Background information
Testosterone therapy for men: craze or cure?
by Anna Sandner
Testosterone therapy and depression – is there a link?
29.8.2025
Translation: Jessica Johnson-Ferguson
Testosterone is the subject of much debate – it’s said to boost energy and libido and have an antidepressant effect. But are we right to believe the hype around this messenger substance people's results from self-medication? Dr Andreas Walther from University of Zurich, who’s an expert in this field, has the answers.
When it comes to the topic of testosterone, emotions quickly run high – this is not least demonstrated by the lively community discussion under my last article on testosterone replacement therapy. Conflicting emotions fuelled by the worry of dropping hormone levels, the hope for new energy and scepticism towards drug advertising have opinions clashing over testosterone intake. You’d struggle to find another hormone that’s tied to so many hopes, advertising promises and myths as the virility hormone testosterone.
But what do the experts say, does a lack of testosterone actually make you depressed? Is hormone therapy as effective as some fitness influencers and manufacturers suggest? If so, what are the risks? To gain more clarity about this complex topic, I spoke to Dr Andreas Walther. As a psychotherapist and hormone expert, he speaks about the latest developments in science and why uninformed self-medication can sometimes do men more harm than good.
Dr Walther, in recent years testosterone has not only been hailed a masculinity booster, but also as a potential remedy for depression. Where did this research approach come from?
Dr Andreas Walther: Both in the beauty and health sector, men have been discovered as an untapped market in recent years. And testosterone plays a role in both sectors. First of all, allow me to address the common misconception that only men have testosterone. Women also have testosterone, but in much smaller quantities. Men have ten to twenty times higher levels, depending on the measurement.
How exactly does testosterone work in the body?
The most solid finding comes from studies on animals. If they’re injected with testosterone, their sexual activity increases. The same applies to humans. Being an anabolic hormone, testosterone also improves body composition. Unlike the catabolic stress hormone cortisol, it builds muscle and increases fat burning. However, there’s no evidence that testosterone improves cognitive function or memory performance. That’s a myth, as clinical studies have revealed nothing pointing towards this.
What about mood? How does testosterone affect your mental health?
Testosterone can directly affect your mood, but it also has an indirect effect. If you’re experiencing an increased libido and act upon it (i.e. have more sex), this will have a positive effect on your mood. Or you might be more physically active because of increased testosterone, which will make you feel better.
We also know from studies conducted on mice that testosterone promotes the survival of neuronal cells. As an anabolic hormone, it supports new connections in the brain, which can be helpful in individuals with depression. For example, if a man has depressive thought patterns and then forms new neuronal connections, they’ll survive better if there’s more testosterone in his system.
Testosterone also inhibits your stress response system. High levels of testosterone reduce the release of stress hormones and slow down inflammatory processes. What’s more, testosterone activates your serotonin system, on which modern-day antidepressants are based.
Does injecting testosterone relieve depression in men?
Dr Walther: This was investigated in a meta-analysis carried out on 1,890 men. The question was if testosterone has an antidepressant effect. And, sure enough, it seems to have a positive effect. The research showed an overall effect, even if it wasn’t mind-blowing. It’s comparable to the effects of antidepressants. However, the scientific evidence for antidepressants is a lot more solid, as studies exist that involved several hundred thousand test subjects.
Did you know: Testosterone has an effect on symptoms of depression regardless of whether the respective men originally had low or regular testosterone levels. In other words, men without hypogonadism (testosterone deficiency) also benefited from it.
Sounds promising. Did you also find a link between depression and low testosterone levels?
The results are contradictory. A colleague of mine carried out a systematic review, which revealed that depressed men had lower testosterone levels than healthy controls. But in our own clinical trial involving 72 depressed men and around 100 healthy controls, we were unable to confirm this.
We were dealing with younger men aged between 25 and 50 with first-time depression without other mental or physical illnesses. We didn’t see that these depressed men had lower testosterone levels. In fact, in some cases the healthy controls even had lower levels. We searched intensively for hypogonadal men (men with testosterone deficiency) among the depressed men, but found none.
It’s been proven that testosterone has a positive effect regardless of the actual level, so why isn’t it simply prescribed to all men with depression?
This was my first thought, too. But the problem with hormones is:
Once you start dabbling with your hormone balance, it can easily become unstable.
If you’re constantly supplying your body with additional testosterone, it’s going to think it has enough and will stop producing it. The body’s long-term ability to release testosterone itself may then become inhibited to such an extent that it may not be able to get back on track when you stop supplementing.
That’s why I’d advise all men against supplementing testosterone if they have normal values. There’s no reason for this.
There are other risks, too. If an undetected prostate carcinoma is present and testosterone is administered, the growth of cancer cells can be promoted.
Why isn’t testosterone used more often to treat depression, at least in men with low levels?
There are several reasons for this. Firstly, the pharmaceutical industry has no interest in testosterone because it’s no longer patented. In other words, you can’t make money with it, because it’s cheap to produce. Secondly, the evidence base proving it’s a good treatment for depression is somewhat weak. There are no large, well-designed studies out there. And thirdly, you’d always have to screen patients before treatment, but it would be too costly if all men with signs of depression needed to take a blood test first.
What advice would you give a man who found out via a self-test that his testosterone levels are on the low side?
The question is how low. As long as you’re above 20 nanomoles per litre, everything’s fine. If you’re looking at 15, 14, or 13 nanomoles per litre, you’re starting to approach the cut-off value of 12.1 nanomoles per litre. This cut-off is based on thorough clinical studies. It’s also important to know that it’s not just testosterone you need to look at, but also androgen receptors (binding sites for male hormones). How sensitive are they? Someone with lower testosterone levels but very sensitive receptors may be feeling better than someone with higher levels and less sensitive receptors.
I strongly advise against experimenting with hormones without medical supervision.
Intervening in these complex systems is risky. And if you’re ordering pills online, you won’t know what’s in them.
When is using testosterone to treat depression a viable option?
We now know that testosterone can influence your mood and drive, as well as affect your stress system and serotonin levels. All these factors play a role in depression. Our own and other studies have shown that testosterone has a positive effect on depressive symptoms, which is also the case regardless of the individual’s initial value. However, although these effects are present, they’re not huge and, above all, are still not scientifically backed up enough by large, well-conducted studies. Unlike antidepressants, there are still far too few test subjects for testosterone and too many unanswered questions. For example about side effects or long-term consequences.
As long as there’s no solid research, i.e. really large, controlled studies with different patient groups, blanket testosterone therapy for depression remains wishful thinking. It’s an exciting field with untapped potential. But there’s still a lot of research to be done.
Header image: Akarawut/Shutterstock
Anna Sandner
Senior Editor
Anna.Sandner@galaxus.deScience editor and biologist. I love animals and am fascinated by plants, their abilities and everything you can do with them. That's why my favourite place is always outside - somewhere in nature, preferably in my wild garden.
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