A man with low testosterone looking anxious and depressed

Low Mood? It Might Be Low T.

Anxiety and depression can be signs of low testosterone.

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Fast Facts

  • Low testosterone can cause anxiety, depression, irritability, and other mood shifts.
  • The link between testosterone, anxiety and depression isn’t fully understood, but testosterone may cross into the brain where it may affect the production of brain cells, create new neural connections, and regulate feel-good neurotransmitters.
  • If your anxiety or depression is caused by low testosterone, testosterone replacement therapy may provide relief.

Anxiety and depression are often pegged as women’s disorders. And while it’s true that women are twice as likely as men to have depression and anxiety disorders, plenty of guys suffer too. And the cause might be something unexpected: testosterone.

Stigma prevents many men from discussing anxiety and depression, says Joshua Calvert, M.D., a physician who works with Hone. “Research shows that it’s considered ‘unmanly’ to discuss mental health disorders, which may explain this disparity,” he notes.

Can Low Testosterone Cause Anxiety and Depression?

When your mood is in the basement, sometimes you can pinpoint the curveball that’s got you down. But what if you haven’t been laid off, had a health setback, or experienced some other negative event? The cause of those anxious or depressed feelings could be more surprising: low testosterone.

Every man’s testosterone levels decrease starting in his mid-30s, but some men experience a sharper dip, and end up with levels that are lower than normal for their age. Men with clinically low testosterone levels can experience a range of symptoms, including weight gain, a loss of libido, erectile dysfunction, and more. But many men don’t know that low T can also affect your mood, making you irritable, anxious, or prone to mood swings.

Knowing if changes in your mood are related to low T can be tricky. Feeling moody, irritable, and like you’re struggling to get through the day—some of the hallmark signs of anxiety and depression—are also common symptoms of low testosterone.

But anxiety and depression can also occur independently of low T. Here’s what you need to know about the connection, and how to figure out if your hormones are contributing to your depression or anxiety.

Shared Symptoms of Low Testosterone, Anxiety, and Depression

Low testosterone and mood disorders like anxiety and depression share a significant number of symptoms:

  • Low sex drive
  • Erectile dysfunction
  • Insomnia and fatigue
  • Trouble concentrating
  • Problems with memory
  • Irritability
  • Sadness
  • Loss of interest in activities you once enjoyed
  • Withdrawing from friends and family
  • Overall decreased sense of well-being
 

The kind of gradual mood changes that are associated with low T can be easy to brush off as signs of day-to-day stress. But feelings of anxiety and depression can be a sign that you should have your hormone levels tested.

Related: Your Chest Pain Might Be From This, Not Heart Problems.

Low Testosterone Can Cause Depression

Around 5.5 percent of US men have depression, which can make it difficult to function at work and home and stay socially connected, according to the Centers for Disease Control and Prevention. The biggest culprits are genetics, illness, and experiencing a traumatic life event. But mood changes can also be linked to low T.

Past research indicates that men with low testosterone levels had an increased risk of depression compared to men with normalized hormones. In one study (1), 21.7 percent of men with hypogonadism were diagnosed with depression versus 7.1 percent in the control group.

Another study (2) found that men who had depression also had lower average free testosterone levels compared to a control group. More recent research (3) found that older men with major depressive disorder had lower testosterone compared to healthy guys. That said, not every study finds (4) a connection.

If you are experiencing anger, changes in appetite, headaches, and digestive woes, or are reaching for alcohol to cope with stress—all symptoms of depression—you may want to consider getting tested for low T, especially if you can’t otherwise understand the reason behind these mood changes.

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Low Testosterone Can Play a Role in Anxiety

If you’re constantly on edge, fatigued, are struggling to focus, and feeling like you’re in a perpetual worry cycle, you may have anxiety, which affects 40 million adults in the U.S., according to the Anxiety & Depression Association of America. A host of factors—from thyroid conditions to caffeine use —can contribute to anxious feelings, but so can low testosterone.

Though not as well-established as depression, research suggests that low T may also play a role (5) in your ability to cope with stress, and anxiety is a frequently reported symptom by men. Experts don’t completely understand the connection between testosterone levels and mood but they have a few theories (6): Testosterone crosses into the brain where it may affect the production of brain cells, create new neural connections that tweak thoughts toward the positive (7), and regulate feel-good neurotransmitters.

Low T 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.

Related: Why You Can’t Get An Erection

How Do I Know If I Have Low Testosterone?

In addition to the symptoms listed above, such as low sex drive and ED, other symptoms of low T include loss of muscle and strength, increased body fat, a loss of body hair, breast development, and infertility.

The best way to know if your T levels are in the normal range is to have them tested, which is done via a simple blood test, like the at-home test offered by Hone.

Low T can also affect your mood, making you irritable, anxious, or prone to mood swings.

Testosterone Replacement Therapy May Help Reduce Anxiety and Depression

Since symptoms of low T and mood disorders are so similar, you might think that medications that treat anxiety and depression could help with low testosterone. But this isn’t the case. Antidepressants may lower testosterone levels (8), and can negatively impact libido.

If low T is the reason you’re feeling low, testosterone replacement therapy can relieve symptoms of depression, according to a 2019 review and meta-analysis of 27 randomized, placebo-controlled clinical trials in JAMA Psychiatry (9). The researchers found that testosterone replacement therapy significantly reduced depressive symptoms compared with those in the control group treated with a placebo, especially among middle-aged men with low testosterone.

The researchers noted that men on higher doses of testosterone had more improvements in mood than those on lower doses, and TRT may be more effective for those experiencing less severe depression. The research also found that 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.

Related: The Benefits of Testosterone Replacement Therapy

Other Best Practices to Manage Anxiety and Depression

Whether or not you have low T, the following steps can also help improve your mood:

Spend time with friends and loved ones

If you feel okay doing so, you can also talk about how you feel. Strong connections buffer against feelings of isolation and improve wellbeing, shows research (10).

Exercise

Whether you like to lift, run, or hop on a bike, exercise has been found (11) to prevent mood disorders and can help manage symptoms. When you have one of those days when you feel as if there’s a dark cloud hovering overhead, you can get it out with a HIIT class, but something simple like getting out for a walk can help, too.

Maintain a daily sleep schedule

Both sleeping too short or too long may trigger (12) low feelings. Go to bed and wake up at consistent times every day and aim for at least seven hours of shut-eye each night.

Minimize alcohol

It’s no secret that alcohol use increased during the pandemic (13), especially for people with anxiety and depression. Finding new ways to cope with stress (exercise is one) or isolation (spending time with sober friends) can help you rely less on an after-work beer for a pick-me-up.

The Bottom Line

Low testosterone can cause anxiety and depression but testosterone replacement therapy can improve symptoms. If you think that you may have low testosterone, a test can confirm whether your levels are in the normal range for your age.
References:
​​1. Shores MM, Sloan KL, Matsumoto AM, Moceri VM, Felker B, Kivlahan DR. Increased incidence of diagnosed depressive illness in hypogonadal older men. Arch Gen Psychiatry. 2004 Feb;61(2):162-7. doi: 10.1001/archpsyc.61.2.162. PMID: 14757592.
2. McIntyre RS, Mancini D, Eisfeld BS, Soczynska JK, Grupp L, Konarski JZ, Kennedy SH. Calculated bioavailable testosterone levels and depression in middle-aged men. Psychoneuroendocrinology. 2006 Oct;31(9):1029-35. doi: 10.1016/j.psyneuen.2006.06.005. Epub 2006 Sep 5. PMID: 16908107.
3. Giltay, Erik J. et al. Plasma Testosterone and the Course of Major Depressive Disorder in Older Men and Women, The American Journal of Geriatric Psychiatry, Volume 25, Issue 4, 425 – 437
4. Justin M. Johnson, Lisa B. Nachtigall, Theodore A. Stern, The Effect of Testosterone Levels on Mood in Men: A Review, Psychosomatics, Volume 54, Issue 6, 2013, Pages 509-514, ISSN 0033-3182, https://doi.org/10.1016/j.psym.2013.06.018.
5. Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020 Nov;8(6):1598-1605. doi: 10.1111/andr.12867. Epub 2020 Jul 30. PMID: 32657051.
6. Erik J. Giltay, Roos C. van der Mast, Esther Lauwen, Annemieke C. Heijboer, Margot W.M. de Waal, Hannie C. Comijs, Plasma Testosterone and the Course of Major Depressive Disorder in Older Men and Women, The American Journal of Geriatric Psychiatry, Volume 25, Issue 4, 2017, Pages 425-437, ISSN 1064-7481, https://doi.org/10.1016/j.jagp.2016.12.014.
7. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734
8. Pavlidi P, Kokras N, Dalla C. Antidepressants’ effects on testosterone and estrogens: What do we know? Eur J Pharmacol. 2021 May 15;899:173998. doi: 10.1016/j.ejphar.2021.173998. Epub 2021 Mar 4. PMID: 33676942.
9. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734
10. Martino, Jessica et al. “The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness.” American journal of lifestyle medicine vol. 11,6 466-475. 7 Oct. 2015, doi:10.1177/1559827615608788
11. Schuch, Felipe Barreto PhD1; Stubbs, Brendon PhD2,3 The Role of Exercise in Preventing and Treating Depression, Current Sports Medicine Reports: August 2019 – Volume 18 – Issue 8 – p 299-304 doi: 10.1249/JSR.0000000000000620
12. Watson, Nathaniel F et al. “Sleep duration and depressive symptoms: a gene-environment interaction.” Sleep vol. 37,2 351-8. 1 Feb. 2014, doi:10.5665/sleep.3412
13. Ariadna Capasso, Abbey M. Jones, Shahmir H. Ali, Joshua Foreman, Yesim Tozan, Ralph J. DiClemente,Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S., Preventive Medicine, Volume 145, 2021, 106422, ISSN 0091-7435, https://doi.org/10.1016/j.ypmed.2021.106422.

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