Testosterone in first-episode schizophrenia

Recent neuroendocrinological studies have suggested that gonadal sex hormones play a significant role in the pathophysiology of schizophrenia. Low testosterone is associated with negative symptoms in chronic schizophrenia. The relevance of these findings has not yet been elucidated. The aim of our naturalistic open study was to explore the association between symptoms, drug response and testosterone levels in first-episode schizophrenia to exclude the effects of age, chronic illness, long-term treatment and institutionalization.

68 males, consecutively hospitalised for the first time with first-episode schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS) on admission (before treatment) and at discharge. Further, plasma testosterone was measured. Total testosterone was assayed using chemiluminescent immunoanalysis (CMIA). All patients were treated openly by monotherapy; risperidone being the drug of first choice. Treatment response was defined as delta PANSS (PANSS total on admission - PANSS total at discharge /PANSS total on admission).

On average the total PANSS and PANSS subscales scores significantly decreased during the acute treatment. In contrast to results in chronic schizophrenia, the mean values of testosterone were within the normal range (15.36 and 22.55 nmol/l respectively) both before and after acute treatment. The range of normal values for the method used is given as 5.76-30.43 nmol/l for males <50 years old. On admission only 6 patients had testosterone values lower than 5.76 nmol/l. No significant correlation between negative symptoms (negative PANSS subscale) at the beginning or at the end of acute treatment or between treatment response and testosterone plasma levels was found.

During the first psychotic breakdown no significant association was observed either between total testosterone plasma levels and symptoms or treatment reactivity. However, schizophrenia is a heterogeneous disease. In some patients with first-episode schizophrenia an alteration of psychoendocrinology parameters has been observed. These patients may be more vulnerable to development of enduring negative symptoms, and pharmacotherapy based on neuroendocrinology profile should be considered.