Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone.

Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). Aim: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. Methods: The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Expected results: Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. Discussion: This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05435222.

How do traditional masculinity ideologies and emotional competence relate to aggression and physical domestic violence in cisgender men?

Background: Men are disproportionately often perpetrators of physical domestic violence (DV). Gender role constructs, such as traditional masculinity ideologies (TMI), are broadly accepted as an explanation for this effect. Emotional competence further constitutes an important role in TMI and the prevention of DV. However, the interactions between these constructs remains unclear. Objective: The present study aims to investigate associations of TMI with aggression, DV perpetration, and emotional competence, while also examining emotional competence as a potential moderator. Method: A sample of 428 cisgender men (M age = 43.9 ± 15.3) from German-speaking countries in Europe completed an anonymous online survey that assessed TMI, aggression, and DV perpetration as well as alexithymia, emotion regulation, and self-compassion as indicators of emotional competence. Results: Strong TMI were associated with high levels of aggression and overall reduced emotional competence, as reflected by high levels of alexithymia, frequent use of expressive suppression, and low levels of self-compassion. Strong conformity to TMI was associated with a higher likelihood for DV perpetration when considering relevant sociodemographic covariates. Moderation analyses revealed that expressive suppression buffered the association between TMI and DV perpetration. Conclusion: Men with strong TMI report high levels of aggression and impaired emotional competence. While strong conformity to TMI was associated with more frequent perpetration of DV, higher expressive suppression seems to buffer the association between TMI and DV perpetration. The present study highlights the importance of addressing gender ideologies when working on aggression, DV perpetration and emotional competence in men.