Loneliness and low mood: exploring the role of testosterone in mental health

Testosterone is more than just strength and muscle - it's integral to many aspects of men's health. As society faces rising mental health challenges, understanding the role of testosterone could be crucial in addressing loneliness and low mood in men.

Let’s take a closer look at the research. 

Why men and loneliness go hand in hand

While anyone can experience loneliness, men often suffer in silence. A 2019 YouGov survey found that one in five men reported having no close friends, a figure that was double the rate for women.¹

As men age, loneliness becomes even more prevalent. Recent studies reveal that older men, particularly those over 70, experience heightened levels of loneliness.² The loss of a partner, social isolation, or long-term disability are key contributors to this issue.²

The consequences of loneliness are severe. It’s linked to an increased risk of mental health disorders, such as depression and anxiety, as well as physical health conditions like cardiovascular disease.^3,4 For men, social isolation and mental health issues often create a vicious cycle, where the reluctance to open up leads to further withdrawal. 

But could part of the problem lie in an underlying biological factor - low testosterone?

Testosterone influences not only mood but also social behaviour. One study showed that testosterone affects behaviours that enhance social status.⁵ Men with higher testosterone levels are more likely to attempt to maintain or improve their social rank, such as by punishing unfairness or rewarding generosity. 

This suggests that testosterone promotes actions that either assert dominance or foster cooperation, depending on the context. When testosterone levels are low, men may be less motivated to put themselves in these kinds of interactions, potentially leading to less social engagement.

Loneliness is a notable predictor of mental health issues. A 2022 review found that loneliness more than doubles the risk of developing depression.⁶ If low testosterone contributes to feelings of isolation, addressing hormonal imbalances could be a key step in improving mental health outcomes.

How testosterone may shape men's mental health

Testosterone levels naturally decline as men age which brings a range of symptoms, including reduced muscle mass and increased body fat, but it also affects mental health. It’s linked to feelings of sadness, irritability, and even depression. 

In one study of 278 men aged 45 and older, all of whom had either normal or low testosterone levels and no prior history of depression, researchers found that after two years, 21% of men with low testosterone developed depression, compared to just 7% of those with normal levels.⁷

Can testosterone therapy improve mental health?

For men with clinically low testosterone, testosterone replacement therapy (TRT) is a widely available treatment. Research shows that it can significantly reduce depressive symptoms. In one study of 790 men aged 65 and older, those who had their testosterone levels restored to a mid-normal range reported better mood and reduced depressive symptoms compared to those on a placebo.⁸ A larger meta-analysis of 27 clinical trials involving 1,890 men also confirmed that testosterone therapy was linked to a notable reduction in depression.⁹  However, more studies are needed to confirm the total efficacy of testosterone therapy on mental health. 

TRT is also not a one-size-fits-all solution. For men with confirmed low testosterone, it can help alleviate both physical and mental symptoms, but a healthcare professional should always guide testosterone treatment. It’s also important to note that raising testosterone levels alone may not resolve mental health issues, especially if other factors are involved.

The stigma around testosterone and mental health

Despite the benefits, many men are hesitant to seek help for mental health issues, and this stigma extends to testosterone as well. Low testosterone is often seen as a natural part of ageing or something only worth addressing if physical symptoms arise. In fact, 90% of men with low testosterone remain undiagnosed or untreated and even when they do seek help, they are often diagnosed incorrectly with depression.¹⁰

The reluctance to seek help stems not just from concerns about testosterone, but also from societal expectations around mental health. Many men feel pressure to "man up" and ignore signs of depression or anxiety, which are often the result of low testosterone. Encouraging men to take their mental health seriously, and consider all potential contributing factors - including testosterone - could help break down these barriers.

For men experiencing poor mental health with normal testosterone levels, it’s vital to seek support - such as by talking to people close to you, reaching out to charities like Mind, or contacting emergency mental health lines like the Samaritans (116 123 in the UK). Opening up about mental health remains an important step in finding the right support. 

The numan take

Testosterone is often overlooked in discussions about mental health, but it deserves more attention. For men struggling with loneliness or low mood, low testosterone could be a contributing factor. 

As research continues to uncover the intricate connections between hormones and mood, it’s becoming clear that testosterone is more than just a physical hormone. It plays a vital role in mental health too.

References

1. Ibbetson, C. (2019, September 25). How many people don’t have a best friend? YouGov. https://yougov.co.uk/topics/relationships/articles-reports/2019/09/25/how-many-people-dont-have-best-friend

2. Botha, F., & Bower, M. (2024). Predictors of male loneliness across life stages: An Australian study of longitudinal data. BMC Public Health, 24, 1285. https://doi.org/10.1186/s12889-024-18770-w

3. Mann, F., Wang, J., Pearce, E., Ma, R., Schlief, M., Lloyd-Evans, B., Ikhtabi, S., & Johnson, S. (2022). Loneliness and the onset of new mental health problems in the general population. Social Psychiatry and Psychiatric Epidemiology, 57(11), 2161–2178. https://doi.org/10.1007/s00127-022-02261-7

4. Xia, N., & Li, H. (2018). Loneliness, Social Isolation, and Cardiovascular Health. Antioxidants & redox signaling, 28(9), 837–851. https://doi.org/10.1089/ars.2017.7312

5. Dreher, J. C., Dunne, S., Pazderska, A., Frodl, T., Nolan, J. J., & O'Doherty, J. P. (2016). Testosterone causes both prosocial and antisocial status-enhancing behaviors in human males. Proceedings of the National Academy of Sciences of the United States of America, 113(41), 11633–11638. https://doi.org/10.1073/pnas.1608085113

6. Mann, F., Wang, J., Pearce, E., Ma, R., Schlief, M., Lloyd-Evans, B., Ikhtabi, S., & Johnson, S. (2022). Loneliness and the onset of new mental health problems in the general population. Social Psychiatry and Psychiatric Epidemiology, 57(11), 2161–2178. https://doi.org/10.1007/s00127-022-02261-7

7. Layton JB, Li D, Meier CR, Sharpless JL, Stürmer T, Jick SS, et al. (2014). Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. J Clin Endocrinol Metab, 99(3), 835–842. Available from: http://dx.doi.org/10.1210/jc.2013-3570

8. Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., Gill, T. M., & Testosterone Trials Investigators. (2016). 

9. Effects of testosterone treatment in older men. The New England Journal of Medicine, 374(7), 611-624. https://doi.org/10.1056/NEJMoa1506119

10. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734