Refractory Nonmotor Symptoms in Male Patients With Parkinson Disease Due to Testosterone Deficiency

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Abstract
PARKINSON DISEASE (PD) is a progressive neurodegenerative disorder characterized by both motor and nonmotor signs and symptoms. Although attention has focused largely on the motor aspects such as bradykinesia, rigidity, tremor, and gait difficulties, of equal, and often even greater importance are the nonmotor symptoms that affect quality of life such as depression, anxiety, sexual dysfunction, and cognitive impairment. In some cases comorbid conditions such as depression, hypothyroidism, and sleep disorders may account for some of the nonmotor symptoms. Recognition of these comorbid conditions is important because, when untreated, they may contribute significantly to the clinical burden. In male patients with PD, we have identified an additional comorbidity, testosterone deficiency. Testosterone deficiency is found in 20% to 25% of the adult males older than age 60 years (depending on age) and is a well-documented cause of depression, fatigue, decreased libido, and decreased work performance.1-4 These deficiency symptoms respond favorably to testosterone replacement therapy (TRT).3,5-7