testosterone
∙5 minute read
There's been a surge in interest in men's mental health in recent years, and all for good reason too—we want our fellow men to speak up. Yet, as awareness grows, so too does the propensity for misdiagnosis. Many non-specialist physicians are quick to diagnose depression without a deeper investigation into the biochemical roots of distress.
Historically, mental health frameworks have predominantly been developed through research on women,1 leading to a skewed understanding when these same models are applied to men. This research has demonstrated that women often exhibit internalising disorders like depression and anxiety, whereas men are more likely to show externalising symptoms, such as substance abuse and aggression. These differences are deeply influenced by both biological distinctions and the societal expectations embedded within traditional gender roles.
One significant but frequently overlooked cause is testosterone deficiency (TD),2 which can mimic or exacerbate depressive symptoms. This oversight points to a broader issue within the healthcare system—a tendency to treat symptoms rather than underlying causes, particularly in men’s health. As society becomes more attuned to the nuances of mental wellbeing, we're beginning to uncover significant gaps in how mental health issues are diagnosed and treated across genders. It may therefore be high time to refine diagnostic approaches to better reflect and address the unique ways in which men experience psychological distress.
Testosterone has long been recognised as crucial in male sexual health, but its role in mental health, particularly depression, is gaining attention. Both high and low levels of testosterone have been linked to increased risks among men.2 Doctors must therefore consider these hormonal balances or imbalances when assessing mental health, as they could be pivotal in accurate diagnosis and effective treatment.
Diving deeper, studies differentiate how testosterone levels affect various types of depression. Men with atypical depression, characterised by symptoms like overeating and oversleeping, tend to have lower levels of free testosterone—the type that is not bound and is bioactive in the body.3 On the other hand, men suffering from melancholic depression, marked by persistent sadness and a loss of pleasure, don't always exhibit this pattern.3 Even more intriguing is the evidence suggesting that high testosterone levels might be just as problematic, linked with depression risks perhaps more consistently than low levels, highlighting the necessity of consistent monitoring when being treated with supplemented testosterone.4
It's easy to mistake the symptoms of low testosterone for other mental health issues like depression, anxiety, or ADHD. Most people, including many doctors, might not immediately think of testing for hormonal imbalances when faced with these symptoms. This oversight means patients often start on treatments for mental health conditions without much success, because the real culprit—hormonal imbalance—goes unchecked. The consequences? At best, no improvement; at worst, an aggravation of symptoms due to inappropriate medication.
Hence, there’s a vital need for comprehensive diagnostic processes. Imagine how different the treatment journey could be with a simple blood test for testosterone levels at the outset. Such a test could redirect the treatment plan towards hormone therapy rather than standard psychiatric treatments, potentially saving a lot of time, distress, and ineffective medication trials.
General practitioners in the UK have been shown to not use standardised psychiatric instruments to diagnose depression, meaning that at least some diagnoses – around 50% – may be inaccurate.5 Therefore, such patients may be at a greater risk to remain untreated and subsequently continue to suffer, or be wrongfully treated, and instead be made to suffer the side effects of unnecessary use of antidepressants.5 Antidepressants, particularly SSRIs, are a go-to solution in the UK, but their interaction with sex hormones can complicate matters further, affecting everything from sexual function to overall behaviour.6
Ultimately, the goal is to avoid a one-size-fits-all approach in mental health diagnoses and treatments. We need to acknowledge the complex relationship between hormones and mental health so that we can ensure more accurate diagnoses and more effective interventions, tailored to the specific needs of each patient.
Smith DT, Mouzon DM, Elliott M. Reviewing the assumptions about men’s mental health: An exploration of the gender binary. Am J Mens Health [Internet]. 2018 [cited 2024 Aug 20];12(1):78–89. Available from: http://dx.doi.org/10.1177/1557988316630953
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, et al. Testosterone and specific symptoms of depression: Evidence from NHANES 2011–2016. Compr Psychoneuroendocrinol [Internet]. 2021 [cited 2024 Aug 20];6(100044):100044. Available from: http://dx.doi.org/10.1016/j.cpnec.2021.100044
Smeeth DM, Dima D, Jones L, Jones I, Craddock N, Owen MJ, et al. Polygenic risk for circulating reproductive hormone levels and their influence on hippocampal volume and depression susceptibility. Psychoneuroendocrinology [Internet]. 2019 [cited 2024 Aug 20];106:284–92. Available from: https://pubmed.ncbi.nlm.nih.gov/31039525/
Johnson JM, Nachtigall LB, Stern TA. The effect of testosterone levels on mood in men: A review. Psychosomatics [Internet]. 2013;54(6):509–14. Available from: http://dx.doi.org/10.1016/j.psym.2013.06.018
Carey M, Jones K, Meadows G, Sanson-Fisher R, D’Este C, Inder K, et al. Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry [Internet]. 2014 [cited 2024 Aug 20];48(6):571–8. Available from: http://dx.doi.org/10.1177/0004867413520047
Pavlidi P, Kokras N, Dalla C. Antidepressants’ effects on testosterone and estrogens: What do we know? Eur J Pharmacol [Internet]. 2021;899(173998):173998. Available from: http://dx.doi.org/10.1016/j.ejphar.2021.173998
