Can Low Testosterone Cause Anxiety and Depression?

Anxiety and depression are a women’s thing, right? Not exactly. While it’s true that women are twice as likely as men to be diagnosed with depression and anxiety disorders, plenty of guys suffer too. And the cause might be something unexpected: low testosterone.

Stigma prevents many men from discussing anxiety and depression, says urologist and men’s health expert Joshua Calvert, M.D. “Research shows that it’s considered ‘unmanly’ to discuss mental health disorders, which may explain this disparity,” he notes.¹ But research has also provided intriguing clues that testosterone may be a key determinant of mood and behavior.²

In this article, we’ll look at how testosterone can cause or worsen men’s anxiety and depression symptoms, including irritability, sadness, and lack of motivation.

About the Experts

Joshua Calvert, M.D., is a urologist specializing in vasectomy and vasectomy reversal, Peyronie’s disease, testosterone management, and male infertility.

Can Low Testosterone Cause Anxiety?

Research does suggest that low testosterone may affect a man’s level of anxiety:

• A 2020 study suggests that low testosterone may make it harder for men to cope with stress³ and can be linked to types of anxiety, such as general fear or panic attacks. 
• A review in 2015 notes that hypogonadal men with low testosterone are more prone to anxiety- and stress-related disorders.⁴
• In a study in 2010, men deemed testosterone deficient (with testosterone levels in the lowest 10th percentile) had higher anxiety scores on a questionnaire.⁵
• Research in 2014 shows that testosterone has anxiety-reducing effects.⁶ 

Can anxiety cause low testosterone?

Yes, it’s possible that anxiety could influence testosterone levels—though whether that influence is more positive or more negative is not entirely clear from the scientific literature. One study found that men with the highest levels of anxiety had the lowest levels of free testosterone.⁷ Other research suggested that higher anxiety correlated with lower testosterone levels.⁸ 

Because low testosterone and anxiety seem to occur so often together, it’s clear that they’re related.  But it’s still a challenge to understand the exact dynamic: Does low testosterone cause anxiety or does anxiety cause low testosterone?⁹ The answer may be yes to both.

What is clear is that anxiety is a chronic stress that triggers dumping of the hormone cortisol into your system from the adrenal glands. Cortisol has widespread effects throughout your body, including on the hypothalamic-pituitary-gonadal (HPG) axis, which regulates testosterone production by the testes. 

Several studies have demonstrated a link between increased cortisol levels due to stress and a reduction in testosterone levels.¹⁰ Similar studies show reductions in testosterone levels with the use of synthetic steroids such as prednisolone or dexamethasone. These glucocorticoids mimic high cortisol levels, so the body responds by lowering its own production of steroid hormones—including testosterone—to maintain hormonal balance.¹¹

Can Low Testosterone Cause Depression?

Past findings indicate that men with low testosterone levels have an increased risk of depression compared to men with normal testosterone levels. The mood disorder may impair testosterone secretion and disrupt the function of the testes, where testosterone is produced.^{12 13} Here’s what the research shows:

• In a 2004 study, 21.7 percent of men with hypogonadism were diagnosed with depression versus 7.1 percent in a group without hypogonadism.¹⁴
• A 2006 study found that men who had depression also had lower average free testosterone levels compared to a group without depression.¹⁵
• Research in 2017 found that older men with major depressive disorder had lower testosterone levels compared to older men who didn’t have depression.¹⁶

However, not every study has uncovered a connection. In reviewing several studies exploring the relationship between low testosterone and depression, one team found that there were about the same number of studies showing no relationship between low testosterone and depression as there were studies confirming a relationship. The study authors felt the connection was, at best, inconclusive.¹⁷

Taken together, the research suggests that low testosterone may be one of many factors that play a role in anxiety and depression. Further research should help identify subgroups of anxiety and depression that will benefit the most from addressing low testosterone.

Why Low Testosterone Causes Anxiety and Depression

Experts don’t completely understand how low testosterone might influence depression, anxiety, and mood, but they have a few theories:¹⁸ 

• Testosterone crosses into the brain, where it may stimulate the growth of brain cells involved in emotion, strengthen neural connections that promote more positive thinking, and influence the balance of feel-good neurotransmitters such as GABA, dopamine and serotonin.
• As noted previously, the stress hormone cortisol can lower the amount of LH (a hormone that tells the testicles to make testosterone) and also make the testicles less responsive to LH. This can lead to lower testosterone levels.
• And since testosterone lowers stress—by reducing secretion of cortisol and other stress hormones and by lessening the negative effects of cortisol on a part of the brain known as the hippocampus, which may be linked to anxiety¹⁹—lower levels can affect your ability to cope. 
• There’s evidence that testosterone affects how cells communicate via systems like the MAPK (mitogen-activated protein kinase) pathway, which is suspected to be involved in depression.²⁰
• Studies show that testosterone alters the response of the amygdala (a part of the brain associated with anxiety) in response to fear and stress.²¹

Low testosterone may also be linked to anxiety in non-biological ways. For example, weight gain from low testosterone levels might dampen your self-confidence and make you feel anxious about your body. Erectile dysfunction and low libido can make you worry about your sexual performance.

If you’re concerned that your depression or anxiety could be driven by low testosterone, the only way to confirm that your levels are clinically low is with a blood test.

10 Shared Symptoms of Low Testosterone, Anxiety, and Depression

These are the symptoms you may notice if you have anxiety, depression and/or low testosterone.

1. Loss of interest in activities you once enjoyed: When combined with depression, low testosterone can result in a state of anhedonia, or the inability to feel joy, which is a defining feature of major depressive disorder.  
2. Withdrawing from friends and family: Not only is social withdrawal a symptom of depression, but symptoms of social anxiety disorders are also more common in those with low testosterone.²² Testosterone may decrease stress associated with social situations.²³
3. Overall decreased sense of well-being: Problems in your sex life, growing fatigue, brain fog, and more, can make you feel less like yourself.
4. Irritability: Irritability is a common symptom of anxiety, which may be connected to low testosterone. Some refer to this as Irritable male syndrome.²⁴
5. Sadness: Especially persistent sadness is a frequent feature of depression, which also may be associated with low testosterone. 
6. Mood swings: Due to testosterone’s influence on brain cells and feel-good neurotransmitters, you may feel more ups and downs.
7. Low sex drive: Testosterone stimulates dopamine in the brain, a reward chemical associated with pleasurable activities like sexual activity.²⁵
8. Erectile dysfunction: Some 64% of men with erectile dysfunction experience depression and 38% experience anxiety.²⁶ Low testosterone might contribute to erectile dysfunction because it maintains nitric oxide production, which boosts blood flow needed for erections. 
9. Insomnia: Lower testosterone levels are associated with less sleep efficiency (the ratio of time spent asleep to time spent in bed), which also affects mood-regulating chemicals in the brain.^{27 28}
10. Fatigue: Low testosterone is also associated with mild anemia, which can cause fatigue.²⁹ Reduced production of hemoglobin for red blood cells affects oxygen in the brain, which then affects mood regulation.³⁰

How to Manage Anxiety and Depression Caused by Low Testosterone

Men experiencing symptoms of anxiety or depression related to low testosterone levels might start to feel better when they start testosterone replacement therapy (TRT).

A 2019 review and meta-analysis of 27 randomized, placebo-controlled clinical trials in JAMA Psychiatry found that testosterone replacement therapy significantly reduced depressive symptoms in men with low testosterone compared with those who received a placebo.³¹

TRT’s impact on depression also might be influenced by: 

• Age: Results were most effective for middle-aged men (45 to 64 years old).^{32 33}
• Dosage: Men on higher doses of testosterone had more improvements in mood than those on lower doses.³⁴
• Severity: TRT may be more effective for those experiencing less severe depression.³⁵
• Timeline: It took about six weeks for men on TRT to feel their mood improve, so it may take a few weeks after starting TRT to feel better.³⁶

Research is not as robust for TRT and anxiety, though it’s plausible that testosterone may relieve anxiety by decreasing perception of perceived threats, improving reward processing (helping the brain respond better to positive experiences), reducing fear, and improving resilience against stress.³⁷ Earlier research found that men receiving TRT benefitted with improved mood, including less anger, nervousness, and irritability.³⁸

It’s important to note, however, that TRT is not a panacea for mental health disorders and can have unintended effects. A 2022 study of almost 264,000 men who received testosterone therapy suggests that long-term use of testosterone may eventually increase the risk of depression and suicide in certain subgroups.³⁹ So, it’s best to think of testosterone as an adjunct, not a replacement, for other antidepressant therapies.

Lifestyle measures to manage low testosterone, depression and anxiety

While testosterone replacement therapy may help reduce symptoms of depression and anxiety in men, maintaining healthy lifestyle habits is equally essential for supporting long-term mental well-being. 

• Spend time with friends and loved ones⁴⁰
• Exercise⁴¹
• Consume a healthy diet
• Maintain a daily sleep schedule⁴²
• Minimize alcohol⁴³
• Reduce stress
• Try mental health therapy such as talk therapy or cognitive behavioral therapy (CBT)⁴⁴
• Consider taking supplements for depression such as zinc, magnesium, vitamin D,⁴⁵ omega-3 fatty acids, and B12. Ashwagandha can improve response to stress and improve sleep, while also potentially increasing testosterone levels.

Before you start any new supplement, be sure to check for interactions with your current medications, be aware of the maximum tolerated dose of any supplement, and do not exceed the manufacturer’s recommended dose, especially before you know how you will respond.

Interested in reading more about testosterone?

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About the author

Jessica Migala is a freelance writer specializing in health, nutrition, fitness, and beauty. She has written for O, The Oprah Magazine; Real Simple; Woman’s Day; Women’s Health; Health; Family Circle; and more.

About the reviewer

Dr. James R. Staheli is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.