Executive Summary

The presence of depression and other mood disturbances in women is a widespread, worldwide phenomenon, crossing cultural and ethnic lines with a lifetime prevalence of up to 23%. Depression and anxiety are twice as likely to occur in women as in men; are a leading cause of dysfunction, decreased productivity and disability in women, and noted in several studies to be a key component of decreased quality of life and sense of well being^. The differences between men and women in depression rates have also been observed worldwide, and these documented sex differences have led to the observation that hormone fluctuations are a major contributor to female rates of depression, anxiety and other altered mood states.

Of utmost concern is only about 10% of women will report these symptoms to their primary care provider, and many practitioners misunderstand and underestimate the encumbering effects of these symptoms.

Hormone decline during the third through fifth decades of life, referred to clinically as the menopausal transition, is central to decreased health and quality of life (QOL). An often misdiagnosed and mismanaged sequelae during this time is depression, anxiety and altered mood states resulting from hormone decline and exacerbated by symptomatology of hormone decline; specifically androgen decline and deficiency. The far-reaching impact of restoring androgen homeostasis on quality of life is also an often-misunderstood phenomenon in both the healthcare and lay communities.

Historically androgen deficiency is not the focus of assessment, diagnosis and subsequent treatment for altered mood states in females, and additional education for healthcare practitioners around the role of androgen decline in depression, anxiety and mood changes and subsequent symptom relief of with replacement of androgens in women is needed.

Family practice, internal medicine, and women’s health physicians, nurse practitioners and PA’s are severely lacking instruction on how to guide women through the menopausal transition. Moreover, there is data lacking in our most popular peer reviewed medical journals with regards to hormone decline as it relates to depression, anxiety and other altered mood states, as well as short and long-term safety and efficacy of natural hormone replacement methodologies, most notably androgen replacement therapy in women.

Lack of awareness and access to data serve as the core foundation to the proposed healthcare provider ePortfolio and subsequent development of an online education and eTraining platform. Utilizing evidence based interventions and modalities the eTraining platform proposed serves to open the dialogue and encourage “outside the box” thinking in the areas of treatment alternatives for hormone related altered mood states.