Low Mood and Low Testosterone: What Is and Is Not Known

So low testosterone and low mood tend to appear together.

By Neil Solomon · 2 min read

Picture a man named Paul, 54. His doctor tells him his testosterone is on the low side. Paul asks the question many men ask: "Is that why I feel down?"

The honest answer has three parts.

The link exists

Two large studies in Australia followed older men over time. In one, men with depression were about 2.7 times more likely to have free testosterone in the lowest fifth of the group. In the other, men with a total testosterone below 6.4 nmol/L had about 1.9 times the risk of later depression. The two studies did not agree on which kind of testosterone mattered. In the second study, free testosterone showed no link.

So low testosterone and low mood tend to appear together. These studies cannot tell us which one comes first, or whether something else, such as poor sleep or weight gain, drives both.

Treatment helps a little

A review of 27 trials with 1,890 men found that testosterone treatment improved depressive symptoms by a small amount (an effect of about 0.2, where 0.8 would be large). The Testosterone Trials, which treated older men with low levels for a year, found slightly better mood.

A large trial called TRAVERSE looked at mood in more than 5,000 men. Treated men reported modest gains in mood and energy. In the 49 men who met strict criteria for lasting depression, the difference was not significant, though that group was small.

What Paul could do

Because the gain is small and depression has well-tested treatments, a doctor could look at mood on its own track. Low mood with a low level may need both conversations.