Can TRT help treat depression?

Dr Doug Savage

MBChB, MRCGP

Medical director

Depression affects millions of people globally. It can have a profound impact on daily life, influencing mood, energy levels, sleep, and even physical health. While traditional treatments, such as antidepressants and therapy, can be effective, they don't always work for everyone.

For some men with low testosterone, testosterone replacement therapy (TRT) can help reduce symptoms of depression. At Leger, we specialise in testosterone treatment and have witnessed firsthand how hormone imbalances can affect mental health.

In this blog, we will look at how TRT can help treat depression. We will discuss when it is right to consider it and what to remember before starting treatment. 

Contents

• The link between testosterone and depression
• When might TRT be considered for depression?
• The science behind TRT and depression
• A patient’s perspective: when TRT makes a difference
• The risks and considerations of TRT
• Is TRT right to treat depression?

The link between testosterone and depression

Depression can arise from a variety of causes—genetic, environmental, chemical, and hormonal. In men, testosterone plays a significant role in both physical and emotional wellbeing. 

Low testosterone levels (hypogonadism) can lead to a host of symptoms, including depression.

Symptoms of low testosterone include [1]:

• Depression
• Difficulty concentrating
• Erectile dysfunction
• Fatigue
• Increased body fat
• Loss of libido (sex drive)

As men age, testosterone levels naturally decline, and this hormonal shift can sometimes trigger or exacerbate depressive symptoms.

The link between low testosterone and depression has been studied extensively. The relationship is complex, but evidence shows that restoring testosterone to normal levels can improve mood. This is especially true for men with low testosterone [2].

When might TRT be considered for depression?

TRT is not a first-line treatment for depression. Typically, doctors recommend antidepressants alongside psychotherapy, as the initial approach to managing depressive symptoms. If traditional treatments don't help, you might consider TRT. This is especially true if you have signs of low testosterone levels.

Some patients experience a significant improvement in their mood with TRT. This is especially true for men with dysthymic disorder or long-term depression.

For older men or those with hypogonadism symptoms, TRT can effectively treat the hormonal imbalance causing their depression.

Doctors should only consider TRT for men with confirmed low testosterone levels through blood tests. It is not a general treatment for depression and may not be effective for men with normal testosterone levels.

The science behind TRT and depression

Several studies have investigated the link between testosterone therapy and improved mood. Research suggests that in men with low levels of available testosterone, restoring those levels may improve mood, energy, and overall wellbeing.

Testosterone is known to influence many aspects of health that overlap with depressive symptoms, including:

• Energy: Low testosterone is often associated with fatigue and low energy, which can contribute to the lethargy seen in depression.
• Libido and sexual function: Decreased libido is common in both depression and low testosterone, and TRT can help restore sexual desire and performance.
• Cognitive function: Testosterone may influence cognitive health, including memory and focus, both of which can be impaired by depression.
• Physical health: TRT can lead to increased muscle mass, improved body composition, and better overall physical health, which may indirectly boost mood and self-esteem.

However, not all studies agree. Some clinical trials have found little to no difference between men treated with testosterone and those given a placebo [3]. More research is needed to fully understand who might benefit from TRT in the context of depression, and why some respond while others do not.

A patient’s perspective: when TRT makes a difference

Dr Doug Savage is a top expert in testosterone therapy at Leger. He's seen many cases where TRT changed the lives of men with depression. One case involved an older man in his 70s who had been struggling with severe depression for years. After being prescribed various antidepressants by his GP, with no success, he was referred to a psychiatrist — but still, his condition didn’t improve.

Doug noticed the man's complaints about intense night sweats. This is a common symptom of low testosterone. Blood tests revealed the man had low testosterone levels, and he was started on TRT. 

The result was remarkable: it wasn’t just his mental health that got better; he regained vitality and physical comfort in his daily life.

Leger advocates for a more comprehensive approach to treating depression in men, particularly those who have not responded to traditional therapies. We believe it’s crucial to check testosterone levels as part of the diagnostic process for male patients with depression, especially when symptoms like fatigue, low libido, and poor concentration are present alongside low mood.

The risks and considerations of TRT

While TRT can offer benefits for men with low testosterone, it's not without risks. 

Testosterone is a powerful hormone, and over-administration can lead to serious side effects, including:

• Cardiovascular risks: TRT may increase the risk of a heart attack or blood clot, especially in older men or those with pre-existing cardiovascular conditions.
• Reproductive issues: High doses of testosterone can suppress sperm production, which may affect fertility.
• Mood swings and aggression: In some cases, TRT can lead to mood instability or increased aggression, particularly if testosterone levels are pushed too high.
• Prostate health: Testosterone therapy can potentially affect prostate size and may not be suitable for men with a history of prostate cancer. A prostate specific antigen (PSA) blood test may be used to monitor prostate health during treatment.

Is TRT right to treat depression?

TRT is a promising treatment for some men with depression and testosterone deficiency. While it’s not a cure-all for depression, it can be a powerful tool in managing mood disorders in specific cases.

If you’re struggling with depression and have not found relief with antidepressants, it might be worth considering whether low testosterone could be contributing to your symptoms. At Leger, we offer thorough testing and expert guidance to help you determine whether TRT is a suitable option for you.

References

1. Khera M. Patients with testosterone deficit syndrome and depression. Arch Esp Urol. 2013 Sep;66(7):729-36. PMID: 24047633.
2. Anderson DJ, Vazirnia P, Loehr C, Sternfels W, Hasoon J, Viswanath O, Kaye AD, Urits I. Testosterone Replacement Therapy in the Treatment of Depression. Health Psychol Res. 2022 Nov 26;10(4):38956. doi: 10.52965/001c.38956. PMID: 36452903; PMCID: PMC9704723.
3. Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, Gill TM, Barrett-Connor E, Swerdloff RS, Wang C, Ensrud KE, Lewis CE, Farrar JT, Cella D, Rosen RC, Pahor M, Crandall JP, Molitch ME, Resnick SM, Budoff M, Mohler ER 3rd, Wenger NK, Cohen HJ, Schrier S, Keaveny TM, Kopperdahl D, Lee D, Cifelli D, Ellenberg SS. Lessons From the Testosterone Trials. Endocr Rev. 2018 Jun 1;39(3):369-386. doi: 10.1210/er.2017-00234. PMID: 29522088; PMCID: PMC6287281.