Does Stress Cause Low Testosterone?

Testosterone and stress are locked in a feedback loop that most men don’t realize they’re trapped in. Short bursts of stress—say, before a big meeting or a workout—can actually give your testosterone a temporary bump. But the chronic, unrelenting kind of stress—the type 45 percent of men say they frequently experience—disrupts hormonal balance in a very different way. ^{1 2}

“Stress and testosterone have a complicated, bidirectional relationship,” says Joshua Calvert, M.D., a board-certified urologist. “Chronic stress lowers testosterone, and low T makes stress harder to handle, fueling a cycle of symptoms like fatigue, mood issues, weight gain, and metabolic dysfunction.”

About the Experts

Joshua Calvert, M.D., M.P.H., a board-certified urologist who practices in Tennessee.

Ramy Abou Ghayda, M.D., M.P.H., a urologist at University Hospitals near Cleveland, Ohio.

Lester Lee, M.D., a regenerative medicine physician specializing in hormone replacement therapy.

The Relationship Between Stress and Testosterone

The reactions that stress triggers in the brain can affect testosterone production, which in turn can make stress more challenging to manage.

During acute stress—like when you’re running late for an important meeting—your sympathetic-adreno-medullar (SAM) kicks into overdrive, activating the famous “fight or flight” response.

Your adrenal glands release epinephrine and norepinephrine, setting off a chain reaction that increases blood pressure, heart rate, and body temperature while enhancing alertness and temporarily dulling pain. ³

Stress also turns up your hypothalamic-pituitary-adrenal (HPA) axis. Your hypothalamus releases corticotropin-releasing hormone (CRH), which signals your pituitary to produce adrenocorticotropic hormone (ACTH). That, in turn, prompts your adrenal glands to release cortisol. ⁴

During chronic stress, this feedback loop stays stuck in the “on” position, pumping out epinephrine and cortisol and driving down testosterone production. ⁵

“Low testosterone can make stress feel more overwhelming and harder to handle,” Calvert says. Worse, chronic stress further suppresses testosterone, reinforcing the cycle. “It leaves men feeling physically and mentally drained, making stress management even harder,” Calvert says.

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How Stress Lowers Testosterone

Stress affects testosterone levels in multiple ways, from cortisol overload and inflammation to shifts in enzyme activity and gene expression.

Cortisol suppresses testosterone production

Chronic stress leads to excess cortisol, which Calvert calls “testosterone’s biochemical rival.” Why? It disrupts the hypothalamic-pituitary-gonadal (HPG) axis—a hormonal pathway crucial for testosterone production. ⁶

In this axis, the hypothalamus signals the pituitary to release luteinizing hormone (LH), which tells the testes to make testosterone. But cortisol can suppress gonadotropin-releasing hormone (GnRH), which reduces LH—and ultimately, testosterone. ⁷, ⁸

Chronic stress can also make your hypothalamus release too much gonadotropin-inhibiting hormone (GnIH), which directly suppresses gonadotropin-releasing hormone (GnRH). ⁹

And there’s competition at the cellular level. Testosterone and cortisol share a common precursor: pregnenolone. When stress pushes pregnenolone toward cortisol production, testosterone takes a hit. ¹⁰ “High cortisol competes with testosterone for resources and can directly inhibit testosterone synthesis,” Calvert says.

Increases inflammation

Chronic stress can spark inflammation in the brain, disrupting reward and pleasure circuits and reducing testosterone.

Here’s how it plays out: Stress triggers the release of inflammatory cytokines, which travel to your brain and interfere with neurotransmitters like dopamine and serotonin. ¹¹ Low levels of these brain chemicals may reduce GnrH production in the hypothalamus, studies in animals suggest. ^{12 13} That, in turn, affects LH and testosterone. ¹⁴

Leads to higher estradiol

Chronic stress can increase aromatase, an enzyme in fat cells that converts testosterone into estrogen. ¹⁵ More aromatase means more testosterone gets turned into an estrogen called estradiol, leaving less testosterone for your body to use.

Alters gene expression

Emerging evidence suggests stress might switch on genetic markers that disrupt testosterone balance. One 2023 study found long-term stress raises cortisol, which activates genes that lower sex hormone binding globulin (SHBG). Since SHBG helps carry testosterone in the blood, lower levels mean less circulating testosterone. ¹⁶

It fuels habits that lower testosterone

Chronic stress can disrupt your schedule and change your habits in ways that exacerbate low testosterone.

• Sleep disruption: Chronic stress interferes with circadian rhythm (your internal body clock). ¹⁷ One review found that testosterone deficiency was 74 percent more likely in men with insomnia and nearly three times as likely in men with circadian rhythm dysfunction. ¹⁸
• Alcohol: Heavy alcohol use impairs Leydig cells (which make testosterone) and raises estrogen through liver metabolism. ^{19 20}
• Smoking: The data is mixed—some studies show smokers have higher testosterone levels, but heavy smoking may reduce testosterone. Either way, the harms outweigh any potential benefits. ²¹

Conditions Linked to Stress and Low Testosterone

Together, high stress and low testosterone increase the risk of chronic health conditions.

Type 2 diabetes

One study found higher cortisol and lower testosterone in men with type 2 diabetes. ²² By increasing cortisol, chronic stress promotes insulin resistance, which is linked to the accumulation of visceral (belly) fat. ^{23 24} Weight gain, especially belly fat, raises aromatase, so more testosterone is converted into estrogen. ²⁵

“Men with type 2 diabetes often have low testosterone, which makes weight loss, energy levels, and even motivation harder to manage,” Calvert says.

Low testosterone, in turn, worsens insulin resistance by disrupting glucose metabolism and mitochondrial function, “creating a metabolic disaster loop where testosterone declines further,” Calvert says. ²⁶

PTSD

Recent findings suggest a negative correlation between post-traumatic stress disorder (PTSD) and testosterone in men, likely driven by genetics. ²⁷

“In practice, many men with PTSD have low testosterone,” Calvert says. They often experience severe mood instability (irritability, anger, or emotional numbness), fatigue, low libido, erectile dysfunction, and lack of motivation that is often mistaken for depression, he adds.

Obesity

Stress and obesity reinforce each other. Stress affects food choices, raises hunger hormones like ghrelin, and promotes abdominal fat. Social stigma around weight gain can add more stress. ²⁸

Excess cortisol also promotes gluconeogenesis—a process that raises blood sugar and drives fat storage—says Lester Lee, M.D., a regenerative medicine physician specializing in hormone replacement therapy. ²⁹

More belly fat means more aromatase, more estrogen, and less testosterone. ³⁰ Low testosterone leads to weight gain, which leads to more stress. And the cycle repeats. “This is why treating low testosterone without addressing stress, diet, and exercise is an incomplete solution,” Calvert says.

Symptoms of Low Testosterone Levels

Low testosterone can cause a wide range of symptoms that affect your body, mind, and fertility.

Physical symptoms

• Reduced libido
• Fewer erections
• Fatigue
• Weight gain
• Muscle loss
• Decrease in testicle size
• Hair loss
• Loss of sense of smell
• Hot flashes ³¹

Psychological symptoms

• Depressed mood
• Irritability
• Trouble concentrating
• Low energy ³²

Reduced fertility

Chronic stress is a common contributor to male infertility. Animal studies suggest that stress can damage mitochondria in Leydig cells, reducing sperm count. ³² While human research is needed, the same thing could happen in men, Calvert says.

How to Manage Chronic Stress

Healthy lifestyle habits can help you manage stress and support healthy testosterone levels.

Stress management strategies

• Practice mindfulness: In one pilot study, young men who meditated daily for a week improved cortisol and testosterone regulation under stress. ³⁴
• Prioritize sleep. CBT-i (cognitive behavioral therapy for insomnia) can improve sleep and stress resilience. ³⁵
• Exercise. Physical activity releases endorphins, which buffer against stress. ³⁶ In men over 40, strength training can raise testosterone.³⁷ One study showed an 8-week program increased testosterone by 37 percent and reduced cortisol by 12 percent. ³⁸

Dietary changes

According to Calvert, eating to support testosterone means:

• Prioritizing high-quality protein from eggs and lean red meat.
• Choosing healthy fats like avocado and extra-virgin olive oil.
• Eating cold-water fatty fish like salmon, tuna, and mackerel for omega-3 fatty acids, vitamin D, and protein. ³⁹
• Including zinc-rich foods like oysters (zinc deficiency is linked to low testosterone). ⁴⁰
• Reducing sugar and processed foods—one study found men who drank the most sugary beverages had more than twice the risk of low testosterone. ⁴¹

Supplements & vitamins

Some herbal supplements, like ashwagandha and fenugreek, show promise in raising testosterone or easing symptoms of low testosterone. But research is still early. Talk to your doctor before trying anything new.

How Testosterone Replacement Therapy Can Help

If you have symptoms of low testosterone and blood work shows your levels are low, a healthcare provider might prescribe TRT. Alongside lifestyle changes, TRT can help break the stress-testosterone feedback loop and improve mood and energy. ⁴¹ “We like to see the levels go up to 600 to 750 ng/dl,” Lee says. “At these levels, patients have a better outlook, better focus, and better motivation.”