry. 2015;172(6):561-569. doi:10.1176/appi.ajp.2014.14070889112. Amann B, Born C, Crespo JM, Pomarol-Clotet E, McKenna P. Lamotrigine: when and where does it act in affective disorders? A systematic review. J Psychopharmacol. 2010;25(10):1289-1294. doi:10.1177/0269881110376695113. K&amp;ouml;hler O, Gasse C, Petersen L, et al. The Effect of Concomitant Treatment With SSRIs and Statins: A Population-Based Study. Am J Psychiatry. 2016;173(8):807-815. doi:10.1176/appi.ajp.2016.15040463114. Furey ML, Zarate CA Jr. Pulsed Intravenous Administration of Scopolamine Produces Rapid Antidepressant Effects and Modest Side Effects. J Clin Psychiatry. 2013;74(08):850-851. doi:10.4088/jcp.13ac08584115. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. The Journal of Clinical Endocrinology &amp;amp; Metabolism. 2001;86(2):724-731. doi:10.1210/jcem.86.2.7219116. Shores MM, Sloan KL, Matsumoto AM, Moceri VM, Felker B, Kivlahan DR. Increased Incidence of Diagnosed Depressive Illness in Hypogonadal Older Men A. Arch Gen Psychiatry. 2004:162-167.&amp;nbsp;117. Wang C, Swerdloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. The Journal of Clinical Endocrinology &amp;amp; Metabolism. 2000;85(8):2839-2853. doi:10.1210/jcem.85.8.6747118. Walther A, Ehlert U. Steroid secretion and psychological well-being in men 40+. In: Rice T, Sher L, eds. Neurobiology of Men&amp;rsquo;s Mental Health. Nova; 2015:287-322.&amp;nbsp;119. Walther A, Philipp M, Lozza N, Ehlert U. The rate of change in declining steroid hormones: a new parameter of healthy aging in men? Oncotarget. 2016;7(38):60844-60857. doi:10.18632/oncotarget.117523PubMed120. Wu FCW, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-135. doi:10.1056/NEJMoa0911101121. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589-598. doi:10.1210/jcem.87.2.8201122. Kische H, Gross S, Wallaschofski H, et al. Associations of androgens with depressive symptoms and cognitive status in the general population. PLoS One. 2017;12(5):e0177272. doi:10.1371/journal.pone.0177272123. Barrett-Connor E, Von M&amp;uuml;hlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endocrinol Metab. 1999;84(2):573-577. doi:10.1210/jcem.84.2.5495124. Almeida OP, Yeap BB, Hankey GJ, Jamrozik K, Flicker L. Low free testosterone concentration as a potentially treatable cause of depressive symptoms in older men. Arch Gen Psychiatry. 2008;65(3):283-289. doi:10.1001/archgenpsychiatry.2007.33125. McIntyre RS, Mancini D, Eisfeld BS, et al. Calculated bioavailable testosterone levels and depression in middle-aged men. Psychoneuroendocrinology. 2006;31(9):1029-1035. doi:10.1016/j.psyneuen.2006.06.005126. Ford AH, Yeap BB, Flicker L, et al. Prospective longitudinal study of testosterone and incident depression in older men: the Health in Men Study. Psychoneuroendocrinology. 2016;64:57-65. doi:10.1016/j.psyneuen.2015.11.012127. Schweiger U, Deuschle M, Weber B, et al. Testosterone, gonadotropin, and cortisol secretion in male patients with major depression. Psychosom Med. 1999;61(3):292-296. doi:10.1097/00006842-199905000-00007128. Rubin RT, Poland RE, Lesser IM. Neuroendocrine aspects of primary endogenous depression, VIII: pituitary-gonadal axis activity in male patients and matched control subjects. Psychoneuroendocrinology. 1989;14(3):217-229. doi:10.1016/0306-4530(89)90020-6129. Seidman SN, Araujo AB, Roose SP, McKinlay JB. Testosterone level, androgen receptor polymorphism, and depressive symptoms in middle-aged men. Biol Psychiatry. 2001;50(5):371-376. doi:10.1016/S0006-3223(01)01148-9130. Booth A, Johnson DR, Granger DA. Testosterone and men&amp;rsquo;s depression: the role of social behavior. J Health Soc Behav. 1999;40(2):130-140. doi:10.2307/267369131. Rodgers S, Grosse Holtforth M, Hengartner MP, et al. Serum testosterone levels and symptom-based depression subtypes in men. Front Psychiatry. 2015;6:61. doi:10.3389/fpsyt.2015.00061132. Davies RH, Harris B, Thomas DR, Cook N, Read G, Riad-Fahmy D. Salivary testosterone levels and major depressive illness in men. Br J Psychiatry. 1992;161(5):629-632. doi:10.1192/bjp.161.5.629133. Elliott J, Kelly SE, Millar AC, et al. Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis. BMJ Open. 2017;7(11):e015284. doi:10.1136/bmjopen-2016-015284134. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229135. Shores MM, Moceri VM, Sloan KL, Matsumoto AM, Kivlahan DR. Low testosterone levels predict incident depressive illness in older men: effects of age and medical morbidity. J Clin Psychiatry. 2005;66(01):7-14. doi:10.4088/jcp.v66n0102136. Frye CA, Walf AA. Depression-like behavior of aged male and female mice is ameliorated with administration of testosterone or its metabolites. Physiology &amp;amp; Behavior. 2009;97(2):266-269. doi:10.1016/j.physbeh.2009.02.022137. Borst SE, Yarrow JF, Conover C, et al. Cognitive effects of testosterone and finasteride administration in older hypogonadal men. Clinical Interventions in Aging. 2014;9:1327-1333. doi:10.2147/cia.s61760138. Zarrouf FA, Artz S, Griffith J, Sirbu C, Kommor M. Testosterone and depression: Systematic review and meta-analysis. Journal of Psychiatric Practice. 2009;15(4):289-305. doi:10.1097/01.pra.0000358315.88931.fc139. Impact of exogenous testosterone on mood: A systematic review and meta-analysis of randomized placebo-controlled trials &amp;ndash; AACP.&amp;nbsp;140. Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of Testosterone Treatment in Older Men. New England Journal of Medicine. 2016;374(7):611-624. doi:10.1056/NEJMOA1506119/SUPPL_FILE/NEJMOA1506119_DISCLOSURES.PDF141. Pope HG, Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: A randomized, placebo-controlled trial. American Journal of Psychiatry. 2003;160(1):105-111. doi:10.1176/APPI.AJP.160.1.105/ASSET/IMAGES/LARGE/L217F1.JPEG142. Giltay EJ, Tishova YA, Mskhalaya GJ, Gooren LJG, Saad F, Kalinchenko SY. Effects of Testosterone Supplementation on Depressive Symptoms and Sexual Dysfunction in Hypogonadal Men with the Metabolic Syndrome. The Journal of Sexual Medicine. 2010;7(7):2572-2582. doi:10.1111/j.1743-6109.2010.01859.x143. Seidman SN, Miyazaki M, Roose SP. Intramuscular testosterone supplementation to selective serotonin reuptake inhibitor in treatment-resistant depressed men: randomized placebo-controlled clinical trial. Journal of Clinical Psychopharmacology. 2005;25(6):584-588. doi:10.1097/01.jcp.0000185424.23515.e5144. Pope HG, Amiaz R, Brennan BP, et al. Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. Journal of Clinical Psychopharmacology. 2010;30(2):126-134. doi:10.1097/jcp.0b013e3181d207ca145. Testosterone Replacement Therapy for Hypogonadal Men With Major Depressive Disorder: A Randomized, Placebo-Controlled Clinical Trial | Psychiatrist.com.&amp;nbsp;146. Wuwongse S, Chang RCC, Law ACK. The putative neurodegenerative links between depression and Alzheimer&amp;rsquo;s disease. Progress in Neurobiology. 2010;91(4):362-375. doi:10.1016/j.pneurobio.2010.04.005147. Cz&amp;eacute;h B, Lucassen PJ. What causes the hippocampal volume decrease in depression? Eur Arch Psychiatry Clin Neurosci. 2007;257(5):250-260. doi:10.1007/s00406-007-0728-0148. Yu S, Holsboer F, Almeida OFX. Neuronal actions of glucocorticoids: Focus on depression. The Journal of Steroid Biochemistry and Molecular Biology. 2008;108(3-5):300-309. doi:10.1016/j.jsbmb.2007.09.014149. Owens MJ, Nemeroff CB. Role of serotonin in the pathophysiology of depression: focus on the serotonin transporter. Clinical Chemistry. 1994;40(2):288-295. doi:10.1093/clinchem/40.2.288150. Leonard BE. The role of noradrenaline in depression: A review. Journal of Psychopharmacology. 1997;11(Suppl 4):S39-S47.&amp;nbsp;151. M&amp;uuml;ller N, Schwarz MJ. The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression. Mol Psychiatry. 2007;12(11):988-1000. doi:10.1038/sj.mp.4002006152. Barreto G, Veiga S, Azcoitia I, Garcia-Segura LM, Garcia-Ovejero D. Testosterone decreases reactive astrocytes and reactive microglia after brain injury in male rats: role of its metabolites, oestradiol and dihydrotestosterone. European Journal of Neuroscience. 2007;25(10):3039-3046. doi:10.1111/j.1460-9568.2007.05563.x153. Kranz GS, Wadsak W, Kaufmann U, et al. High-dose testosterone treatment increases serotonin transporter binding in transgender people. Biological Psychiatry. 2015;78(8):525-533. doi:10.1016/J.BIOPSYCH.2014.09.010/ATTACHMENT/68A16E1D-C268-47AC-B11D-688D42816A47/MMC1.PDF154. McQueen JK, Wilson H, Sumner BEH, Fink G. Serotonin transporter (SERT) mRNA and binding site densities in male rat brain affected by sex steroids. Molecular Brain Research. 1999;63(2):241-247. doi:10.1016/s0169-328x(98)00281-2155. Robichaud M, Debonnel G. Oestrogen and testosterone modulate the firing activity of dorsal raphe nucleus serotonergic neurones in both male and female rats. J Neuroendocrinol. 2005;17(3):179-185. doi:10.1111/j.1365-2826.2005.01292.x156. Paizanis E, Hamon M, Lanfumey L. Hippocampal neurogenesis, depressive disorders, and antidepressant therapy. Neural Plasticity. 2007;2007:1-7. doi:10.1155/2007/73754157. Jha S, Rajendran R, Davda J, Vaidya VA. Selective serotonin depletion does not regulate hippocampal neurogenesis in the adult rat brain: differential effects of p-chlorophenylalanine and 5,7-dihydroxytryptamine. Brain Research. 2006;1075(1):48-59. doi:10.1016/j.brainres.2005.12.110158. Brezun JM, Daszuta A. Serotonin may stimulate granule cell proliferation in the adult hippocampus, as observed in rats grafted with foetal raphe neurons. European Journal of Neuroscience. 2000;12(1):391-396. doi:10.1046/j.1460-9568.2000.00932.x159. Garcia-Estrada J, Del Rio JA, Luquin S, Soriano E, Garcia-Segura LM. Gonadal hormones downregulate reactive gliosis and astrocyte proliferation after a penetrating brain injury. Brain Res. 1993;628(1-2):271-278. doi:10.1016/0006-8993(93)90964-o160. Spritzer MD, Roy EA. Testosterone and Adult Neurogenesis. Biomolecules. 2020;10(2):225. doi:10.3390/biom10020225161. Chen Z, Ye R, Goldman SA. Testosterone modulation of angiogenesis and neurogenesis in the adult songbird brain. Neuroscience. 2013;239:139-148. doi:10.1016/j.neuroscience.2012.12.043162. Azizi H, Mehrjardi NZ, Shahbazi E, Hemmesi K, Bahmani MK, Baharvand H. Dehydroepiandrosterone stimulates neurogenesis in mouse embryonal carcinoma cell- and human embryonic stem cell-derived neural progenitors and induces dopaminergic neurons. Stem Cells and Development. 2010;19(6):809-818. doi:10.1089/scd.2009.0261/ASSET/IMAGES/LARGE/FIGURE4.JPEG163. Karishma KK, Herbert J. Dehydroepiandrosterone (DHEA) stimulates neurogenesis in the hippocampus of the rat, promotes survival of newly formed neurons and prevents corticosterone-induced suppression. European Journal of Neuroscience. 2002;16(3):445-453. doi:10.1046/j.1460-9568.2002.02099.x164. Snyder PJ. Use of androgens and other hormones by athletes. UpToDate. Published March 31, 2022. Accessed June 28, 2022. https://www.uptodate.com/contents/use-of-androgens-and-other-hormones-by-athletes165. Hausmann R, Hammer S, Betz P. Performance enhancing drugs (doping agents) and sudden death - a case report and review of the literature. Int J Legal Med. 1998;111(5):261-264. doi:10.1007/s004140050165166. Kennedy MC, Lawrence C. Anabolic steroid abuse and cardiac death. Med J Aust. 1993;158(5):346-348. doi:10.5694/j.1326-5377.1993.tb121797.x167. Payne JR, Kotwinski PJ, Montgomery HE. Cardiac effects of anabolic steroids. Heart. 2004;90(5):473-475. doi:10.1136/hrt.2003.025783168. Hartgens F, Cheriex EC, Kuipers H. Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes. Int J Sports Med. 2003;24(5):344-351. doi:10.1055/s-2003-40705169. Thompson PD, Cullinane EM, Sady SP, et al. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. JAMA. 1989;261(8):1165-1168. doi:10.1001/jama.1989.034200805036170. Brown GA, Vukovich MD, Martini ER, et al. Endocrine responses to chronic androstenedione intake in 30- to 56-year-old men. J Clin Endocrinol Metab. 2000;85(11):4074-4080. doi:10.1210/jcem.85.11.6940171. Bhasin S, Woodhouse L, Casaburi R, et al. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab. 2001;281(6):E1172-E1181. doi:10.1152/ajpendo.2001.281.6.e1172172. Fern&amp;aacute;ndez-Balsells MM, Murad MH, Lane M, et al. Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2010;95(6):2560-2575. doi:10.1210/jc.2009-2575173. Ferenchick GS, Hirokawa S, Mammen EF, Schwartz KA. Anabolic-androgenic steroid abuse in weight lifters: evidence for activation of the hemostatic system. Am J Hematol. 1995;49(4):282-288. doi:10.1002/ajh.2830490405174. Coviello AD, Kaplan B, Lakshman KM, Chen T, Singh AB, Bhasin S. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab. 2008;93(3):914-919. doi:10.1210/jc.2007-1692175. Stergiopoulos K, Mathews R, Brennan JJ, Setaro JF, Kort S. Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature. VHRM. 2008;4(6):1475-1480. doi:10.2147/vhrm.s4261176. Aitken C, Delalande C, Stanton K. Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic&amp;ndash;androgenic steroid injectors in Victoria, Australia. Drug Alcohol Depend. 2002;65(3):303-308. doi:10.1016/s0376-8716(01)00174-0177. Snyder PJ. Use of androgens and other hormones by athletes. UpToDate. Published March 31, 2022. Accessed June 28, 2022. https://www.uptodate.com/contents/use-of-androgens-and-other-hormones-by-athletes178. Kanayama G, DeLuca J, Meehan WP III, et al. Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study. Am J Sports Med. 2015;43(11):2638-2644. doi:10.1177/0363546515602010179. Sollender JL, Rayan GM, Barden GA. Triceps tendon rupture in weight lifters. J Shoulder Elbow Surg. 1998;7(2):151-153. doi:10.1016/s1058-2746(98)90227-0180. Cope MR, Ali A, Bayliss NC. Biceps rupture in bodybuilders: three case reports of rupture of the long head of the biceps at the tendon-labrum junction. J Shoulder Elbow Surg. 2004;13(5):580-582. doi:10.1016/j.jse.2004.03.003181. Pope HG Jr, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use: a controlled study of 160 athletes. Arch Gen Psychiatry. 1994;51(5):375-382. doi:10.1001/archpsyc.1994.0395003504182. O&amp;rsquo;Connor DB, Archer J, Hair WM, Wu FC. Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men. Physiol Behav. 2002;75(4):557-566. doi:10.1016/s0031-9384(02)00647-9183. Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: a randomized controlled trial. Arch Gen Psychiatry. 2000;57(2):133-156. doi:10.1001/archpsyc.57.2.133184. Buckman JF, Farris SG, Yusko DA. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug Alcohol Depend. 2013;131(1-2):50-55. doi:10.1016/j.drugalcdep.2013.04.023185. McCabe SE, Brower KJ, West BT, Nelson TF, Wechsler H. Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys. Drug Alcohol Depend. 2007;90(2-3):243-251. doi:10.1016/j.drugalcdep.2007.04.004186. Beaver KM, Vaughn MG, Delisi M, Wright JP. Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the United States. Am J Public Health. 2008;98(12):2185-2187. doi:10.2105/ajph.2008.137018187. Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid&amp;ndash;induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271-1279. doi:10.1016/j.fertnstert.2014.02.002188. Coward RM, Rajanahally S, Kovac JR, Smith RP, Pastuszak AW, Lipshultz LI. Anabolic steroid induced hypogonadism in young men. J Urol. 2013;190(6):2200-2205. doi:10.1016/j.juro.2013.06.010189. Knuth UA, Maniera H, Nieschlag E. Anabolic steroids and semen parameters in bodybuilders. Fertil&amp;nbsp;Steril. 1989;52(6):1041-1047. doi:10.1016/s0015-028&amp;nbsp;2(16)53172-0&amp;nbsp;190. Gazvani MR, Buckett W, Luckas MJ, Aird IA, Hipkin LJ, Lewis-Jones DI. Conservative management of azoospermia following steroid abuse. Hum Reprod. 1997;12(8):1706-1708. doi:10.1093/humrep/12.8.1706&amp;nbsp;191. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341-375.&amp;nbsp;doi:10.1210/er.2013-1058</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
