Testosterone Levels and Mental Health: The Association Between Anxiety, Depression, and Hormones

Hormone imbalances can significantly affect quality of life and health. Testosterone is no different. Testosterone imbalances in males and females can cause several symptoms and may worsen mental health. This article explores the association between anxiety, depression, and testosterone.

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Understanding Testosterone

Testosterone is a steroid hormone responsible for primary sexual development in males.  It also plays a role in developing traditionally male characteristics such as male hair patterns and deepening of voice during puberty. [28] While testosterone is thought of by many as a male hormone, it is also crucial in women's health.[11]  

Testosterone in women is essential for bone density, muscle mass, strength, libido, and sexual function.[33] Testosterone may also play a role in the female menstrual cycle and fertility.[23]

What are Normal Testosterone Levels?

Normal testosterone levels fluctuate based on age, sex, and specific health factors.  They may also fluctuate throughout the day. Normal testosterone levels in men range from 300 to 1,000 nanograms per deciliter (serum) and 17 to 70 nanograms per deciliter in women (serum).[34]  

Low Testosterone Symptoms

Symptoms of low testosterone may vary between males and females:

What Are the Symptoms of Low Testosterone in Males?

Low testosterone has many symptoms, including[37]:

• Decreased sex drive
• Difficulty with erections
• Decreased muscle mass
• Increased body fat
• Decreased bone density
• Changes in mood
• Tiredness and lack of energy

Low testosterone may also affect mood. Irritability, dysphoria, and major depression are also seen with low testosterone.[37]

What are the Symptoms of Low Testosterone in Females?

Low testosterone may also cause symptoms in females.   Females with low testosterone may experience[21]:

• Decreased sex drive
• Decreased energy and increased fatigue
• Decreased strength and muscle tone
• Difficulty conceiving
• Irregular menstrual cycles
• Vaginal dryness
• Thinning or dry hair or skin
• Difficulty sleeping
• Mood changes

Depression and anxiety are also associated with low testosterone in females.[23]   

Does Low Testosterone Cause Anxiety?

Anxiety seems to be particularly affected by testosterone levels.[2] The exact mechanism for how this occurred was not well known for many years. A 2023 study in Molecular Psychiatry has discovered a link between a receptor in the brain called Tachykinin receptor 3 (TACR3) that may play a role in the relationship between testosterone and anxiety.[36] 

The relationship between anxiety and total and free testosterone appears to be inverse; however, having too much testosterone may also increase anxiety levels.[39] Testosterone is believed to help anxiety by improving certain neurotransmitters like serotonin and gamma-aminobutyric acid (GABA). These brain chemicals have been linked to social anxiety.[14]

The symptoms of low testosterone also share a lot of the same characteristics as those of depression. Testosterone appears to be beneficial in helping control both anxiety and depression in men and women.[25]  Like with anxiety, there seems to be a correlation between depressive symptoms and the upper and lower extremes of testosterone levels.[21]

Does High Testosterone Cause Anxiety?

As previously mentioned, elevated testosterone levels may also contribute to mental health conditions. High testosterone levels can cause symptoms in both males and females.  

In females, the most common reason for elevated testosterone levels is polycystic ovarian syndrome. The symptoms of elevated testosterone in females include [20]:

• Acne
• Difficulty getting pregnant
• Irregular menstrual periods
• Enlarged clitoris
• Excessive hair growth in the face, chest, abdomen, or back

In males, elevated testosterone levels can cause[17]:

• Low sperm count
• Damage to the heart muscle
• Prostate enlargement 
• Trouble urinating
• Liver problems
• Acne
• Fluid retention
• Weight gain
• High blood pressure
• Difficulty sleeping
• Increased risk of blood clots
• Headaches
• Poor growth in adolescents
• Aggressive behavior
• Mood swings, irritability

Testosterone replacement therapy has been associated with an increased risk of some mental health conditions, such as depression and suicidal thoughts.[27]

Because testosterone can increase anxiety and depression rates at both the upper and lower extremes, maintaining balanced testosterone levels is essential for mental health.

Diagnosis and Treatment

Testosterone is vital in the body, and ensuring it is balanced is essential.  

Diagnosing Testosterone Imbalances

The first step in figuring out if testosterone therapy would be helpful is to determine what the levels are. Fortunately, there are several tests available to evaluate testosterone levels.[9,33]

• Blood testing for testosterone is best done in the morning because of the natural fluctuations throughout the day. It's usually highest in the morning. 
• Saliva testing for testosterone can help determine how much testosterone is available in your tissues for immediate use.
• Urine testing shows how the enzymes that affect testosterone levels are working. Urine testing shows how testosterone is broken down.

Additional testing may be necessary to help determine the cause of low or high testosterone if it is present.

Treatment Options

Treating low testosterone levels can include lifestyle changes or medical treatments.

Many lifestyle changes can affect testosterone levels, especially as you age.  Some of these include[30]:

• Obesity is associated with lower testosterone levels, so maintaining a healthy weight can help balance testosterone levels. Weight loss may help improve testosterone levels by up to 30%.
• Physical activity promotes a healthy weight and improves testosterone levels. This is especially true for moderate to high-intensity resistance exercises.
• A well-rounded diet can be beneficial to testosterone levels. Foods high in omega-3 fatty acids are beneficial. These include fatty fish, oysters, and extra virgin olive oil.
• Smoking is associated with lower levels of testosterone and can also negatively affect reproductive health. Quitting smoking or not starting may be helpful.
• Alcohol can also impair testosterone and reproductive health. Limiting alcohol consumption may be beneficial.
• Certain hormone-disrupting chemicals, such as those in some plastics, may also harm testosterone levels.
• Quality sleep is vital for testosterone levels, as most testosterone is released during rapid eye movement (REM) sleep.
• Managing stress levels is also essential. Chronic elevated stress levels can increase cortisol levels, interfering with testosterone.

Medication treatments for low testosterone levels include hormone replacement therapy and medications such as clomiphene, which is used off-label by some healthcare providers to increase testosterone levels.[21, 18]

Integrative Approaches

An integrative approach to low testosterone levels takes a whole-person approach to treating the condition. This may include lifestyle changes, supplements, or medications.

Practitioners' Insights

Best practices for evaluating and treating low testosterone include checking hormone levels only when patients are having symptoms. The evidence for treating age-related decline is mixed.[15,19]   Other best practices for testosterone replacement therapy include[31]:

• Don't prescribe testosterone therapy to men contemplating or attempting pregnancy
• Don't prescribe testosterone therapy for men with erectile dysfunction if normal testosterone levels are present
• Don't prescribe testosterone therapy without documented testosterone deficiency

Patient Guidance

If you've had symptoms of low testosterone, it's essential to consult your healthcare provider for evaluation and treatment. It may also be worth pursuing testing if you're experiencing anxiety, especially if it's been challenging to treat.

Many of the lifestyle changes that are associated with improving testosterone levels may also help with anxiety levels. Lowering stress levels, a balanced diet, regular exercise, and quality sleep are all self-care techniques with potential benefits for your testosterone levels and anxiety.

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Key Takeaways

• Low testosterone is common.
• Testosterone imbalance, both low and high, can contribute to anxiety and depression.
• Lifestyle modifications may improve testosterone levels.
• Medication may also be used if indicated.
• Best practices include only using testosterone replacement therapies if the labs show low levels.