By Justin Groce, MSN,NP-C,CSCS Want to learn more from Justin about the connection between testosterone and mental health? Attend his eye-opening presentation at The Elite Nurse Practitioner’s annual conference in San Antonio, TX on October 25-27! 

When most people think of testosterone, they typically think of being big and strong. Being aggressive. Being hairy. Or simply put, being a man! However, these preconceived notions do not account for the full range of effects testosterone has on the human body.  

Testosterone is one of the most important hormones in the human body, regardless of sex.  In fact, it’s the most abundant sex hormone found in both men and women. We already know that testosterone is important for anabolic processes, such as building bones and muscle, but there is little information available about the ways testosterone can affect our mental health.  

The psychological effects of testosterone  

Testosterone is essential for the development of neurotransmitters dopamine and serotonin. Emerging literature is demonstrating just how important testosterone is to a man’s psychological function. As men age our testosterone levels will decline, but with that decline comes possible deleterious outcomes not only to our metabolic health, but our psychological health. Some of these problems include worsening insulin sensitivity and cardiovascular health, decreased bone density, increased visceral fat, and symptoms of anxiety and/or depression. 

Parallels between low testosterone and depression  

These changes can lead to fatigue, irritability, excessive sleeping, over or undereating, anxiety, brain fog, and lack of enjoyment of life (anhedonia). Many of these are common symptoms of depression, but there may be hormonal factors at play.  

This is why understanding the psychological influence of testosterone is crucial.  Statistically-speaking, almost 50% of men with low testosterone report depressive symptoms.  This means that we, as clinicians, need to rule out low testosterone when men present with depressive complaints.  Not doing so may ultimately lead to these patients being misdiagnosed. 

The degree of depressive symptoms reported in a patient is inversely related to the level of testosterone he may present with, especially his free testosterone levels. This means the lower his levels are, the worse his depression symptoms may be. The level of his testosterone is also inversely related to his functional capacity, which translates into more lost hours of productivity as well as his inability to perform in day-to-day life.  This can negatively impact a person’s professional or personal life.  

Diagnostic tools for clinicians  

As a clinician, it’s imperative to test patients for low testosterone (hypogonadism) concurrently during depression screenings. At a minimum, I recommend using both the PHQ9, sexual health inventory for men (SHIM), and the ADAM questionnaire (preferably the quantified ADAM).  These various inventories can help you gain insight into the severity of his symptoms and how they are manifesting. 

When it comes to obtaining blood work for possible hypogonadism, we minimally recommend a complete blood cell (CBC), complete metabolic panel (CMP), follicle-stimulating hormone (FSH) (FSH/LH), total testosterone, and sex hormone binding globulin. Obtaining the SHBG will allow you to calculate the patient’s free testosterone levels. Some labs do this as part of their testosterone profile.  

Another thing to consider about testosterone blood work is that the levels you obtain simply reflect how the patient feels at that specific level. This means that even when testosterone levels are “in range”, symptoms of depression can exist.  We’ve been conventionally trained to only treat a patient when their levels exist outside of the range, but this approach to hormone optimization requires stepping outside of the box.