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Testosterone and Depression: What You Don’t Know

Doctors Are Prescribing the Wrong Drugs

by Dr. Christopher Senger | 07/23/18

When it comes to Testosterone and Depression, in many cases, it may be the most powerful weapon of all against depression and related mental illnesses.

Here’s what you need to know…

  • Doctors prescribe any one of a number of drugs to treat mental illnesses. The most effective drug, however, may actually be testosterone.
  • Doctors are over-prescribing drugs to the point where they’re even recommending antidepressants to combat normal mood variations.
  • Numerous studies have shown that men with low testosterone are more prone to depression. Few doctors, though, do hormonal assessments on these patients.
  • Hypogonadal men who are treated with testosterone experience great improvements in mood and depressive symptoms.
  • Low levels of thyroid hormones can also cause depression, fatigue, and nervousness.

Primary care physicians and psychiatrists – partners in crime – try to treat or control a host of mental illnesses by prescribing from their huge artillery of magic pharmaceutical bullets.

Their patients, often misdiagnosed, supposedly suffer from a multitude of psychiatric/psychological conditions including bipolar illness (running the gamut from Bipolar I, Bipolar II to cyclothymic mood disorders), major depression, recurrent major depression (both mild and severe), anxiety, and more.

Oddly enough, nowhere among these magic bullets is testosterone. And in many cases, it may be the most powerful weapon of all against depression and related mental illnesses.


It’s the Hormones!

As is the case with many medical/psychological puzzles, the answer to a large number of our mental health challenges is right in front of us. While some psychiatric disorders do have genetic, biochemical, or environmental origins, all too often clinicians look in the wrong places.

The answer to many mental health issues can be found in the human endocrine system where an elaborate and delicately balanced mix of hormones work in synergy to keep our bodies running smoothly. If this delicate balance is thrown out of kilter, for any of a myriad of reasons, your physical and emotional health will be in jeopardy.

Fortunately, physicians in some of our more sophisticated men’s health clinics are now at the forefront of exciting new discoveries about the relationship of hormonal imbalances to a large number of mental illnesses, including depression, bipolar illness, and anxiety. Slowly but surely these discoveries are changing the way many physicians approach mental health challenges.

And, as the king of the androgen hormones, testosterone has a huge impact on our cognition and mental health.


The Relationship between Low T and Depression


Numerous clinical trials and studies have demonstrated that men with below normal testosterone levels are more prone to depression than the general population. For example, in a 2015 study of 200 men conducted by George Washington University’s Center for Andrology, 56% of the participants presented with significant depressive symptoms.

Dr. Michael Irwig, M.D. said that more than half of the men who were referred because of borderline testosterone levels suffered from depression. In addition, nearly 90% of the patients suffered from erectile dysfunction, more than 40% reported sleep disturbances, and 27% told clinicians they had difficulty concentrating (1).

Furthermore, in 2014, researchers from the Department of Neurology and Psychiatry at St. Louis University reviewed 16 clinical trials that studied the relationship between low testosterone and depression. All the trials were double-blind with placebo controls (2).


Here are the salient points from the analysis of these clinical trials:

  • Testosterone has been effective in treating depression in males. The data demonstrates that testosterone had a positive effect on mood.
  • The impact of testosterone was greatest in men less than 60 years of age. (The study yielded uncertain results in the ability of testosterone to improve mood in older men.)
  • Men whose testosterone levels were normal prior to treatment were less likely to experience improved moods. However, those who registered low baseline testosterone levels before treatment showed significant improvement.
  • Testosterone works best in men with minor depression as well as those who suffer from cyclothymic depression, which is marked by less severe symptoms that last longer than typical depressive illnesses.


Incorrect Diagnoses, Bad Medicine

Unfortunately, despite these findings, psychiatrists are quick to prescribe anti-depressants to treat melancholia rather than take complete metabolic assessments. In fact, many psychiatrists and primary care providers rely solely on their patients’ descriptions and history of their apparent depressive episodes.

As such, it’s no surprise that every year the level of anti-depressant use increases dramatically. Consider that in 2010, a study of 5639 participants by the Johns Hopkins Bloomberg School of Public Health found that in the previous two decades, antidepressant use in the U.S. increased 400%, with more than 10% of all Americans over the age of 12 taking anti-depressant medication.

Some experts believe that doctors are overreacting to the point that they prescribe anti-depressants to combat NORMAL mood variations. However, these same experts tend to overlook the influence that hormonal abnormalities contribute to depression.

The rampant rate of misdiagnoses is due, in part, because the information that researchers and scientists rely on is based on flawed or anecdotal data.

Oftentimes, a drug that’s intended to solve one medical problem seems to provide a better line of defense against another. For example, Klonopin (generic, clonazepam), developed by Roche as an anti-seizure medication, is prescribed more often for anxiety.

An addictive benzodiazepine-class drug, Klonopin does more harm than good if used inappropriately, and if the underlying cause of the patient’s problem is hormonal rather than neurological, the medication will never work effectively.



Hypogonadism, Anxiety, and Depression: The Link

Hypogonadism is a condition that causes reduced testosterone levels as a result of impaired function in the gonads, and researchers have been aware of a link between hypogonadism and the onset of anxiety and depression for more than two decades.

A similar scenario of increased incidences of anxiety and depression is present in men who undergo androgen deprivation therapy for prostate cancer.

Conversely, clinicians have found that men with hypogonadism who are treated with testosterone replacement therapy experience great improvement in mood, amelioration of depressive symptoms, and reduced symptoms of depression.


Bipolar Disorder Linked to Hormonal Imbalances

The treatment of bipolar disorder, otherwise known as manic depression (to describe the wild swings between depressive mood and maniacal behavior) has long baffled psychiatrists, who generally prescribe a litany of mood stabilizers and other powerful medications in an often-fruitless effort to ameliorate this highly destructive illness.

Unfortunately, many of these medications cause numerous harmful side effects such as lethargy, weight gain, and cognitive dissonance. Again, doctors are often looking in the wrong area, as mounting evidence points to hormonal dysfunction as a contributing factor in the development of bipolar disorder.

While study results do not indict hormonal imbalances as the primary cause of bipolar illness, clinicians should note that out-of-kilter testosterone and estrogen levels can exacerbate the condition (3).


Hypothyroidism, Hyperthyroidism and Mental Health Issues

The thyroid gland stores or secretes hormones that have an impact of the function of virtually every organ in our bodies. Triiodothyronine (T3) and thyroxine (T4) are the two primary hormones produced by the thyroid.

The hypothalamus and pituitary gland work in synergy to regulate the levels of these two hormones, and abnormalities in their levels lead to a number of cognitive issues that often mimic the symptoms of mental illnesses.

The two most common thyroid abnormalities are hypothyroidism and hyperthyroidism. Hypothyroidism is characterized by reduced production of hormones while hyperthyroidism results in greater-than-normal hormonal production.

Symptoms of hypothyroidism include depressed affect (slumped shoulders, frowning, negative attitude) and fatigue, along with symptoms like nervousness, hyperactivity, anxiety, and irritability. Unless a patient receives a comprehensive thyroid blood test, these symptoms can be misdiagnosed as the result of depression or anxiety.


Mental Illness: Ruling Out Hormonal Causes

Many patients who visit men’s health-optimization clinics report symptoms of lethargy, fatigue, problems with cognition, and depression. A competent physician does not immediately assume that these symptoms are caused by low testosterone.

Instead, a specialized doctor should take a complete medical history, review symptoms, provide proper examination and then administer comprehensive metabolic and hormonal blood screenings. They will rule out other reasons for the physical and emotional symptoms and recommend appropriate treatment such as thyroid medications or TRT, either of which can possibly improve or eliminate symptoms of depression, anxiety, and reduced cognitive abilities.


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GW Researchers Find that Men Referred for Borderline Testosterone Levels Have Higher Rates of Depression and Depressive Symptoms, GW School of Medicine & Health Sciences, July 1, 2015.

Impact of exogenous testosterone on mood: A systematic review and meta-analysis of randomized placebo-controlled trials, Annals of Clinical Psychiatry, 2014;26(1):19-32.

Hormone Imbalance, Not Bipolar Disorder: Many people diagnosed BPD are NOT, but have hormonal dysregulation syndromes by Jay Goodman, M.D, Psychology Today (online), October 15, 2013.