Testosterone and Mental Health: Effects on Mood, Energy, and Depression
The relationship between testosterone and mental health is a complex one. Low testosterone and depression have very similar symptoms, and as a result, they are frequently mistaken for one another or co-occur without detection.
Complicating matters further is that many men are less likely to seek mental health care, and when they do, the hormonal component is often not part of the conversation. This means that the role of testosterone in mental health may often be underappreciated by patients and clinicians alike.
But there are ways to address this gap in understanding. Educating yourself about testosterone and how it makes you feel is an important first step. In this guide, we explore many elements of the mental health-testosterone relationship, including:
- The testosterone-mental health link.
- Symptoms of low testosterone.
- Testosterone’s impact on mood, anxiety, and depression.
- Testosterone replacement therapy.
- Steps to take if low testosterone is affecting your mood.
Link Between Mental Health and Testosterone
When you hear “testosterone,” you may think of it as a sex hormone. While that’s true, testosterone serves additional purposes, which is part of why testosterone and mental health are linked.
Testosterone has effects on numerous parts of your brain, including the hippocampus and amygdala, that regulate:[1]
- Emotion.
- Mood.
- Motivation.
Testosterone is regulated by the hypothalamic-pituitary-gonadal (HPG) axis. Your hypothalamus sends a signal to your pituitary gland, which then signals your testes to produce testosterone.[2]
When testosterone levels are high enough, your brain detects it and signals the HPG axis to slow production. You might think of it as your body’s thermostat for testosterone, turning it on when more testosterone is needed and turning it off when it’s not.[2][3]
As you age, your testosterone levels gradually decrease at a rate of around 1-2 percent each year after you turn 40. By age 45, about one-third of men show reduced testosterone levels. As your body produces less testosterone, you might experience depressive symptoms. But the relationship between testosterone and depression is bidirectional: depression itself can suppress testosterone levels.[4]
This occurs through specific pathways in your body. It begins when depression activates your body’s stress response system, which triggers the release of cortisol, your body’s primary stress hormone. When cortisol levels are chronically elevated, testosterone production is diminished. The longer the depression goes untreated, the more it suppresses testosterone, which then deepens the depression further.[5][6]
Recognizing the Symptoms of Low Testosterone
The “low T” and mental health issue is more common than is often recognized. Studies show that about one-fourth of men under 50 and as many as half of men over 80 have clinically low levels of testosterone.[5]
Since the symptoms of low testosterone significantly overlap with anxiety and depression, it often goes undiagnosed or is misdiagnosed altogether.[4]
Emotional and Psychological Symptoms
Focusing on the specific symptoms of low testosterone can help ensure a proper diagnosis. Specifically, you might feel the following emotional and psychological symptoms:[1][5][6]
- Depressed mood, anxiety, and irritability
- Poor concentration and mental fog
- Low motivation and flat mood
Of these, depressed mood, anxiety, and irritability are by far the most commonly reported psychological effects of low testosterone.[1][4]
Physical Symptoms That Affect Mental Health
There is a physiological component to low testosterone as well. If your levels are low, you might experience fatigue and sleep disruption. Fatigue and testosterone deficiency are very closely linked, and men with low testosterone levels often report persistent tiredness. This isn’t just being tired, though. It is chronic fatigue that doesn’t go away with appropriate rest.[1]
With low testosterone, you may experience disruptions to your sleep and reduced sleep quality.[7] This can compound the emotional and psychological symptoms and make fatigue worse, too. Furthermore, as the feedback loop continues (reduced energy triggers worse depressive symptoms, which contribute back to reduced energy), it can become harder and harder to determine cause from effect.[4][6]
How Testosterone Affects Mood, Anxiety, and Depression
Testosterone and depression don’t have a superficial relationship, as testosterone can actively change your brain’s chemistry through multiple pathways.[3] That relationship isn’t linear, either: low testosterone levels, and sometimes even high testosterone levels, are associated with depression in some populations.[4]
For example, men with very high testosterone levels struggle with fatigue and sleep problems. Conversely, very low testosterone levels are associated with low energy and appetite disruptions. What this suggests is twofold:[4]
- There is an optimal range of testosterone that has benefits for mood and well-being.
- Its effects on the brain are highly individualized.
Testosterone, Serotonin, and Brain Chemistry
The effects of testosterone on your brain go even deeper. For example, testosterone influences serotonin in your hippocampus, which, as discussed earlier, is critically important for mood regulation. Furthermore, testosterone supports the activity of dopamine in your brain, where it plays a part in everything from your energy levels to motivation to reward-seeking behavior.[3][6]
There is a testosterone-anxiety connection as well. Studies show that testosterone can help regulate unconscious fear responses in your amygdala, so it has anxiolytic effects.5 Testosterone also acts on GABA, the primary inhibitory system in your brain, giving it anti-anxiety properties.[8]
Age, Declining Testosterone, and Depression Risk
Since testosterone naturally declines with age, it comes with an increased risk of depression.1 The strongest correlation isn’t with major depression, though. Instead, older men with low testosterone commonly have dysthymia, a chronic, low-grade form of depression.[4][9]
Furthermore, the most frequent depressive symptoms older men experience are:[7]
- Fatigue.
- Appetite changes.
- Sleep problems.
In other words, the depressive experience is sometimes more somatic or physiological than it is cognitive or emotional.
Nevertheless, even low-grade symptoms can be persistent and difficult to resolve. Hormonal imbalance and depression in men often present this way, making it easy to overlook the hormonal part of it.
Testosterone Replacement Therapy and Mental Health
Testosterone replacement therapy (TRT) is a legitimate option if you’re experiencing low testosterone problems. It doesn’t work for everyone, and it isn’t a replacement for psychological interventions or drug therapies for mood. However, it can be a meaningful addition to treatment for many people.
What the Research Shows
Testosterone therapy benefits mental health in many different ways. On the one hand, research shows testosterone has a significant antidepressant effect, and in some cases, offers a similar magnitude of effect as typical antidepressants.[9]
Moreover, higher doses of testosterone show stronger antidepressant effects in some people. And these benefits aren’t just for people with low testosterone. Men with normal levels of testosterone who also have depressive symptoms showed improvement in some clinical trials.[9]
Additional research shows that men receiving TRT injections had significantly lower scores on the Beck Depression Inventory after treatment.[5]
TRT can have cognitive benefits, too. In men with mild cognitive impairment, treatment led to improvements in cognitive performance scores within eight months.[5] Moreover, older men taking moderate doses of testosterone show improvements in verbal and spatial memory after six weeks.[3] Research also shows improvements in:[1]
- Self-perception.
- Cognitive sharpness.
- Ratings of quality of life.
This points to a broader improvement across the board in mood, thought, and behavior. Hormone therapy for depression in men is becoming an increasingly studied area as this evidence accumulates.
Who May Benefit From TRT (And Who May Not)
TRT doesn’t have a positive impact on everyone. Those who benefit most from this treatment include men with dysthymia or treatment-resistant depression. TRT also shows promise for treating depression when it co-occurs with HIV infection.[4]9 Its positive effects aren’t age-related, either; younger and older men respond well to TRT for depressive symptoms.[9]
Conversely, TRT has not yet shown usefulness in treating major depression in men with normal testosterone levels. It’s also not recommended for use as a standalone antidepressant.[9] It has numerous side effects to be aware of as well, including:[2][4]
- Cardiovascular considerations.
- Elevated red blood cell count.
- Worsening sleep apnea.
TRT isn’t recommended if you have prostate cancer or certain heart conditions, either.[2][4]
Regardless of the unique circumstances of your situation, a proper diagnosis for low testosterone must come first. This typically involves:[2][4]
- Morning serum testosterone testing.
- Clinical symptom evaluation.
- Ruling out other causes of depression.
That decision is often made collaboratively by healthcare professionals, including your physician, mental health provider, and endocrinologist.[2][4]
What to Do if You Suspect Low Testosterone Is Affecting Your Mood
If low motivation, depressed mood, anxiety, or persistent fatigue have bothered you recently, low testosterone might be worth exploring. As described earlier, many symptoms associated with low testosterone align with other issues, namely depression and anxiety.
They also overlap with other conditions, including thyroid disorders and sleep apnea. Having a clinical workup done will help eliminate other causes first, so you and your doctor can proceed with an effective treatment plan.[4]
Most treatment plans for low testosterone include a lifestyle adjustment. Maintaining a healthy body weight, getting quality sleep, reducing alcohol consumption, and regular exercise all support healthier testosterone levels (and improve mood, too).
None of these interventions is a standalone method. Still, they are meaningful additions to proper medical and mental health care because they address specific biological reasons why low testosterone might be a problem in the first place.[2]
A good example of this is excess body fat. Having excess fat can accelerate the decline of testosterone because fat converts testosterone into estrogen. Poor sleep can suppress testosterone production, since most of your daily testosterone is released during sleep. These lifestyle factors can directly influence testosterone production, so addressing them isn’t just good health practice; it’s part of an effective line of treatment.[2]
TRT is not a replacement for mental health treatment. The greatest benefits are derived from a combination of approaches, including psychotherapy and lifestyle changes.[6][9] The key is to treat the whole problem: depression and low testosterone. Addressing one but not the other is not likely to resolve the mood issues you’re experiencing.[3]
Find Effective Treatment for Low Testosterone Mental Health Conditions
It can be confusing to feel persistently off, especially if you’re not sure where to turn for help. That’s where Mission Connection comes in.
Our clinicians know that what you’re experiencing doesn’t exist in isolation. Low testosterone might be part of the picture, but you might also have depression, anxiety, or other issues that also need to be addressed.
We offer effective outpatient mental health treatment. Flexible options include in-person programs at one of our locations in California, Virginia, or Washington, telehealth care, or a hybrid program that blends in-person and virtual programming.
We pride ourselves on providing care that is compassionate, individualized, and meets you where you are. Reaching out is a sign that you’re paying attention to your body and what it’s telling you. Call us for a free, no obligation conversation at 866-833-1822.
