Some men reach their 40s and feel a subtle but disorienting shift. Despite thriving careers, strong friendships, and fulfilling family lives, something feels off. They might feel moody and have trouble focusing at work. They may snap at others over nothing or feel unusually drained.

As a doctor, I’ve seen this happen quite often. In many cases, lifestyle factors are to blame. Getting more exercise, eating healthier, and getting more sleep can make a big difference.

In other cases, the culprit is something less expected – low testosterone.

Testosterone naturally declines by about 1% per year starting in a man’s 30s and 40s.1,2 And this change can influence far more than muscle mass and libido.

When testosterone dips too low, it can quietly erode energy, mental clarity, and emotional resilience. The stress of these symptoms can temporarily suppress testosterone levels even further, making it even harder to escape the cycle of fatigue and low mood.3,4

While often overlooked, the connection between testosterone and mental well-being is profound – and understanding it could be the key to breaking the cycle.

Your brain on T

Scientists have long known that testosterone works with the brain in ways that influence the way you think, feel, and act.

  • A natural serotonin booster. Studies in animals suggest that testosterone increases serotonin levels, a neurotransmitter linked to feelings of well-being.2,5 This could explain why men with low testosterone sometimes experience anxiety, mood swings, or depression – and why research has found a connection between testosterone deficiency and major depressive disorder.3,6
  • A supporter of neuroplasticity. In the hippocampus, a region critical for memory and emotional regulation, testosterone helps foster neural growth.2,5 When levels decline, cognitive function may suffer, stress resilience can weaken, and anxiety or depression risks may rise.
  • A key player in gene activity. Testosterone interacts with key genes involved in inflammation and insulin signaling – both of which are linked to cognitive performance.7 

The confidence factor

Testosterone is often a central part in a man’s sense of confidence and identity. When levels drop, so can motivation and self-assurance, leaving men feeling a step behind their former selves.2,8

Perhaps the most distressing effect of low testosterone is its most well-known: its impact on sexual health. At typical levels, testosterone serves as the engine behind libido, erectile function, and sperm production. When levels decline, desire can dwindle, and performance can suffer.8

This can set off a frustrating chain reaction – relationship strain leads to stress, stress fuels self-doubt, and before long, anxiety and depression enter the mix.

Testosterone therapy: A boost or just hype?

It might seem like the obvious solution would be to use testosterone therapy as an antidepressant. After all, if low testosterone affects mood, testosterone replacement therapy should fix it, right? 

The reality, however, is more nuanced. Here's why:

  • The research is mixed. Some studies have found that testosterone therapy reduces depression, particularly in middle-aged and older men.5,9 But other experts aren't so sure. Research in this area is often a mixed bag, thanks to varying methods for measuring testosterone and defining depression. Plus, many studies include both men with clinically low testosterone (hypogonadal) and those with normal levels (eugonadal), making it harder to determine who benefits most from treatment.3
  • Not all depression is linked to testosterone. A large-scale analysis of U.S. health data found only a weak link between low testosterone and appetite changes, with no strong connection to overall depression scores. In other words, plenty of factors – like trauma, poor sleep, and chronic stress – can drag down a man's mood without hormones being the culprit.4
  • Testosterone therapy isn't one-size-fits-all. Delivery methods vary, and they each come with pros and cons. Injections provide long-lasting effects but can cause mood swings as levels fluctuate. Patches offer steady absorption but may cause skin irritation and can rub off on others. Pills are convenient but can strain the liver. All have side effects. Finding the right approach can be more complicated than other treatments for depression or anxiety.10

In short, while testosterone may support mood regulation, it’s not a cure-all for depression. For some men, particularly those with clinically low levels, testosterone therapy could offer a boost. For others, it might not make much of a difference. 

That’s why working with a healthcare professional is crucial before pursuing hormone-based treatments. In most cases, lifestyle changes should be addressed first.

The manhood myth: Why mental health isn’t a weakness

The real issue isn’t low testosterone or mental health struggles – it’s that many men don’t seek help in the first place.

The outdated notion that “real men don’t talk about their feelings” has contributed to a culture where men are significantly less likely to seek mental health support than women.11-13 In fact, they're more likely to reach for unhealthy coping mechanisms – like drinking, smoking, or overworking – than to call a mental health professional.14

But acknowledging mental health struggles isn’t a sign of weakness. It’s a sign of self-awareness and intelligence. Just as no one would shame a man for treating high blood pressure, there should be no stigma in addressing hormonal imbalances or seeking therapy for depression or anxiety.

How to optimize testosterone and mental health

Now for some good news. If you suspect low testosterone is affecting your mental health, there are steps you can take.

1. Get tested
A simple blood test can determine whether your testosterone levels are within a normal range. If low testosterone (hypogonadism) is diagnosed, treatment options may be available.

2. Prioritize lifestyle changes
Both testosterone levels and mental health symptoms are influenced by diet, exercise, sleep, and stress. Regular exercise, a diet rich in healthy fats and protein, and 7-9 hours of quality sleep each night can naturally support hormone production.

3. Consider testosterone therapy – but do your research
Testosterone replacement therapy can be life-changing for some, but it’s not for everyone. Discuss the risks and benefits with your healthcare professional before starting treatment.

4. Seek mental health support
Whether low testosterone is to blame or not, therapy offers powerful tools for tackling depression, anxiety, and self-doubt. Cognitive-behavioral therapy (CBT), in particular, helps rewire negative thought patterns and build resilience.

5. Redefine strength
True strength isn’t about ignoring emotions – it’s about recognizing when help is needed and taking action. Seeking support is a sign of resilience, not weakness.

Taking control of your mental well-being

For men dealing with mood disturbances, the best approach is a combination of medical evaluation, lifestyle improvements, and – most importantly – a willingness to challenge outdated stigmas around male mental health.12

Read more about male menopause, testosterone therapy, and natural treatment options I often discuss with patients here. 

A word from Thorne

If you are looking for more learning options, you can check out this article at Take 5 Daily that covers common signs, symptoms, and causes of low T in men and some simple lifestyle and botanical approaches to balanced testosterone levels. Thorne’s Advanced Testosterone Support includes shilajit and a supporting cast of herbal extracts and zinc to support healthy testosterone levels in men.*

If you enjoy listening to podcasts, Thorne has you covered:

References

  1. Huhtaniemi IT, Wu FCW. Ageing male (part I): Pathophysiology and diagnosis of functional hypogonadism. Best Pract Res Clin Endocrinol Metab. 2022;36(4):101622.
  2. Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020;8(6):1598-1605.
  3. Zito S, Nosari G, Pigoni A, et al. Association between testosterone levels and mood disorders: A minireview. J Affect Disord. 2023;330:48-56.
  4. Määttänen I, Gluschkoff K, Komulainen K, et al. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021;6:100044.
  5. 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.
  6. The 'male menopause.' NHS. https://www.nhs.uk/conditions/male-menopause/. [Accessed March 3, 2025.]
  7. Nguyen HD, Vu GH, Kim WK. The molecular mechanisms of steroid hormone effects on cognitive function. Arch Gerontol Geriatr. 2025;129:105684.
  8. Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022;23(6):1159-1172.
  9. Evaluation and management of testosterone deficiency (2024). American Urological Association. https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline. [Accessed March 3, 2025.]
  10. Gurayah AA, Dullea A, Weber A, et al. Long vs short acting testosterone treatments: A look at the risks. Urology. 2023;172:5-12.
  11. Men and mental health. National Institutes of Health. https://www.nimh.nih.gov/health/topics/men-and-mental-health. [Accessed March 3, 2025.]
  12. Men: A different depression. American Psychological Association. https://www.apa.org/topics/men-boys/depression. [Accessed March 3, 2025.]
  13. McKenzie SK, Oliffe JL, Black A, et al. Men's experiences of mental illness stigma across the lifespan: A scoping review. Am J Mens Health. 2022;16(1):15579883221074789.
  14. von Zimmermann C, Hübner M, Mühle C, et al. Masculine depression and its problem behaviors: Use alcohol and drugs, work hard, and avoid psychiatry! Eur Arch Psychiatry Clin Neurosci. 2024;274(2):321-333.