As a psychiatrist, I have become increasingly interested in the link between depression and low testosterone levels. Low testosterone (or hypogonadism) in older men may not only worsen a preexisting depression, but may in some be the cause of it. With age, it is not uncommon to see a decline in testosterone levels. Low levels of this male hormone may cause many of the same symptoms that are seen in clinical depression such as fatigue, irritability, diminished libido, concentration difficulties, insomnia and lack of motivation. 

It is estimated that men with low T are four times more likely to be diagnosed with depression. Further, uncorrected hypogonadism may result in only partial benefit from anti-depressant therapy. It is believed that low testosterone can effect serotonin and norepinephrine levels in the brain. Serotonin and norepinephrine are brain neurotransmitter that helps regulate mood. Many of the anti-depressants on the market today work by increasing the amount of serotonin and / or norepinephrine in the brain.

Many psychiatrists and primary health physicians rarely order testosterone levels. However, it seems to increasingly make sense to  routinely check the level of this important hormone in men over forty in light of the increased awareness of the impact of low T on both physical and mental health especially if there is a complaint of decreased sex drive and / or erectile difficulties. 

One of the challenges patients encounter is  that even if the doctor does check their total and free testosterone levels, they often will not treat the patient with hormone replacement therapy (HRT) if the patient’s levels are within the “normal range.” Many physicians do not take into account that for many men being in the low end of the normal range may represent of drop in the amount of free hormone available to them and may not be the optimal part of the range for them to experience optimal health. 

To be clear- not all  older males with depression have low T, and not all men with low T have have depression; but it make sense to be mindful about the connection between the two conditions.