Vol.2, No.5, 441-447 (2010)
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/
Openly accessible at
Blood lipids may have influence on the emotional
well-being in young men
Edyta Kramek, Sylwia Jastrzebska, Renata Walczak-Jedrzejowska, Katarzyna Marchlewska,
Elzbieta Oszukowska, Anna Guminska, Krzysztof Kula, Jolanta Slowikowska-Hilczer*
Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland;
*Corresponding Author: jolanta.slowikowska-hilczer@umed.lodz.pl
Received 14 January 2010; revised 4 February 2010; accepted 6 February 2010.
Anamnestic data on general health and medical
conditions were achieved from 136 men (20-49
yrs). Beck Depression Inventory II (BDI-II) ques-
tionnaire was used to assess depressive symp-
tomatology. Body weight, height, waist and hip
circumference, arterial blood pressure were mea-
sured. Serum levels of total cholesterol (TC), LDL
cholesterol (LDL-C), HDL cholesterol (HDL-C),
triglicerydes (TG), glucose, SHBG, total testos-
terone, DHEA-S and estradiol were determined.
Calculated were body mass index (BMI), waist to
hip ratio (WHR) and free testosterone index (FTI).
In men aged 40-49 general health significantly
got worse, BMI, WHR, blood pressure increased
and mean serum levels of FTI, DHEA-S, estradiol
decreased in comparison to younger men. Only
in 40-49 age band BDI-II scoring was negatively
related with FTI, however, in the whole group
there were no significant correlations. Neverthe-
less, some symptoms of depression were nega-
tively related with LDL-C or HDL-C and positively
with TG. Similar relations were found among
young men, but not in the middle-aged. Conclu-
sions: Only blood lipids may have influence on
emotional well-being in young healthy men. The
decreased testosterone level becomes probably
the main risk factor for the lower mood in mid-
dle-aged men. Atherosclerosis risk factors and
general health worsen with the advancing age,
but they have no significant effect on psycho-
logical situation.
Keywords: Man; Depression; Sex Steroids; Lipids;
General Health
There are evidences of the relationship between hormo-
nal changes in menstrual cycle and changes in mood in
women [1,2]. Recent long-term, prospective studies have
demonstrated that the transition to menopause is associ-
ated with higher risk for new onset and recurrent depres-
sion [3]. In men, however, interrelationship between the
emotional state and sex steroids serum levels are con-
troversial. Low testosterone serum level in hypogonadal
men is characterised by depressed mood and emotional
instability [4,5]. Androgen deficiency in the aging male,
also referred to as late-onset hypogonadism (LOH), is a
clinical and biochemical syndrome associated with ad-
vancing age and deficiency in serum testosterone levels
below the young healthy adult male reference range [6].
It includes, among other symptoms, depressed mood,
decreased vitality and low sex drive [7,8]. Several stud-
ies showed the significant improvement in the emotional
well-being after testosterone [9-11] or dehydroepian-
drosterone sulphate (DHEA-S) administration in hypo-
gonadal men [12,13]. Nevertheless, physiologic studies
were usually not successful in demonstrating a signifi-
cantly negative relation of androgens with lower mood,
especially in young men [14,15].
Other evidences indicate that vascular disease may
cause depression and thus cerebral atherosclerosis may
be responsible for late-life depressed mood [16,17]. On
the other side, several studies assessed the negative as-
sociation between serum levels of total cholesterol or
LDL-cholesterol and depressive symptoms, what denies
the “vascular theory” [18,19].
The aim of our study was to assess if emotional
well-being in young men demonstrates a relationship
with sex hormones or atherosclerosis risk factors in
comparison to middle-aged men.
2.1. Subjects and Study Design
The study was performed after the approval of the Bio-
ethical Committee of the Medical University in Lodz,
E. Kramek et al. / HEALTH 2 (2010) 441-447
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/Openly accessible at
Poland. A group of 300 men was randomly recruited
from the Lodz’s city population register for participation
in this study. The only criterion of the selection was age
between 20-49 years. Subjects were invited by a letter to
attend for a screening visit at the Department of Androl-
ogy and Reproductive Endocrinology. The overall re-
sponse rate for participation was 46%. Men who agreed
to participate in the study (136 subjects, mean age 35.5 ±
10 years) were divided into age bands: 20-29 (44 sub-
jects), 30-39 (36 subjects) and 40-49 (56 subjects).
Subjects were asked to complete an interviewer- as-
sisted questionnaire gathered information on sociode-
mographic, medical conditions and medications. General
health was scored from 0, when very good, to 3, when
very bad.
Although it is not possible to do it concisely, but we
defined emotional well-being as the capacity to live a
full and creative life, and the flexibility to deal with life's
inevitable challenges. Overall it means the lack of de-
pression symptoms [20]. To measure depressive symp-
tomatology the Beck Depression Inventory II (BDI-II)
questionnaire was used [21]. BDI-II contains 21 ques-
tions concerning: 1) sadness, 2) pessimism, 3) past fail-
ures, 4) loss of pleasure from things a man used to enjoy,
5) feelings of guilty, 6) feelings of punishment, 7)
self-dislike, 8) self-criticism, 9) suicidal thoughts and
wishes, 10) crying, 11) agitation, 12) loss of interest in
other people or activities, 13) indecisiveness, 14) worth-
lessness, 15) loss of energy, 16) changes in sleeping pat-
tern, 17) irritability, 18) changes in appetite, 19) concen-
tration difficulty, 20) tiredness or fatigue, and 21) loss of
interest in sex during past two weeks including a day of
meeting. Each answer was scored on a scale value of 0
to 3. Cutoffs used: 0-13—lack or minimal depression,
14-19—mild depression, 20-28—moderate depression,
29-63—severe depression.
Body weight and height, waist and hip circumference
and arterial blood pressure were measured using stan-
dard procedures. Calculated were body mass index (BMI
= weight/height2) and waist to hip ratio (WHR).
2.2. Hormone and Lipid Measurements
Single venous blood samples were taken in the morning
hours (8.00-10.00) in a fasting state, 12 hours after the
last meal. Serum was separated and stored at –80oC until
assayed at the end of the study, not longer than 6
Serum determinations of total testosterone, DHEA-S,
estradiol and sex hormone binding globulin (SHBG)
were performed. All hormones were measured using
chemiluminescence immunoassay (Immulite 1000, DPC,
USA). Detection limits were for: total testosterone—0.5
nmol/L, DHEA-S—3 μg/dl, estradiol—20 pmol/L and
SHBG—0.2 nmol/L. Free testosterone index (FTI) was
calculated as following: total testosterone/SHBG × 100.
Serum levels of total cholesterol (TC, normal range:
3.0-5.2 mmol/L), LDL cholesterol (LDL-C, normal
range: < 2.6 mmol/L), HDL cholesterol (HDL-C, normal
range: > 1.0 mmol/L), triglicerydes (TG, normal range: <
1.7 mmol/L), and glucose (normal range: 3.3-5.5 mmol/L)
were determined with the use of enzymatic methods
(Cobas Integra 800, Roche Diagnostics, Poland).
2.3. Statistical Analysis
All statistical analyses were performed using Statistica
for Windows PL software, version 8.0 (Statsoft, Cracow,
Poland). Mean ± standard deviation (SD) and median
values have been used to express group data. Nonpara-
metric analysis (Mann-Whitney U-test) was applied for
comparison between groups after verification of values
distribution (ANOVA). Correlations were examined us-
ing Spearman’s linear regression analysis. P < 0.05 was
considered significant.
3. Results
Table 1 presents self-reported health and physical status.
General health significantly got worse in men aged
40-49 in comparison to younger ones. Significantly in-
creased BMI, WHR, systolic and diastolic blood pres-
sure were found also in this age band. One or more mor-
bidities were reported by 16 men. The most frequent
Table 1. Results of physical and self-reported health character-
Age band (years)
n = 44
n = 36
n= 56
General health
(score) 1.1 ± 1.5 1.8 ± 1.5 2.0 ± 1.3a
BMI (kg/m2) 24.7 ± 3.6 26.1 ± 3.7c 26.9 ± 3.9a
WHR 0.88 ± 0.1 0.92 ± 0.1 0.96 ± 0.1a
Systolic BP 131.5 ± 12.8 132.1 ± 13.5 142.9 ± 20.4a
Diastolic BP 76.9 ± 9.1 78.0 ± 9.6 88.3 ± 12.9a
ap < 0.001; cp < 0.05 vs. 20-29 age band; Mann-Whitney U-test; n –
number of subjects; BMI – body mass index; WHR – waist to hip ratio;
BP – blood pressure; CAD – coronary artery disease; GIU – gastroin-
testinal ulcer; BPH – benign prostate hyperplasia
E. Kramek et al. / HEALTH 2 (2010) 441-447
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/Openly accessible at
were gastrointestinal ulcer (50%) and hypertension
(37.5%). Nobody used antidepressants, psychotropic
drugs, narcotics or lipid-lowering medications. None
was denoted as alcoholic or drug addict.
Mean serum levels of DHEA-S, estradiol, as well as
FTI, were significantly decreased, while SHBG in-
creased, in men aged 40-49 in comparison to men aged
20-29 as shown in Table 2. In men 30-39 years old
Table 2. Results of hormonal determinations and serum levels of lipids in men between 20 and 49 years of age.
Age band (years)
Hormones and lipids 20-29
n = 44
n = 36
n = 56
x SD 18.5 4.1 18.4 6.4 18.3 5.7
median 17.9 18.7 18.0
range 8.4-28.0 7.5-34.6 7.4-35.6
x SD 84.5 30.4 71.8 26.7c 45.5 13.8a
median 76.6 66.1 44.5
range 27.1-168.9 31.9-160.2 23.1-83.9
x SD 287.3 107.7 259.0 102.3 246.5 89.7c
median 251.5 233.0 229.5
range 107.0-572.0 129.0-572.0 88.4-456.9
x SD 124.5 41.1 100.3 36.9b 90.0 26.1a
median 117.3 93.5 87.6
range 45.5-208.8 44.1-178.1 45.3-164.4
x SD 24.0 8.4 27.8 12.8 43.3 19.4a
median 22.7 25.4 39.4
range 8.9-49.9 12.5-69.5 15.4-106.0
x SD 4.2 0.9 4.8 1.0b 6.1 0.9a
median 4.1 4.6 6.2
range 2.6-7.5 3.0-7.5 3.8-7.5
x SD 1.5 0.3 1.5 0.4 1.6 0.2c
median 1.4 1.5 1.6
range 0.9-2.3 0.9-2.4 1.2-2.6
x SD 2.2 0.8 2.7 0.9c 3.5 1.2a
median 2.2 2.5 3.3
range 1.0-5.0 1.2-5.3 1.2-6.1
x SD 1.1 0.7 1.5 1.2 1.9 1.2a
median 0.9 1.1 1.5
range 0.4-4.4 0.3-5.7 0.8-5.8
ap < 0.001; bp < 0.01; cp < 0.05 vs. 20-29 age band, Mann-Whitney U-test; n – number of subjects, x - mean value, SD - standard deviation;
TT – total testosterone; FTI – free testosterone index; DHEA-S – dehydroepiandrosterone sulphate; SHBG – sex hormone binding globuline;
TC – total cholesterol; HDL-C – HDL cholesterol; LDL-C – LDL – cholesterol; TG – triglycerides
E. Kramek et al. / HEALTH 2 (2010) 441-447
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significantly decreased were only FTI and estradiol. The
mean serum levels of total testosterone did not differ
significantly between the age groups.
Serum levels of all lipids were significantly increased
in the oldest group of men in comparison to 20-29 age
band. In those aged 30-39 significantly increased were
TC and LDL-C. The level of glucose was within the
normal range in all of the subjects.
It was recognised that 12 men (8.8%) had mild de-
pression (Table 3). One men from the youngest age band
presented symptoms of severe depression. He had nor-
mal levels of all studied parameters (FTI-121.5). In 4
men aged 40-49 moderate depression was diagnosed,
while in none of younger. All of them had low FTI
(28.3-51.9) and increased TC (5.3-7.5 mmol/L). How-
ever, all of the subjects with more intensive depression
reported adverse life events during last six months such
as major financial problems, serious illness or injury to a
close relatives, broken off a steady relationship and get-
ting the sack from a job. These events might be reasons
of lower mood.
Total scoring of BDI-II was not related with age, gen-
eral health scoring, blood lipids and sex hormones serum
levels. When correlations where performed for each age
band separately it appeared that total scoring of BDI-II
was negatively related with FTI, but only in 40-49 age
band (r = –0.26, p < 0.05). Other correlations of total
BDI-II where not found.
Among different symptoms of depression only diffi-
culties in concentration were positively associated with
the age (r = 0.18, p < 0.05). Among hormones a negative
association was observed between FTI and loss of inter-
est in sex (r = –0.21, p < 0.05). More associations were
found between lipids and symptoms of depression: nega-
tive between LDL-C and loss of energy (r = –0.22, p <
0.01) or loss of pleasure from things a man used to enjoy
(r = –0.2, p < 0.05), HDL-C and feelings of past failures
(r = –0.31, p < 0.01) or suicidal thoughts or wishes (r =
–0.24, p < 0.05). TG were positively correlated with feel-
ings of past failures (r = 0.29, p < 0.01) and negatively
with the self-assessment of general health (r = –0.18, p <
0.05). Serum levels of TC were not associated with the
Table 3. Results of the Beck Depression Inventory II (BDI-II)
in men 20-49 years old.
Age band (years)
intensity 20-29
n = 44 (%)
n = 36 (%)
n = 56 (%)
Lack or minimal 40 (90.9) 31(86.1) 48 (85.8)
Mild 3 (6.8) 5 (13.9) 4 (7.1)
Moderate 0 0 4 (7.1)
Severe 1 (2.3) 0 0
separate symptoms of depression. Similar relations were
found among young men, but not in the middle-aged.
BMI, WHR and blood pressure were not correlated
with the total scoring of BDI-II or single depression
symptoms or the scoring of general health in the whole
group, as well as in each age band.
Although total testosterone serum levels were unchanged
with the age in our study, FTI, which is a counterpart of
biologically active testosterone, decreased significantly.
Moreover, DHEA-S and estradiol decreased with the
advancing age, while the level of SHBG increased. Such
phenomena were described in several studies [22-24].
There is a general consensus that serum levels of testos-
terone decline with age. This decline begins at about the
30th year of life and decreases progressively as men get
older. The European Male Aging Study (EMAS) pro-
vides one of the largest data sets to investigate hormonal
variations in aging men. It revealed that total testoster-
one decreased by only 0.4%/year, whereas free testos-
terone decreased by 1.3%/year [24]. Serum free testos-
terone concentrations decrease more than the total tes-
tosterone because of the increased levels of SHBG in
older men. Since the circulating non-SHBG-bound tes-
tosterone (free and albumin-bound) is the biologically
available form for activity at the target organs, meas-
urements of this non-SHBG-bound testosterone better
reflect the clinically important state of circulating tes-
tosterone than the total testosterone concentrations [25].
It is also known that serum concentrations of adrenal
androgens such as dehydroepiandrosterone and its sul-
phate (DHEA and DHEA-S) and androstendione de-
crease with the increasing age [26,27]. The age trend of
serum estrogen in men has been reported variously as
declining [27,28] or steady [29].
Although significant decrease in serum levels of sex
steroids were observed with the advancing age, in this
study we have not found the direct relationship between
emotional well-being and sex steroids in young men.
Only in 40-49 age band total scoring of BDI-II was
negatively related with FTI. It may indicate that after 40
testosterone serum level is so low that it may negatively
influence the mood. Nevertheless, although most of the
men with higher intensity of depression were above 40,
the most severe depression occurred in the 25-year-old
man, who had normal levels of sex steroids. The reason
of lower mood was probably situational, because all of
the depressed men reported recent adverse life events.
The results of other studies on the influence of sex ster-
oids on mood in men are controversial. In the Rancho
Bernardo Study of 856 men aged 50-89, the BDI score
was significantly and inversely associated with
E. Kramek et al. / HEALTH 2 (2010) 441-447
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Openly accessible at
bioavailable testosterone, independent of age, weight
change and physical activity [30]. Similar associations
were seen for dihydrotestosterone, while estradiol was
not associated with depressed mood. The Massachusetts
Male Aging Study (MMAS) of 1709 men aged 40-70
revealed no correlation between the Center for Epidemi-
ologic Studies Depression Scale (CES-D) and serum
testosterone level [31]. Rubin et al. [15] showed that age
was negatively correlated with baseline serum testoster-
one in patients with endogenous depression, but not in
controls. Similar results, revealing that among men with
major depression testosterone secretion may be reduced,
were achieved by others [32,33]. However, signs and
symptoms of major depression may overlap with appar-
ent psychiatric sequel of hypogonadism. Woodman and
Williams [34] found that 39% of hypogonadal men
treated in an endocrinology clinic were also treated with
medication for a psychiatric illnesses. These data suggest
that some depressed older men may have
state-dependent low testosterone levels and that some of
them may improve with androgen treatment.
Among sex steroids only FTI was associated with the
lost of interest in sex as the separate parameter of de-
pression. There are a lot of studies showing the relation-
ship between libido and androgens [7,35]. EMAS re-
vealed that men with the lowest levels of total and free
testosterone reported lower overall sexual function (OSF)
scores in comparison to men with the highest testoster-
one levels [36]. There is also an improvement in the
sexual function after treatment with testosterone [37].
We investigated also the state of general health be-
cause it may, as the only factor, lead to significant dete-
rioration of mood. The oldest men worse estimated their
health in comparison to younger and they reported more
morbidities. They had more atherosclerosis risk factors:
higher BMI, WHR, blood pressure and increased serum
levels of TC, LDL-C and TG. In hypogonadal men, as
well as in aging men, increase in total adipose tissue
mass and the redistribution of fat from peripheral subcu-
taneous depots to central, intra-abdominal depots is
well-documented [38-40]. Decreased testosterone level
and visceral adipose tissue accumulation in the aging
male probably represents the most important factor for
premature morbidity and mortality from cardiovascular
disease [41,42]. However, we did not find the impair-
ment of mood with the advancing age or associations of
total BDI-II scores with blood lipids, anthropometric
results and the general health scoring. Nevertheless,
there were relations between some symptoms of depres-
sion and blood lipids. LDL-C correlated negatively with
the loss of energy and the loss of pleasure from things a
man used to enjoy. It was found previously by other au-
thors that low LDL-C level may predispose to acute de-
pression and the risk of suicidal behaviour [43]. HDL-C
correlated negatively with feelings of past failures or
suicidal thoughts. Nevertheless, we did not find associa-
tions between TC and symptoms of depression what was
shown by other authors [44]. Maes et al. [45] suggested
that major depression was accompanied by reduced for-
mation of cholesterol esters and perhaps by impairment
of reverse cholesterol transport. The latter is accompa-
nied by lower serum HDL-C. Serum HDL-C was sig-
nificantly lower in depressed men who had made suici-
dal attempts than in those without such suicidal behav-
iour. Maimanee and Al-Hazimi [46] suggested that the
youth with low level of TC was more exposed to acute
depression than the elders. It is known that brain mem-
branes have a very high content of polyunsaturated fatty
acids (PUFAs): omega 3 and 6. These two classes of
fatty acids cannot be synthesised by the organism and
have to be taken from alimentation. Phospholipids com-
posed of PUFAs chains increase the membrane fluidity
which is also determined by the phospholipids/free cho-
lesterol ratio, as cholesterol increases membrane viscos-
ity. Any dietary lack of essential PUFAs has conse-
quences on cerebral development [44,47]. It has been
suggested that the increased prevalence of depression in
the European countries in the 20th century could be re-
lated to changes in alimentary patterns, in which con-
sumption of omega 3 PUFAs constantly diminished [48].
These findings have challenged the public health pro-
grams aimed at promoting the decrease of cholesterol,
and even suggested to suspend the administration of
lipid lowering drugs [44].
Only low blood lipids may have influence on emotional
well-being in young healthy men. The decreased testos-
terone level becomes probably the main risk factor for
the lower mood in middle-aged men. Atherosclerosis
risk factors and general health worsen with the advanc-
ing age, but they have no significant effect on psycho-
logical situation.
This work was supported by Grants No. 508-02-054 and 503-1089-2/3
from the Medical University of Lodz, Poland.
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