Low Testosterone and Depression: What is the connection?

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When people think of depression, they often focus on psychological triggers or life circumstances. But behind the scenes, your hormones play a large role in shaping your emotional well-being. Hormones are the body’s chemical messengers, travelling through the bloodstream to regulate vital processes, from metabolism and sleep to mood and motivation. An imbalance in these messengers can have profound effects, including the development or worsening of depressive symptoms.

One hormone that has recently gained attention in this space is testosterone, traditionally known for its role in male sexual health and physical development. In this article, we’ll explore the emerging link between low testosterone and depression, the science behind it, and how addressing hormonal imbalances may offer new hope for those struggling with mood disorders.

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Hormones: The body’s chemical messenger

Hormones are chemical messengers produced by glands such as the pituitary gland and thyroid. They travel through the bloodstream to different parts of the body, instructing organs on what to do and when to do it. Hormones control nearly every function, including mood, stress, metabolism, muscle strength, sexual function, and sleep.

Target organs have receptors specific to each hormone. These receptors bind to hormones and stimulate organs to take specific actions, including those related to physical and emotional well-being.

Hormone imbalance and depression

Hormones must remain at normal levels to support overall well-being. Having too much or too little of them can lead to a variety of medical conditions, such as type 2 diabetes, obesity, and major depressive disorder. Several hormones have been closely linked to mental health conditions, including anxiety and depression. Circulating reproductive hormone levels play a vital role in maintaining mood stability, and imbalances can trigger emotional changes and depressive symptoms.

Key hormones that may contribute to depression.

Dopamine and Depression: Known as the “motivation hormone,” dopamine promotes feelings of pleasure. Studies show dopamine deficiency can cause depression. Common symptoms that individuals with low dopamine feel include reduced motivation, fatigue, low energy, and mood swings. Increasing dopamine can ease this type of depressive disorder.

Cortisol and Depression: Cortisol, the stress hormone, rises during high-stress situations. Chronic elevation may lead to inflammation and long-term emotional symptoms, contributing to depression.

Oestrogen and Depression: As a female sex hormone, oestrogen fluctuates across a woman’s life. Low levels, especially during menopause, may explain the mood-related symptoms commonly experienced.

Testosterone and Depression: Testosterone plays a key role in maintaining muscle mass, bone density, sex drive, and emotional balance. When testosterone levels fall, either through ageing or health conditions, men may experience low testosterone and depression, reduced motivation, and decreased sexual desire and sexual dysfunction.

What is Testosterone?

Testosterone is a hormone primarily produced in the testes in men and smaller amounts in the ovaries and adrenal glands in women. It’s often referred to as the ‘male hormone’ because of its crucial role in the male reproductive system and physical attributes. Testosterone contributes to a variety of bodily functions including:

• Bone density
• Muscle strength
• Sperm production
• Sex drive
• Body fat distribution

What causes Low Testosterone?

Low testosterone, also known as hypogonadism, is a condition in which the body doesn’t produce enough sex hormones, such as testosterone in men or oestrogen in women, or produces them at the wrong time. This hormonal deficiency can affect physical development, sexual function, and overall health. There are two types of hypogonadism: primary and secondary;

Primary hypogonadism: Originates in the testicles, which produce testosterone. Causes may include:

• Cancer treatments
• Mumps
• Iron overload

Secondary hypogonadism: The pituitary gland fails to signal testosterone production. Causes include:

• Aging
• Obesity
• HIV/AIDS

What are the Symptoms of Low Testosterone?

Low testosterone can cause a variety of emotional and physical symptoms in both women and men. It is not uncommon for men with low levels of testosterone to see a significant decline in their sex drive or to experience difficulties achieving and maintaining an erection.

As testosterone is also closely related to muscle strength and bone density, low levels can also lead to a reduction in muscle mass and sudden weight gain. These symptoms also increase the risk of diabetes, osteoporosis and heart disease. There are many clinical signs of low testosterone. Take a look at the table below for the most common signs:

Low Testosterone and Depression

While depression is influenced by genetic, psychological, and environmental factors, research is increasingly highlighting the role that testosterone plays in mental health. Understanding the intricate connection between depression and circulating reproductive hormone levels, including free testosterone, is crucial for comprehensive mental health care and offers new avenues for the treatment of mood disorders.

Studies on testosterone and mood disorders

Several studies demonstrate that men with low T have an increased risk of depression compared to men with healthy testosterone levels.

A 2014 review from Saint Louis University found testosterone therapy most effective for men under 60 and those with low testosterone levels to begin with.

A study by TU Dresden, published in JAMA Psychiatry, analysed data from over 1,800 men. It concluded that men receiving synthetic testosterone treatment were significantly more likely to see improvements in depression symptoms, with a significant difference in outcomes compared to placebo groups.

While more studies are needed to define the optimal dose and treatment duration, current data suggests that many men experience relief within six weeks.

How does low testosterone cause depression?

Though the precise mechanism is unclear, studies suggest several explanations:

• Low testosterone disrupts neurotransmitters that regulate mood, including those affected by serotonin reuptake.
• Hormonal imbalance may increase vulnerability to depression symptoms.
• Chronic inflammation and oxidative stress is common in men with low testosterone and are linked to depressive disorders.
• Reduced sexual desire, fatigue, and low motivation are all symptoms of androgen deficiency and can contribute to negative psychological states.

According to the WHO, depression is among the top global health issues. In the UK, ONS data shows 17% of men experience anxiety or symptoms of depression. Many of these men may unknowingly be experiencing androgen deficiency.

Addressing hormone imbalance

The good news is that hormone imbalance can be treated in different ways. If you suspect your hormone levels are disturbed, here is what you should do.

Consult with a Healthcare Professional

Start by seeing a hormone specialist. They’ll assess your medical history, conduct exams, and recommend tests to determine whether you’re experiencing androgen deficiency or other imbalances.

Lifestyle Modifications

To support normal testosterone levels, you can:

• Exercise to promote hormone balance and preserve muscle strength.
• Follow a nutritious diet and avoid sugary drinks.
• Practice stress-reducing techniques like meditation.
• Maintain a healthy weight – excess fat disrupts hormonal health.
• Get 7–9 hours of sleep for hormone regulation and tissue repair.

Testosterone Replacement Therapy (TRT)

Testosterone replacement therapy (TRT) is a widely used treatment for low testosterone among men and women. It’s a medical treatment used to restore normal testosterone levels in individuals with bioidentical testosterone, helping to alleviate related physical and emotional symptoms such as fatigue, low libido, decreased muscle mass, and mood changes. Forms include gels, patches, injections, and pellets. Injections are particularly popular due to convenience and efficacy.

What else do I need to know about TRT?

If you’re considering TRT for hormone imbalance, here is what you need to know about the treatment.

Customised treatment: TRT is tailored to each patient’s unique needs. While designing a custom treatment plan, your healthcare provider will consider several elements, like age, lifestyle, current hormone levels, and personal preferences.

Potential side effects: Overall, TRT is a safe procedure, but it has some potential side effects that you can avoid by closely assessing the effects of the treatment on your body.

Close monitoring and evaluation: You will have to monitor your hormone levels on a regular basis to ensure they stay within the desirable range. Your healthcare provider may increase or decrease your dose during treatment based on your changing testosterone levels.

Long-term considerations: It is often a lifelong treatment. Your T levels will stay stable as long as you keep administering them. You will have follow-up appointments with your healthcare provider to measure your T levels and address changes in symptoms.

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Summing up

Although testosterone therapy is not yet officially classified as an antidepressant, growing evidence suggests it can significantly improve depression symptoms in men with low testosterone levels. Studies consistently show that hormone replacement therapy may offer real benefits for men experiencing depression and low testosterone, particularly when conventional treatments have fallen short. While NICE does not currently recommend testosterone for depression, this stance could evolve as further research reinforces its potential.

If you’re experiencing symptoms of low testosterone, get in touch with us to check your levels and explore effective treatment options like TRT.

Bibliography/Scientific studies/Further reading/References

Depression. Health Topics. The World Health Organisation. https://www.who.int/health-topics/depression#tab=tab_1

Measuring national well-being: Life in the UK: 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2016#how-good-is-our-health

What Is the Link Between Low Testosterone and Depression. University Health News 2015. https://universityhealthnews.com/daily/depression/compelling-new-research-examines-low-testosterone-and-depression/

Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734

Carnahan, R.M. and Perry, P.J., 2004. Depression in aging men: the role of testosterone. Drugs & aging, 21, pp.361-376.

Khera, M., 2013. Patients with testosterone deficiency syndrome and depression. Archivos espanoles de urologia, 1(1), pp.729-736.

Vartolomei, M.D., Kimura, S., Vartolomei, L. and Shariat, S.F., 2020. Systematic review of the impact of testosterone replacement therapy on depression in patients with late-onset testosterone deficiency. European Urology Focus, 6(1), pp.170-177.

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