Low testosterone and depression frequently show up together, and clinicians have long noticed that men with clinically low testosterone report depressed mood, low motivation, and reduced enjoyment of daily life at higher rates than men with normal levels. Depressive symptoms have been reported in roughly 35 to 50 percent of men evaluated for hypogonadism in cross-sectional studies, which is a meaningfully higher rate than in the general population.

This article covers how testosterone interacts with the brain systems involved in mood, what the clinical evidence shows about depression and low testosterone in men, whether testosterone replacement therapy actually improves depressive symptoms, and how to tell whether a mood change is worth a hormone evaluation.

How Testosterone and Mood Are Connected

Testosterone acts on androgen receptors throughout brain regions involved in emotional regulation, including the amygdala and hippocampus, both of which play a role in processing mood and stress. Research also points to a bidirectional relationship: low testosterone can contribute to depressive symptoms, and depression itself can suppress the hypothalamic-pituitary-gonadal axis, which lowers testosterone production (Indirli et al., Frontiers in Endocrinology, 2023). Chronic stress adds another layer, since persistently elevated cortisol can suppress testosterone production through its effects on the same hormonal axis, which may partly explain why stress, low mood, and low testosterone often cluster together.

Because of this two-way relationship, it is not always possible to know from symptoms alone whether low testosterone is a cause or a consequence of a mood change, which is one reason clinical evaluation typically looks at the full picture rather than treating either condition in isolation.

What the Evidence Shows About Testosterone Replacement and Depression

Multiple systematic reviews have examined whether restoring low testosterone actually improves depressive symptoms. A network meta-analysis of twelve placebo-controlled randomized trials involving 852 men with testosterone levels below 12 nmol/L found that testosterone replacement therapy was associated with a statistically significant improvement in depression scores compared with placebo (Elliott et al., BMJ Open, 2017).

More recent evidence adds nuance to this picture. A dedicated substudy of the large TRAVERSE trial specifically evaluated men with hypogonadism and depressive syndromes and found that testosterone replacement therapy was associated with improvement in depressive symptoms over time, though the effect size was modest and men with more severe baseline depression may need additional or alternative treatment approaches rather than testosterone alone (Bhasin et al., Journal of Clinical Endocrinology & Metabolism, 2024). Taken together, the evidence suggests testosterone replacement can meaningfully help mood in men with confirmed low levels, but it is not positioned as a standalone treatment for clinical depression, particularly moderate to severe cases.

Can Low Testosterone Cause Depression and Anxiety at the Same Time?

Depression and anxiety commonly appear together in men with hypogonadism rather than as separate, unrelated symptoms. Reviews describe depressed mood, anxiety, irritability, and reduced motivation as part of a broader symptom cluster associated with low testosterone, rather than isolated, independent complaints (Indirli et al., Frontiers in Endocrinology, 2023). This overlap is part of why a single symptom, such as low mood alone, is rarely enough to confirm a hormonal cause, and why a broader symptom and lab picture is typically needed before attributing a mental health change to testosterone.

The Endocrine Society’s clinical practice guideline recommends diagnosing low testosterone using consistently low levels on repeat morning bloodwork together with recognized symptoms, which can include mood changes, low energy, and reduced libido, rather than relying on mood symptoms in isolation (Bhasin et al., Journal of Clinical Endocrinology & Metabolism, 2018).

Depression and Low Testosterone in Men: Why the Overlap Matters for Treatment

Because fatigue, low motivation, disrupted sleep, and reduced interest in activities overlap heavily between the two conditions, an evaluation for one should generally include screening for the other. Men being treated for depression who do not fully respond to standard treatment, or who have other symptoms suggestive of low testosterone such as reduced libido or loss of muscle mass, may benefit from bloodwork to rule out a hormonal contributor. Similarly, men diagnosed with low testosterone who have persistent depressive symptoms after treatment should be evaluated for depression as its own condition rather than assuming hormone therapy alone will resolve it.

This overlapping presentation is also why testosterone therapy is not recommended as a first-line treatment for depression in men with normal testosterone levels. Current evidence supports its use specifically in men with confirmed, clinically low testosterone and associated symptoms.

Safety and Practical Considerations

Testosterone therapy requires medical supervision and ongoing monitoring, including bloodwork to track testosterone levels, hematocrit, and other relevant markers. It is not appropriate for men whose testosterone levels are within a normal range, and it should not be viewed as a replacement for established depression treatments such as therapy or antidepressant medication when clinically indicated. The most effective approach for men with both low testosterone and depression is often a coordinated plan between an endocrinology-minded provider and a mental health professional, rather than addressing either condition alone.

Frequently Asked Questions

Can low testosterone cause depression?

Research suggests low testosterone is associated with depressive symptoms in a meaningful percentage of affected men, and restoring testosterone to a normal range has been shown to improve mood in several controlled trials. It is one contributing factor among several rather than the sole cause of depression.

Do depression and anxiety commonly occur together in men with hypogonadism?

Yes. They frequently appear together as part of the broader symptom pattern associated with hypogonadism, rather than as separate, unrelated conditions.

Does treating low testosterone cure depression?

Not necessarily. Evidence shows testosterone replacement can improve depressive symptoms in men with confirmed low levels, but it does not reliably resolve moderate to severe depression on its own, and additional treatment may still be needed.

How is low testosterone and depression in men diagnosed?

Diagnosis typically involves a morning fasting blood test for testosterone, confirmed with a repeat test, alongside a clinical evaluation of mood, energy, libido, and other symptoms rather than mood symptoms alone.

Is the relationship between these two conditions one-directional?

No. Research indicates the relationship works both ways: low testosterone may contribute to depressive symptoms, and depression itself can suppress testosterone production through its effects on the hormonal axis that regulates it.

Should men with depression be routinely tested for low testosterone?

Men with depression who also have symptoms such as reduced libido, fatigue, or loss of muscle mass, or whose depression has not responded well to standard treatment, may benefit from testosterone testing as part of a broader evaluation.

Can antidepressants affect testosterone levels?

Some evidence suggests certain antidepressants can affect sexual function and, in some cases, hormone levels, which is another reason a comprehensive evaluation is useful when both conditions are suspected.

Key Takeaways

• Depressive symptoms are reported in a substantial percentage of men evaluated for low testosterone, well above rates in the general population.
• The relationship appears to run in both directions, with each condition capable of influencing the other.
• Controlled trials and a network meta-analysis show testosterone replacement therapy is associated with measurable improvements in depression scores in men with confirmed low levels.
• Testosterone therapy is not a standalone treatment for depression, particularly moderate to severe cases, and works best alongside appropriate mental health care when needed.
• The hormonal picture frequently overlaps with anxiety, fatigue, and reduced libido, supporting a broader evaluation rather than a single-symptom approach.
• Diagnosis requires confirmed, repeated low testosterone levels alongside recognized symptoms, not mood changes alone.

Schedule a Consultation

If low mood, low energy, or reduced motivation have been persistent, a comprehensive hormone evaluation can help clarify whether testosterone is playing a role. Ways2Well takes a proactive, evidence-based approach to hormone health, and its hormone optimization programs begin with thorough bloodwork so any hormonal contributor to mood symptoms can be identified and addressed with a personalized, monitored plan. Schedule a consultation to discuss your symptoms and levels with a clinician.

For related reading, see Ways2Well’s guides on testosterone and stress and signs of low testosterone in men by age group.

Sources

• Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis (BMJ Open, 2017)
• The association of hypogonadism with depression and its treatments (Frontiers in Endocrinology, 2023)
• Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy (Journal of Clinical Endocrinology & Metabolism, 2024)
• Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline (Journal of Clinical Endocrinology & Metabolism, 2018)

Author: Ways2Well Editorial Team

Reviewed by: Scientific Advisory Board member