Testosterone Replacement Therapy for Anxiety

Mr. A, a 34-year-old man, was diagnosed with generalized anxiety disorder. His symptoms included mental exhaustion, irritability, insomnia, poor concentration, and decreased libido. He unsuccessfully tried relaxation techniques and biofeedback before beginning treatment with buspirone, 30 mg/day. After noticing improvement, he discontinued the medication after 2 months but resumed taking it 6 months later, when his anxiety returned.

A review of his medical record indicated that Mr. A had undergone a right orchiectomy several years earlier for an undescended testicle. Blood samples were taken for laboratory analysis. His testosterone level was 185 ng/dl (normal=241–827), and his free testosterone level was 8.9 pg/ml (normal=18–39). His luteinizing hormone level was 18.7 mIU/ml (normal=2–12), and his level of follicle-stimulating hormone was 31.4 mIU/ml (normal=1–8). The results of a physical examination and laboratory tests were within normal limits. Mr. A tapered his buspirone treatment and elected not to begin treatment with paroxetine.

Mr. A was referred to an endocrinologist, who ruled out occult malignancy and prescribed testosterone enanthate, 200 mg i.m. every 2 weeks. He reported resolution of his anxiety symptoms after 1 month. His concentration and libido increased, and he reported better orgasms. He tried to decrease the frequency of his injections but remained on the bimonthly schedule after feeling his anxiety symptoms returning. He has been on the regimen for more than 18 months and has experienced no side effects. This treatment plan may be continued indefinitely.