Does having low levels of testosterone cause depression? Or is it the other way around: Does having depression lead to low levels of testosterone?
It’s a chicken-versus-egg medical conundrum that’s difficult to answer. The symptoms of depression and low testosterone (low T) are not mutually exclusive. Both conditions share several symptoms, such as:
- Low libido
- Erectile dysfunction
- Insomnia or poor sleep quality
- Lack of energy
- Inability to focus and concentrate
- Loss of muscle mass
- Increase in body fat percentage
Researchers have been examining the link between depression and testosterone for decades. But it wasn’t until the late 1990s that studies suggested a correlation between low T and depressive disorders.
Since then, however, some studies have failed to show a link, adding to the mystery of whether low T is to blame for depression. (Or vice versa.)
Despite the lack of definitive causation, most recent studies indeed suggest that low T contributes to depression, which in 2017 topped the World Health Organization (WHO)’s leading causes of disability worldwide.
Does TRT Work For Depression?
The question then becomes, if there is a correlation between depression and testosterone, can functional medicine help? Take testosterone replacement therapy, or TRT, for instance.
A 2013 study in a Spanish urology journal put that question to the test. The researchers explained that as men get older, they are more likely to experience depression and hypogonadism, a condition where their body doesn’t produce enough testosterone.
The researchers aimed to expand on previous studies that showed that treating men with hypogonadism with testosterone can improve their symptoms of depression.
But here’s the catch: Not all men with depression and low T respond the same way to TRT. Some men respond better to TRT than others.
The researchers’ takeaway was that if someone has symptoms of depression and low T, TRT should be used for at least three months. The reason why is that it takes at least that long to assess whether depressive symptoms will be alleviated or go away.
However, depression can be caused by many different factors, not just low T. Therefore, TRT may not be the only treatment needed to improve symptoms of depression.
How Common Is Having Both Depression And Low T?
Unfortunately, there is no reliable hard data on the percentage of men clinically diagnosed with depression and low T. There are a few reasons why there’s a shortage of data on this.
First, it’s the lack of definitive causation, even though many recent studies suggest a strong correlation between depression and testosterone levels. And second, there’s a lack of consensus on the official threshold of low T levels.
That’s not to say there aren’t some parameters.
“Normal” testosterone levels in adult men should be 300–1,000 ng/dL (nanograms per deciliter), according to Mount Sinai. But suppose you’re a middle-aged man with a reading of 300 ng/DL. Your doctor may consider your “T” level to be normal. However, if your reading is on the low end of normal, you may not feel great; this could indeed be a suboptimal testosterone level.
Adding to the confusion is that there are two testosterone markers: total T and free T. Your total T level may fall in the low end of the normal range, but your free T level may be lower than it should be. Free T levels carry much weight when identifying and treating clinical symptoms. So it’s sometimes about more than just your total T marker.
It’s also important to mention that many doctors are not adequately trained to provide TRT. Make sure that yours is.
Conclusion: Can Depression Be Alleviated With TRT?
The short answer is, for most people, probably.
If your depression is caused by low testosterone, or partly because of it, TRT may be worth exploring. But, of course, the only way to know if you have low testosterone is to have an androgen hormone (sex hormones) panel performed—ideally by a TRT expert.
Testosterone directly impacts levels of serotonin, the neurotransmitter that controls mood, sex drive, sleep, and other functions. So once your testosterone levels begin to decline (usually beginning at around age 40), you may start to feel more irritable. And eventually, as T levels continue to plummet—by as much as 3% per year, says a study in Clinical Interventions in Aging—the lack of circulating serotonin may contribute to depression.
One of the best studies to examine the link between depression and testosterone was published in 2019 in JAMA Psychiatry. To date, it’s believed to be the largest meta-analysis of the association between testosterone treatment for depressive symptoms in men. The review looked at 27 randomized placebo-controlled clinical trials involving 1,890 men. What was the conclusion?
“Testosterone treatment was associated with a significant reduction of depressive symptoms, particularly in participants who received higher-dosage regimens.”
So is TRT right for you?
Contact us to find out.
