06/19/2009 - Articles

Not enough testosterone?

By: Robert W. Griffith, MD


It is commonly accepted that much of the aggression seen in young men is associated with high blood levels of the male sex hormone testosterone. The amount of this hormone in the blood peaks around age 20, and is higher in men at times of success in competition and after strenuous exercise.

It declines with age, however, at a fairly steady rate. It is not surprising, therefore, that people have questioned whether the depression often seen in elderly man is related to insufficient testosterone. A recent review has examined this question.

Testosterone has effects on both sexual and other behavior. Irritability, impulsiveness, depression and violence have all been related to high testosterone levels, showing that the hormone has effects other than those related to sex. Furthermore, in people with testosterone deficiency, physical changes are seen that are quite similar to those of the aging process - increased body fat, decreased muscle mass, and lessened facial hair; there is also loss of appetite and impaired memory. Testosterone replacement can reverse these changes in young patients, and, to a lesser extent, in older men. Little is known, however, about the benefits of such replacement treatment on the symptoms of depression seen in older men.

Fairly frequent attempts have been made to link testosterone levels with depressive illness. Two large studies measured morning testosterone levels and depressive symptom scores, but were unable to show a clear-cut association between the two. Other studies compared the testosterone levels in depressed men with those of non-depressed normal subjects. Again, there were no consistent associations. In one study the actual hormone level varied with the age of depressed patients, while there was no such relationship in normal control subjects. This suggests that depressed men may be more sensitive to the normal decline in testosterone levels with age.

Other publications describe the administration of testosterone to men with abnormally low levels. The hormone treatment increases friendliness, energy and well-being, and decreases nervousness, irritability, sadness and anger. However, testosterone treatment in patients with established depression has not been fully studied. Even in those studies where testosterone treatment improved the symptoms of depression, it is not evident whether this was due to a direct effect on the symptoms themselves, an indirect effect due to increased testosterone levels, or whether the benefits were merely a so-called "placebo response".

There is no doubt that testosterone administration has adverse effects in some patients - reduced plasma HDL-cholesterol (the "good" cholesterol), increased formation of red blood cells and accelerated growth of an existing prostate cancer.

All these results are insufficient to allow the authors of the review to recommend that testosterone should be given for late-life depression in men. Further research is needed to see if any benefits obtained are greater than the possible risk of dangerous adverse effects. It seems that too little testosterone is not the obvious answer to depression in older men.


Testosterone and depression in aging men. SN. Seidman , BT.  Walsh , Am J Geriatr Psychiatry , 1999, vol. 7, pp. 18--33

Created on: 06/29/1999
Reviewed on: 06/19/2009

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