Androgen deficiency: association with increased anxiety and depression symptom severity in anorexia nervosa.
OBJECTIVE
Anorexia nervosa is associated with a high prevalence of psychiatric comorbidities, including anxiety and depression, and with endocrine dysfunction, including relative androgen deficiency compared with healthy young women. Because androgens are known to affect mood and behavior, we hypothesized that low endogenous androgen production in anorexia nervosa would predict anxiety and depression severity.


METHODS
Serum androgen levels and severity of depression (Hamilton Rating Scale for Depression) and anxiety (Hamilton Rating Scale for Anxiety) were measured in 43 community-dwelling women with DSM-IV-defined anorexia nervosa from May 2004 to July 2006.


RESULTS
Strong inverse associations were observed between both total and free testosterone and anxiety and depression severity, independent of weight. Free testosterone was also inversely associated with 4 eating-disordered thinking and behavior subscales of the Eating Disorder Inventory 2 (EDI-2). Mean free testosterone blood levels were lower in women with clinically significant anxiety and in women with clinically significant depression, compared with those without. In stepwise regression models, free testosterone was an important predictor of anxiety and depression severity. EDI-2 ineffectiveness, perfectionism, interpersonal distress, and social insecurity scores were also inversely associated with androgen levels, independent of weight.


CONCLUSIONS
Our data suggest that low androgen levels may contribute to anxiety, depression, and eating-disordered thinking and behavior in women with anorexia nervosa and form the basis for future studies to investigate the effectiveness of androgen replacement therapy.


BACKGROUND
ClinicalTrials.gov identifier NCT00089843.
Miller
Karen K
KK
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. KKMiller@Partners.org
Wexler
Tamara L
TL
Zha
Alicia M
AM
Lawson
Elizabeth A
EA
Meenaghan
Erinne M
EM
Misra
Madhusmita
M
Binstock
Anna B
AB
Herzog
David B
DB
Klibanski
Anne
A
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood* / Q000523:psychology*; D001007:Anxiety / Q000097:blood*; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D011237:Predictive Value of Tests; D012649:Self Concept; D012720:Severity of Illness Index; D012919:Social Behavior; D013739:Testosterone / Q000097:blood / Q000172:deficiency*
D013739:Testosterone