Many men suffer in silence with symptoms such as decreased sex drive, lack of motivation, irritability, and fatigue. If you go to your doctor or do a quick internet search of these symptoms, you may be told you are suffering from Depression.
Depression is very real and quite common. WHO cited depression as the 3rd leading cause of global disability in men and women in 2004 and predict it will be the leading cause of global disability by 2030.
But What Causes Depression in a Male?
One very common, but highly misdiagnosed reason for depression is Low Testosterone (T). If you type Testosterone and Depression in a Google Scholar search, you will find 156,000 publications. Obviously, the relationship between low Testosterone and Depression is well known and well-studied! Why then are men not being treated with Testosterone for their depression rather than anti-depressants?
Low T Can Often Manifest as Depressive Symptoms
- 9% of men in the US have daily feelings of anxiety or depression
- 6 million men in the US suffer from depression per year
- 30.6% of men have suffered from a period of depression in their lifetime
- 10-40% of men have testosterone deficiency. This percent increases with age.
- And yet <10% of men receive treatment for testosterone deficiency
Low T itself in men is common, underdiagnosed and undertreated. This blog will review the connection between low T and depression.
Root Causes of Depression
Conventionally, physical root causes of depression are not sought out and often missed. Root causes of depression include the following:
- Hormone imbalance including low T
- Chronic stress
- Chronic inflammation
- Immune dysfunction
- Blood sugar dysregulation and obesity
- Gut dysbiosis
- Environmental factors
- Genetics
- Sedentary lifestyle
- Social isolation
- Diet
Low hormones can contribute to development of depression including low thyroid, growth hormone, DHEA, testosterone and estrogen. Typically, doctors will prescribe antidepressants to patients presenting with depressive symptoms, which can lead to worsened symptoms and further imbalances within the body because anti-depressants are not treating the physical root cause.
Understanding the Role of Testosterone Physically, Emotionally, and Mentally
Testosterone is a critical hormone in both men and women though men produce it in much higher concentrations. In men, T is produced primarily in the testicles and therefore plays a crucial role in reproductive health. While most people associate a decrease in sexual desire and erectile dysfunction to Low T, T plays a large role in many other processes in the body including:
- fat distribution
- red blood cell production
- self esteem
- sperm production
- facial and body hair
- muscle mass
- bone density
- cardiovascular health
- cognitive and mental health
- low self esteem
- Lack of motivation
- energy/ fatigue
Testosterone levels peak between 18-30, but around 30 years of age, levels begin to naturally decline. This decline accelerates in the 40s and 50s.
Low Testosterone in Men is Often Underdiagnosed
Testosterone deficiency, or “Low T” is a common but unrecognized and underdiagnosed condition. Low testosterone levels may be attributed to “normal” aging or other chronic physical conditions and is therefore never addressed. “Normal” T ranges on testing are much lower than optimal ranges. Most studies define testosterone deficiency as 345 ng/dL or less whereas the optimal T range, where the majority of men have no complaints of Low T, is 690 – 1200 ng/dL. This means the prevalence of testosterone deficiency is likely much higher than what is currently reported.
It is estimated 10-40% of men have testosterone deficiency. With increasing age, the prevalence rises. It is estimated, less than 10% of men with testosterone deficiency receive treatment. Age-related decline of testosterone can be an ambiguous process leading to misdiagnosis of Low T as a cause of depression.
Low T is not only underdiagnosed but may be misdiagnosed as other conditions such as depression due to commonality of symptoms.
Men with Depressive Symptoms Improved with Testosterone Therapy
A 2019 systematic review and meta-analysis of 27 randomized placebo-controlled trials investigating the association of testosterone treatment with alleviation of depressive symptoms in 1,890 men found significant antidepressant effect with testosterone treatment. While the authors conclude larger trials are necessary to fully assess testosterone therapy and it’s effect on depression, this analysis showed:
- a clinically relevant reduction in depressive symptoms for both depression and treatment-resistant depression with T replacement
- better treatment response for depression may require higher dosages of T
- effects on depressive symptoms were first noticeable after 6 weeks of T therapy
- all men, younger to older, with depression and suboptimal T may benefit from T treatment
- there is a high acceptability of T treatment in men suggesting a positive experience with T replacement therapy
- there are rare adverse effects when treating Lw T in men with depression
Low T, A Cause of Depression
The bottom line is to always have the underlying cause of depression sought out and treated. One common cause of depression in men is Low T. When Low T is treated, depression can go go away and anti-depressants are not needed.
Optimizing testosterone levels is not only important for relieving depression, but also for reduction of cardiovascular disease, osteoporosis, neurodegenerative disease, metabolic disease and prostate cancer. It is important to have hormone levels checked and optimized for health and vitality. If you are depressed, check your T levels and make sure they are in the optimal range of 690-1100 ng/dL before being treated with an anti-depressant. Remember, low T can be diagnosed at any age.
Have an awesome day! Dr D