Working Against the Clock: Depression and Hormonal Imbalance in Shift-Working Men

To assess the relationship between depression, testosterone levels, and shift work in men presenting to a single-center, tertiary urology clinic with symptoms of hypogonadism.

A retrospective chart review and survey were conducted on 766 men presenting to a single-center academic urology clinic between 2014 and 2017. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Shift Work Sleep Disorder (SWSD) Questionnaire at intake. Serum testosterone levels, medication history (testosterone therapy, clomiphene citrate, and PDE5 inhibitors) were collected. Data was analyzed using linear regression and nonparametric testing.

The mean testosterone level in this cohort was 611 ng/dL with a mean PHQ-9 of 5.28 (mild depression). A significant inverse relationship was found: each 1 ng/dL increase in testosterone corresponded to a 0.18-point decrease in PHQ-9 score (p < 0.05). Men at low risk for sleep work disorder had lower PHQ-9 scores than those at high risk (median 2 vs 9, p = 0.001) and were less likely to report suicidal ideation (p = 0.00098). No significant differences were noted in PHQ-9 between patients on testosterone and clomiphene citrate. A difference in total PHQ-9 was seen between eugonadal and hypogonadal men not on medication therapy (p < 0.020).

This study demonstrates the significant impact and association between testosterone levels, shift work, and depressive symptoms. These findings highlight the importance of routine depression screening and counseling for men presenting with hypogonadal symptoms, particularly those engaged in shift work.