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There is evidence that low levels of testosterone can increase symptoms of depression and anxiety in men and women.
Doctors are not ready to say that low testosterone is a direct cause of depression. However, there is significant research to indicate a distinct link between the two conditions.
For example, a 2004 study indicated that men diagnosed with low testosterone levels are four times as likely to suffer from clinical depression than men their same age who have normal testosterone levels. Then in 2016, another study, this one published in the journal, Psychoneuroendocrinology, found that in older men, “low serum testosterone was associated with an 86% increased hazard of depression.”
Just as there can be many causes for low testosterone itself, there are many causes of depression. However, we now know that low testosterone can certainly contribute to depressive symptoms, as well as anxiety, increased irritability, and other negative emotional states.
Because of this link, and perhaps in spite of it, the symptoms of depression and low testosterone can often overlap, prompting you to wonder, “do I have low testosterone, or am I just depressed?
Symptoms that are common to both low T and depression include:
While the symptoms of low testosterone and depression often go hand in hand, one way to tell one from the other is to look at any physical symptoms you may be going through in addition to your emotional symptoms.
If you, in addition to feeling the blues you also are experiencing weight gain, erectile dysfunction, or other sexual issues and loss of muscle, chances are your depressive symptoms are related to a testosterone imbalance.
If, on the other hand, you are feeling sad, anxious, or depressed without the physical symptoms of muscle loss and weight gain, chances are your depressive symptoms are not related to low testosterone.
Men and women with low testosterone are at a greater risk of developing depression and anxiety.
Doctors do not like to say that low testosterone can "cause" depression. But it is hard to deny the evidence of a connection between men with low testosterone who also exhibit symptoms of major depressive disorder. But what is the connection? Is it physical or emotional, or both?
We know that low testosterone also leads to erectile dysfunction, low sex drive, and a lack of physical energy. These physical symptoms can lead to less enjoyment in life, which can influence feelings of depression. But the research indicates there could be something more to the link between low-T and depression.
Researchers and doctors who specialize in men’s health are coming to realize that the link between low testosterone and depression in men and women has everything to do with the influence that testosterone has on the production of neurotransmitters, and in particular, serotonin.
Neurotransmitters like serotonin help to relay messages across areas of the brain. Research has found that a person’s levels of serotonin are related to moods — particularly depression. People with clinical depression have low levels of serotonin. People with low testosterone tend to be depressed or have anxiety or other mood swings.
People with lower than normal testosterone levels also tend to have low serotonin levels. Is this because there is a relationship between testosterone, serotonin, and depression?
Current research seems to suggest that such a link is indeed the case.
We know that depression and mood swings are symptoms of low testosterone. Researchers have yet to define exactly how or why low testosterone causes depression. However, studies seem to indicate that it does have something to do with the impact testosterone has on the levels of neurotransmitters like serotonin.
Testosterone stimulates the release of dopamine, another neurotransmitter in your brain that is responsible for your feelings of pleasure. Serotonin, like dopamine, is also related to "feeling good." When serotonin levels drop, depression and anxiety are often the results.
Studies have found that testosterone plays a role in regulating serotonin levels. A recent study in mice showed that low testosterone may directly alter brain chemistry –specifically serotonin levels. Studies of humans show that serotonin levels are lower in older adults with clinical depression. Older men also tend to suffer from low testosterone.
Levels of testosterone and serotonin are directly related. The lower your testosterone, the lower your serotonin levels.
In addition to the studies already mentioned above, a recent study published in Biological Psychiatry found that testosterone increases the number of proteins that transport serotonin into the brain. The research was done by a team from MedUni in Vienna. The study team believes this apparent link between testosterone and serotonin explains not only why testosterone supplements can boost mood but also why depression affects women more than men and older men more than younger men.
It’s all about the link between testosterone levels and serotonin levels. The higher the level of testosterone in your blood, the higher the level of the “feel good” chemical, serotonin, in your brain. The reverse is also true. The lower your testosterone level, the lower your serotonin level, and therefore your increased risk of depression.
A 2004 study on the incidence of depression in men with low testosterone found that men with low testosterone who were studied over a two-year period were four times more likely to be diagnosed with clinical depression.
The head researcher on the projects, Molly M. Shores, MD, director of the Veterans Affairs Puget Sound Health Care System and the University of Washington in Seattle, said, "Older men would be particularly vulnerable to [the effects of low testosterone on depression] because serotonin receptors are already decreased from normal aging…”
But the most definitive study on testosterone and depression was published in 2019 in the journal JAMA Psychology.
The study was a meta-analysis or a "study of studies" that looked at testosterone and depression. After analyzing relevant studies that had nearly 2000 participants, the researchers concluded, “Testosterone treatment appears to be effective and efficacious in reducing depressive symptoms in men, particularly when higher-dosage regimens were applied in carefully selected samples.”
In addition to impacting depression, low testosterone can affect your mental health in other ways. Testosterone plays a vital role in your physical abilities. It is necessary for strength, energy, and your capacity to build muscle and burn fat.
But we also know that testosterone is a neuroactive steroid. This means that your testosterone level also affects the functions of your central nervous system functions, including those functions related to mood, emotional wellbeing, and mental health.
We now understand that the main reason that low testosterone can affect your moods is because of the impact it has on the level of brain chemicals like serotonin.
Serotonin is responsible for maintaining healthy brain cells. It is also critical to the production of new brain cells. When serotonin levels are low, fewer new brain cells are created to replace dead and dying ones. This suppression of new brain cells leads to anxiety, mood swings, and depression.
The most effective antidepressant medications are known as "selective serotonin reuptake inhibitors," or SSRIs. SSRIs work by slowing the "reuptake," or use of serotonin, so that serotonin levels remain higher in the brain for longer periods of time. Mental health professionals believe that this boost in serotonin levels increases the production of new brain cells, which in turn helps to lift the fog of depression.
Current research suggests that testosterone produces the same “inhibition of serotonin reuptake” effect as SSRIs.
The link that has now been well-established between testosterone, depression, and serotonin levels does not necessarily mean that testosterone replacement therapy is indicated as a direct treatment for depression.
However, it does provide a viable explanation as to why men with low testosterone often report depression and anxiety as one of their symptoms. This now established relationship between serotonin levels and testosterone levels also explains why men taking testosterone injections have improved moods and an overall "better" outlook on life.
Siegfried Kasper, the lead researcher on the MedUni study, suggests that while testosterone therapy is not a treatment for depression, it could be a helpful addition to patients already taking commonly prescribed antidepressants known as Selective Serotonin Reuptake Inhibitors, or SSRIs.
He is not the first researcher to draw such a conclusion – doctors who provide hormone replacement therapy often pair antidepressants with testosterone for men with low testosterone and depression. There has been a wealth of anecdotal evidence of the effectiveness of this combined treatment.
Currently, there are studies going on to look into the possibilities of testosterone as a stand-alone treatment for depression. If it could be proven to be as effective in raising serotonin levels as SSRIs, testosterone could be a treatment option with far fewer side effects than those associated with prescription antidepressants.
Testosterone therapy combats depression and improves mood, most likely by increasing the levels of serotonin and other “feel good” chemicals in the brain.
Now that you know more about the link between low testosterone and depression, why not take a minute to contact us and learn more about how testosterone replacement therapy can improve your quality of life.
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