Can low testosterone cause anxiety or depression? It can add to both, but it is rarely the whole story. In a large trial of men with confirmed low testosterone, about half scored high enough on a depression questionnaire to count as having significant depressive symptoms. Yet testosterone treatment in that same trial did nothing for the men who had major depression. Both are true. The rest of this article explains how those two findings fit together, what separates a hormone problem from a mood disorder, and when it makes sense to check for each one.
Quick answer: Low testosterone can contribute to low mood, irritability, poor sleep and anxiety, and the symptoms overlap heavily with depression. It is rarely the only cause. Confirming it takes two early-morning blood tests plus matching symptoms. Testosterone therapy is not a treatment for depression, so a man with depressed mood should be screened for both problems.
Can low testosterone cause anxiety, and what does the research show?
The short answer is maybe, for some men. Cleveland Clinic lists anxiety among the symptoms that low testosterone and mental health problems have in common, alongside irritability, mood swings, fatigue, lack of motivation, social withdrawal, trouble focusing and interrupted sleep. Baptist Health describes a knock-on effect: loss of muscle, weight gain and erectile problems can dent a man’s confidence, and that loss of confidence can feed anxiety.
The direct evidence for anxiety is thinner than the evidence for depressed mood. A 2024 study in Molecular Psychiatry that drew headlines for linking testosterone to anxiety through a brain receptor called TACR3 was done in rats. That work is interesting. It is not proof that a man’s racing thoughts at 2 a.m. come from his hormone levels.
Low testosterone anxiety is a real thing to ask about, then, but the honest version is that anxiety has many causes and testosterone is one of the less common ones.
Does low testosterone cause depression?
Australia’s Healthy Male puts it plainly: low testosterone alone can’t cause depression, but it may be one of several factors that contribute. That matches the wider view from the U.S. National Institute of Mental Health, which describes depression as the product of genetic, biological, environmental and psychological factors together.
What the research does show is overlap. In TRAVERSE, a trial of 5,204 men aged 45 to 80 with two fasting testosterone readings under 300 ng/dL, 50.8% had significant depressive symptoms on the PHQ-9 questionnaire. Endocrine News reported that more than 10% of the men in TRAVERSE reported major depressive disorder or had severe depressive symptoms.
Half. That is a lot of men with low testosterone and low mood in the same room.
Which came first for any one of them, the hormone drop or the mood? The studies that measure both at a single point in time cannot say, and Healthy Male notes those are the least reliable kind of study on this question, with mixed results. Cleveland Clinic also notes that some people are misdiagnosed with clinical depression when the problem is low testosterone. The reverse mistake is possible too, where a borderline lab result gets the blame for a depression that needs its own care.
Low testosterone and depression: how to tell them apart
You cannot sort this out from a symptom list alone. The lists overlap. Still, a few patterns point one way or the other. Cleveland Clinic urologist Lawrence Hakim, MD, says men with low testosterone often describe no energy, no desire for sex and a drop in muscle mass. Mayo Clinic lists reduced sex drive, fatigue and mood changes as early signs of male hypogonadism, with loss of body hair, breast tissue growth and weaker bones coming later.
Depression in men often looks different from the textbook picture. Mayo Clinic’s page on how depression shows up in men lists irritability or anger that gets out of control, escapist behavior such as spending long hours at work or on sports, headaches and digestive problems, heavier drinking and reckless risks.
| What you notice | Points more toward low testosterone | Points more toward depression |
|---|---|---|
| Sex drive | Low desire is often one of the first changes | Loss of pleasure in most activities, not only sex |
| Body changes | Less muscle, less body hair, breast tissue growth | Headaches, digestive problems, aches and pain |
| Mood | Tired, flat, irritable, low energy | Sad, hopeless or empty; anger that gets out of control |
| Behavior | Less motivation, pulling back socially | Escaping into work or sports, more alcohol, risky driving |
| How it is confirmed | Two early-morning total testosterone tests below about 300 ng/dL, plus symptoms | A clinical evaluation, often with a questionnaire such as the PHQ-9 |
| First-line care | Finding and treating the underlying cause | Talk therapy, medication or brain stimulation therapy |
Sleep and concentration show up on both sides, so they tell you little. A man can also have both conditions at once, which is the case the table handles worst.
Low testosterone mood swings and irritability
Low testosterone mood swings rarely settle the question alone. Irritability is listed for low testosterone by Cleveland Clinic and for male depression by Mayo Clinic, so on its own it points nowhere. Hormone swings in the other direction matter too: Cleveland Clinic notes that testosterone that is too high can make a man irritable or quick to anger. Mood changes across middle age are covered in more detail in our piece on andropause and mood changes.
Testosterone and depression treatment: what the trials found
This is where many pages oversell. The trials show a small mood benefit in men whose testosterone is truly low, and no benefit for men with a depressive disorder.
The Testosterone Trials enrolled 790 men aged 65 and older with testosterone under 275 ng/dL and followed them for a year. Men on testosterone reported slightly better mood and lower depression scores than men on placebo, according to Urology Times. Slightly is the right word.
TRAVERSE went further. Among men with low testosterone and significant depressive symptoms, treatment gave modest improvements in mood and energy. In men with major depressive disorder, Endocrine News reported that it did not improve depressive symptoms. Only 1.5% of the men met criteria for a milder, long-running form called low-grade persistent depressive disorder, and in that group there was no significant difference on any outcome.
A 2019 meta-analysis in JAMA Psychiatry by Walther and colleagues pooled 27 randomized trials covering 1,890 men and found a moderate average effect on depressive symptoms, about 2.2 points on the Beck Depression Inventory. The authors themselves flagged how few trials had studied men who were depressed but otherwise healthy, and called for more safety data.
The American Urological Association guideline says men should be told testosterone therapy may improve depressive symptoms when they have confirmed testosterone deficiency. The Endocrine Society guideline does not name mood disorders as a reason to start treatment. Put together, testosterone therapy can lift mood a little in men with confirmed low testosterone. It is not a depression treatment, and a man with major depression who gets testosterone instead of mental health care has been let down.
Myth: If your testosterone is low and you feel depressed, fixing the hormone will fix the depression.
Fact: In TRAVERSE, testosterone therapy helped mood and energy modestly in men with low testosterone, but it did not improve depressive symptoms in men with major depressive disorder. Depression needs its own evaluation and care.
When to get checked, and for what
Get both questions answered. The Endocrine Society recommends against routine testosterone screening of all men, and asks for symptoms plus consistently low morning results before diagnosing low testosterone. The AUA guideline sets 300 ng/dL as a reasonable cut-off and requires two early-morning total testosterone tests on separate days. One low number, drawn at 4 p.m. after a bad week of sleep and a long drive to the lab, is not a diagnosis, and a man who starts treatment on that basis may be treating the wrong problem for months.
Dr. Hakim’s advice is that men with these symptoms, especially sexual dysfunction, should have total and free testosterone checked. A full hormone panel adds tests such as LH and FSH alongside testosterone. At the same time, a depression screen belongs in the same visit. Our article on naturopathic care for anxiety and depression covers the mental health side in more depth.
If you are in crisis or thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline. It is free, confidential and open 24/7, and you can also chat at chat.988lifeline.org. Veterans can call 988 and press 1. Do not wait on a lab result for this.
How Proactive Choice looks at mood and testosterone
At Proactive Choice, Dr. Drew Collins, ND, confirms low testosterone the way the Endocrine Society describes: a fasting, early-morning total testosterone test, repeated on a second morning, with treatment only when results stay low and symptoms fit. The panel usually adds free testosterone, SHBG, estradiol, LH and FSH. His hour-long appointment covers stress, trauma, social environment, current medications, diet and exercise along with the labs, which is where mood problems that have nothing to do with hormones tend to surface.
If you want to know whether testing makes sense before ordering anything, the male TRT clinic in Bend offers a free 10-minute call before any labs are ordered. Call +1 (858) 333-5196.
Frequently asked questions
Can low testosterone cause anxiety?
It may contribute. Cleveland Clinic lists anxiety among the symptoms low testosterone shares with mental health conditions, and Baptist Health notes that body changes from low testosterone can erode confidence and feed anxiety. The direct evidence is limited, and some widely reported work was done in animals. Anxiety has many causes, so a clinician should look at the full picture, not only hormone levels.
Does low testosterone cause depression?
Not on its own, according to Healthy Male, but it can be one of several contributing factors. In the TRAVERSE trial, about half of men with confirmed low testosterone had significant depressive symptoms. Low mood and low testosterone often travel together, which is why both should be checked when a man has persistent low mood, fatigue and low sex drive.
Will testosterone therapy cure my depression?
No. In the TRAVERSE trial, testosterone therapy gave modest improvements in mood and energy in men with low testosterone, but it did not improve depressive symptoms in men with major depressive disorder. The AUA says men with confirmed deficiency may see some improvement in depressive symptoms. Depression still needs its own evaluation and treatment from a qualified clinician.
How is low testosterone confirmed?
The AUA guideline calls for two total testosterone tests on separate days, both drawn in the early morning, with a level below about 300 ng/dL as a reasonable cut-off. Symptoms or signs must also be present. The Endocrine Society adds that tests should be fasting and that routine screening of all men is not recommended.
What should I do if I feel hopeless or have thoughts of suicide?
Call or text 988 to reach the 988 Suicide and Crisis Lifeline, or chat at chat.988lifeline.org. It is free, confidential and available 24 hours a day. Veterans can call 988 and press 1. If you are in immediate danger, call 911. A hormone test can wait; your safety comes first.
Sources
- Cleveland Clinic: Low testosterone and mental health
- Baptist Health: Can low testosterone cause anxiety?
- Healthy Male: Can low testosterone cause depression?
- Endocrine News: The top endocrine science of 2024, part IV (TRAVERSE mood findings)
- MIMS: Depressive symptoms common in hypogonadal men (TRAVERSE, J Clin Endocrinol Metab 2024)
- Urology Times: Testosterone Trials in men 65 and older
- The Hospitalist: Walther et al. meta-analysis, JAMA Psychiatry 2019
- American Urological Association: Testosterone deficiency guideline
- Endocrine Society: Testosterone therapy in men with hypogonadism (Bhasin et al. 2018)
- Mayo Clinic: Male hypogonadism
- Mayo Clinic: Male depression
- National Institute of Mental Health: Men and depression
- University of the Basque Country: Research links anxiety to testosterone and the TACR3 receptor
- 988 Suicide and Crisis Lifeline
Medically reviewed content from Proactive Choice. This article is for education and is not a diagnosis. Talk with a licensed clinician about your own labs and symptoms.
Want to talk this through for your own health? Book a visit with Dr. Drew Collins, ND at 601 NW Harmon Blvd in Bend, or call (858) 333-5196.
