Medical experts have been trying to determine whether testosterone replacement therapy can effectively reduce the symptoms of depression in men for several decades. The issue is undoubtedly complex, however recent publication of some compelling new research and meta-analysis is attempting to bring a greater level of clarity to this important subject, particularly as currently available medications for mood disorders do not work for everyone.
What is Testosterone?
Testosterone is the principal male sex hormone, although it is also present in women in markedly lower concentrations. Testosterone contributes to a variety of bodily functions including:
- Bone density
- Muscle strength
- Sperm production
- Sex drive
- Body fat distribution
What causes Low Testosterone?
Also known as hypogonadism, low testosterone can be categorised into two groups; primary and secondary.
Primary hypogonadism relates to an issue with the testicles, which are the organs that produce testosterone in the male body. Men who have sustained a testicular injury might also demonstrate primary hypogonadism and these symptoms could be initiated by:
- Treatment for cancer
- High levels of iron in the blood
Secondary hypogonadism happens when the pituitary gland does not receive the signals it needs to produce more testosterone. Reasons for this can include:
- HIV and 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 weight gain. These symptoms also increase the risk of diabetes, osteoporosis and heart disease.
The World Health Organisation (WHO) has described depression as a leading cause of ill health worldwide. ONS research illustrates that approximately 17% of men in the UK have symptoms of anxiety or depression. Anxiety, irritability and depression are common amongst both men and women with low levels of testosterone.
Can Testosterone Therapies Alleviate Symptoms of Mood Disorders?
In 2014, researchers from Saint Louis University published a review looking at 16 trials which focused on low testosterone and depression. They found that the effects of testosterone treatment on mood were most significant in men under 60. The data also shows that treatment was more effective on participants with low baseline testosterone levels than in those who presented normal levels of testosterone before starting treatment.
Researchers from TU Dresden, a leading German university, looked at 27 clinical trials which involved more than 1,800 men to try to determine whether testosterone treatment could be used to successfully alleviate the symptoms of depression. Their analysis of the available evidence has been published in the Jama Psychiatry journal and it shows that testosterone treatment is linked with a substantial reduction in depressive symptoms in trial participants.
Additionally, data demonstrates that, when directly compared with a placebo, trial participants who received testosterone treatment were 130% more likely to see at least a 50% improvement in their depressive symptoms. Additional trials are currently required to determine a variety of moderators including dosages, efficacy and safety, however current research suggests that benefits can be seen within six weeks in both younger and older participants.
Conclusions from scientific studies have been mixed. However, although it is not currently possible to categorically state that there is a direct link between testosterone and depression, in some cases testosterone therapies can help with mood disorders.
Although the UK health watchdog Nice does not currently recommend testosterone therapies to treat depression, if it is convincingly shown to be an effective antidepressant then that viewpoint could be set to change.