How Testosterone Influences Mood Disorders in Men and Women

Is Low Testosterone an Underdiagnosed Cause of Depression in Men?

When people hear the word testosterone, they usually think of muscles, masculinity, or athletic performance. Rarely does anyone think about mood, motivation, or emotional stability. Yet testosterone is not just a “sex hormone.” It is a neuroactive steroid that directly affects the brain — influencing how we feel, think, react, and even connect with others.

The relationship between testosterone and mood disorders is more complex than most people realize. Too little can leave someone feeling flat, fatigued, and unmotivated. Too much can increase irritability and impulsivity. And in women, imbalance can subtly reshape emotional patterns in ways that are often overlooked.

So the real question is this: could low testosterone be an underdiagnosed factor in certain cases of depression, especially in men?

Let’s unpack the science.

Testosterone: A Brain Hormone, Not Just a Body Hormone

Testosterone is produced primarily in the testes in men and in smaller amounts in the ovaries and adrenal glands in women. While it plays obvious roles in sexual development and muscle mass, it also crosses the blood–brain barrier and interacts with key regions such as the amygdala, hippocampus, and prefrontal cortex.

These brain areas regulate:

Emotional processing
Motivation and reward
Memory
Stress response

Testosterone influences neurotransmitters like dopamine and serotonin — chemicals strongly associated with mood regulation. Dopamine, in particular, drives motivation, pleasure, and goal-directed behavior. When testosterone levels drop, dopamine signaling may weaken, which can result in reduced drive, apathy, and loss of interest — classic features of depression.

This is where the conversation becomes clinically relevant.

Low Testosterone and Depression in Men

Major depressive disorder is typically approached through psychological therapy and antidepressant medications that target serotonin pathways. But in men, especially those over 30 or 40, an underlying hormonal component may sometimes be missed.

Low testosterone — clinically termed hypogonadism — can produce symptoms that closely resemble depression:

Persistent fatigue
Low libido
Reduced motivation
Irritability
Difficulty concentrating
Decreased self-confidence

Notice how much overlap there is.

Several clinical studies have found that men with low testosterone levels report higher rates of depressive symptoms. In some cases, testosterone replacement therapy (TRT) has improved mood in men who were both clinically hypogonadal and depressed.

However, this does not mean testosterone is a universal antidepressant. The relationship is nuanced.

Men with normal testosterone levels generally do not benefit from supplementation for mood alone. But in men whose levels are medically low, restoring hormonal balance may alleviate depressive symptoms — particularly those tied to energy, drive, and vitality.

The key issue is underdiagnosis. Many men are treated for depression without ever having their hormone levels evaluated. Given that testosterone naturally declines by about 1% per year after age 30, the hormonal contribution to mood disturbance may increase with age.

The Irritability Factor: When Testosterone Is Too High

If low testosterone is linked to low mood and apathy, what happens when levels are excessively high?

Contrary to popular belief, high testosterone does not automatically make someone aggressive. The science is more precise: testosterone increases sensitivity to status and social dominance cues. It can amplify responses to perceived threats or competition.

When testosterone levels are extremely elevated — particularly due to anabolic steroid use — individuals may experience:

Mood swings
Impulsivity
Increased irritability
Heightened aggression

This is sometimes referred to colloquially as “roid rage,” though that term oversimplifies the phenomenon.

High testosterone seems to enhance emotional reactivity rather than create aggression from nothing. If a person already struggles with emotional regulation, excessive testosterone may intensify those tendencies.

So again, balance matters. The brain does not function optimally at hormonal extremes.

Testosterone and Mood in Women

While testosterone is often labeled a “male hormone,” it is essential for women too. Women produce lower levels, but those levels are biologically significant.

In women, testosterone contributes to:

Energy levels
Sexual desire
Motivation
Cognitive sharpness

Conditions like polycystic ovary syndrome (PCOS) — characterized by elevated androgens — can affect mood. Women with PCOS often report higher rates of anxiety and depressive symptoms. However, the mood effects are influenced by multiple factors, including metabolic changes, body image concerns, and insulin resistance.

On the other end of the spectrum, low testosterone in women, especially after menopause, can contribute to low energy and reduced sense of well-being.

The key takeaway: testosterone influences mood in both sexes, though the expression and thresholds differ.

The Stress Connection: Cortisol vs Testosterone

Mood disorders rarely exist in isolation from stress physiology.

Cortisol, the primary stress hormone, often rises during chronic stress and depression. Interestingly, cortisol and testosterone tend to have an inverse relationship. High chronic stress can suppress testosterone production.

This creates a feedback loop:

Chronic stress elevates cortisol.
Elevated cortisol suppresses testosterone.
Lower testosterone reduces motivation and resilience.
Reduced resilience worsens depressive symptoms.

Over time, this hormonal imbalance may deepen emotional fatigue.

This interplay suggests that mood disorders cannot be fully understood without considering the broader endocrine environment.

Is Low Testosterone an Underdiagnosed Cause of Depression?

The answer is both yes and no — depending on context.

Low testosterone is unlikely to be the sole cause of major depression in most cases. Depression is multifactorial, involving genetics, environment, trauma, inflammation, neurochemistry, and psychological factors.

However, in men with clinically low levels, testosterone deficiency can be a significant contributing factor — especially when symptoms include:

Low energy more than sadness
Reduced libido
Loss of physical vitality
Brain fog

In such cases, failing to assess hormone levels may delay targeted treatment.

The more accurate framing may be this: low testosterone is sometimes an overlooked biological contributor to depressive symptoms, particularly in aging men.

The Risks of Oversimplification

There is growing commercial interest in testosterone therapy, often marketed as a solution for fatigue, low drive, and mood decline. This trend risks oversimplifying the science.

Testosterone replacement therapy carries potential risks, including:

Increased red blood cell count
Fertility suppression
Cardiovascular concerns (still debated)

Hormonal therapy should only be considered after proper medical evaluation and laboratory confirmation of deficiency.

Mood disorders should never be reduced to a single hormone explanation. But neither should hormonal imbalance be ignored.

A More Integrated View of Mental Health

The broader lesson here is that mental health and physical health are deeply intertwined. Hormones, neurotransmitters, sleep, metabolism, stress, and social environment all interact.

Testosterone affects dopamine. Dopamine affects motivation. Motivation influences behavior. Behavior shapes life outcomes. Life outcomes feed back into mood.

This is not a linear chain — it is a biological network.

Understanding testosterone’s role in mood does not diminish psychological or social explanations of depression. Instead, it adds a layer of biological nuance.

Final Thoughts

Testosterone is not simply a hormone of masculinity or muscle. It is a regulator of drive, resilience, and emotional tone. Too little may contribute to apathy and low mood. Too much may amplify irritability and impulsivity. And in both men and women, balance is key.

The idea that low testosterone could be an underdiagnosed contributor to depression — particularly in aging men — deserves thoughtful attention, not hype.

The future of mental health treatment may lie in integration: psychiatry, endocrinology, lifestyle medicine, and neuroscience working together rather than in silos.

Because sometimes, what feels like a purely emotional struggle may also have a hormonal dimension.

And recognizing that possibility could change the way we approach mood disorders altogether.