Testosterone and Depression

The Times of India published an article today ("Depression, male sex hormone linked") about a study that found lower testosterone levels in men to correlate with higher levels of depression.  I wish these articles would include more information about how these studies were conducted, because there is nothing whatsoever to evaluate with such a brief sound-byte of information.  The article assumes that the study has elucidated a causal link between testosterone and depression, because it suggests that testosterone may therefore be used in treating depression among men (and I think, what about women?).  However, this assumption completely glosses over the more important questions about methodology, reliability, and validity: Did the researchers even study the nature of the link between testosterone and depression, or did they just see some kind of correlation?  How would you even study the exact nature of the link, without some kind of elaborate research program where you took men, controlled their entire social and economic environment, and then lowered their testosterone to see if it led to depression?

For all we know the link may be completely circumstantial - there could be a million social or economic factors that may relate to both lower testosterone and depression, without the two being causally related at all.  Of course this question is valid for any kind of study - especially for something as complex as psychiatric illness, there's just no way of definitively determining if a certain biological factor is directly causative of mental illness, or if it may be causative of certain socio-economic conditions that in turn may be involved in mental illness.  Or perhaps a socio-economic factor is to blame for the biological phenomenon as well as the psychiatric illness.  Alternatively, of course, there's the likelihood that both biological conditions and socio-economic factors are involved in the onset of psychiatric disorders.

And what about an inverse causal relationship?  What if the psychiatric illness - or the psychiatric medications one takes to manage it - are the cause behind the biological issue?

The point: these things are difficult, if not impossible, to determine definitively, and that caveat needs to be included in articles like these.

And something else isn't sitting well.  The whole idea of linking testosterone back to depression sort of tastes like easy theories about the gender discrepancy in the incidence of depression.  'Findings' like these reported here only help to solidify the idea that there is something inherently 'female' about depression - that the higher incidence relates not to the particular stressors that women may face (keep in mind that women are also more likely than men to be poor, single parents, and bear other burdens that often entail a lower socio-economic status) but to something in our biology - something that makes us 'weaker', of course... A man with less testosterone is less of a man, and apparently thereby more prone to depression.

But of course, any study that points to a biological factor involved in mental illness is likely to get a lot more attention than some discussion about the complexity of mental illness...

A study like the one reported in Science Daily ("Gene Variants May Increase Risk of Anxiety Disorders") is a much better example, and actually describes its methodology in some detail.  Of course the audience for this source is much more scientifically oriented than the readers of Times of India, so maybe I should cut the latter a bit of slack.  But still, without some kind of explanation you only mislead your audience about what these studies mean, and aren't newspapers supposed to inform and educate?  To some extent, at least?

The following makes me feel hopeful about a career in psychiatry: In a discussion about what restrictions on the amount of hours residents can work have done for patient care and the medical profession, an article states about psychiatry: "In contrast to the experiences of many surgical and some primary care and pediatric subspecialty programs, for many decades psychiatric training programs have rarely if ever required residents to work 80 or more per week.  The major impact of work-hour regulation in psychiatry has resulted from the continuous on-site duty rule that limits residents to 24 consecutive hours of patient care with up to an additional 6 hours available to participate in didactics and to transfer care of patients, and from the requirement that residents have at least 10 hours off between shifts."  Medicine seems like a fraternity world sometimes.  The main critics of restrictions to 'duty-hours' seem to be the older generation who had no such restrictions when they went through residency, and labor under the philosophy that 'if I went through it, you have to suffer through it' - sounds a lot like hazing to me... How will you ever make progress with a mindset like that?