Low testosterone can contribute to low mood and low energy, and a few small studies link it with anxiety, but it is rarely the whole story. Depression, anxiety and fatigue have many common causes that have nothing to do with hormones. Only an evaluation with proper morning blood tests can show whether testosterone plays a part for you.
It makes sense to wonder about hormones when you feel worn down. Testosterone does affect the brain and body, and Cleveland Clinic notes that it helps boost energy and mood in men. But the research on each symptom is different, so it helps to look at them one at a time.
Can low testosterone cause depression?
Low testosterone is associated with depressed mood, and treating confirmed low testosterone may modestly improve depressive symptoms. It is not a replacement for proven depression care.
Cleveland Clinic lists depressed mood and trouble concentrating among the signs of low testosterone. The American Urological Association guideline says men with low testosterone should be told that treatment may improve depressive symptoms, among other possible benefits.
What the research shows
- A 2019 meta-analysis in JAMA Psychiatry pooled 27 randomized trials with 1,890 men and found testosterone was associated with a significant reduction in depressive symptoms compared with placebo (Walther et al., 2019). The authors called for more trials designed with depression as the main goal.
- The Testosterone Trials in men 65 and older found that men on testosterone reported slightly better mood and lower severity of depressive symptoms than men on placebo (Snyder et al., NEJM, 2016).
- A TRAVERSE substudy of men with confirmed low testosterone found small improvements in mood and energy with treatment. In the small group with a rigorously defined chronic low-grade depressive disorder, there was no significant difference from placebo, possibly because the group was too small to tell (Bhasin et al., 2024).
The takeaway: in men whose testosterone is truly low, treatment may help mood a little. Depression has many causes, and the National Institute of Mental Health notes that genetic, biological, environmental and psychological factors all play a role.
If you are struggling right now
If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988, or chat at 988lifeline.org. It is free, confidential and available 24/7. In a life-threatening situation, call 911. Please do not wait for a hormone evaluation to get this help.
Can low testosterone cause anxiety?
The evidence linking low testosterone to anxiety is limited and mixed. Anxiety is more often driven by other factors, and it has effective treatments of its own.
Cleveland Clinic’s list of low testosterone symptoms includes depressed mood and concentration problems but does not list anxiety. Research on anxiety is mostly small:
- A 2012 study of 39 young men with a congenital form of low testosterone found higher anxiety scores than in healthy men. After 6 months of testosterone treatment, the improvement in anxiety scores was not statistically significant, while depression and sexual function scores did improve.
That is not strong enough to say low testosterone causes anxiety in most men. MedlinePlus notes that the cause of generalized anxiety disorder is unknown, that genes and stress may contribute, and that an exam or lab tests may be done to rule out other conditions with similar symptoms. Talk therapy such as cognitive behavioral therapy and certain medicines are standard treatments.
Can low testosterone cause fatigue?
Low energy is a common complaint in men with low testosterone, but the evidence that TRT fixes fatigue is inconclusive. Fatigue is one of the least specific symptoms there is.
The AUA guideline says patients should be told the evidence is inconclusive on whether testosterone therapy improves energy or fatigue. Trial results are mixed:
- The Testosterone Trials found no significant benefit for vitality, measured with a fatigue scale, after one year.
- The TRAVERSE substudy found small improvements in energy in men with confirmed low testosterone.
Fatigue that does not improve with rest, sleep and less stress deserves its own evaluation, whatever your testosterone level.
The many non-hormonal causes
Most fatigue, low mood and anxiety have causes other than testosterone, and many of them are very treatable. A good evaluation looks for these alongside hormone tests.
MedlinePlus lists common causes of fatigue, including:
- Anemia or iron deficiency
- Depression or grief
- Sleep disorders such as insomnia, obstructive sleep apnea or narcolepsy
- An underactive or overactive thyroid
- Medicines, including sedatives, antihistamines, blood pressure medicines and some antidepressants
- Alcohol or drug use
- Ongoing pain, kidney disease, liver disease or infections
Some of these also lower testosterone. Cleveland Clinic notes that obesity, poorly managed diabetes, obstructive sleep apnea and opioid use are linked to low testosterone. In those cases, treating the underlying problem is part of the plan.
A note for women
Women can also notice changes in mood, energy and sleep around perimenopause and menopause. At Hormone Balance Centers, women’s hormone evaluation is a separate pathway from men’s TRT. Learn more about care for women.
What an appointment at Hormone Balance Centers looks like
Hormone Balance Centers offers telehealth care for eligible adults in Utah and Idaho by secure video, with evening appointments available and no walk-in office. Care is led by Adam Russell, PA-C, a board-certified Physician Assistant with experience in endocrinology and internal medicine.
- Call or text 385-361-8549.
- Complete labs. Your provider decides which tests are appropriate.
- Meet online to review your symptoms, history, labs, risks and goals.
- Receive an individualized care and monitoring plan if treatment is appropriate.
Hormone Balance Centers evaluates the whole clinical picture and does not assume every symptom needs hormones. If your symptoms point somewhere else, that is useful information too. Read more about men’s health and low testosterone.
Frequently asked questions
Can TRT treat depression?
TRT is not a treatment for depression on its own. In men with confirmed low testosterone, studies show it may modestly improve depressive symptoms. Depression should be evaluated and treated directly, and anyone with thoughts of suicide should call or text 988.
Does low testosterone cause panic attacks?
There is no strong evidence that low testosterone causes panic attacks. Research on testosterone and anxiety is limited and mostly small. Panic and anxiety symptoms deserve their own evaluation, because effective treatments exist and other medical conditions can mimic them.
How do I know if my fatigue is from low T?
Only testing can tell. Guidelines call for symptoms plus repeated low morning testosterone levels for a diagnosis. Because fatigue has so many causes, including sleep apnea, anemia and thyroid problems, a full evaluation is more useful than a testosterone test alone.
Will TRT give me more energy?
It might, but it is not guaranteed. The AUA describes the evidence on energy and fatigue as inconclusive. One large trial found small energy improvements in men with confirmed low testosterone, while another found no significant benefit for vitality.
Find out what is really going on
Low mood, anxiety and fatigue are real and worth taking seriously. An evaluation and labs are the only way to know whether testosterone is part of the picture. Call or text 385-361-8549, or get started online. Learn more about low testosterone.
If you are in crisis, call or text 988 now.
This article is for education only and is not a diagnosis. Talk with a licensed clinician about your own health.
Sources
- Cleveland Clinic. Low Testosterone (Male Hypogonadism). https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism
- American Urological Association. Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018, validity confirmed 2024). https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline
- Walther A, et al. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31-40. https://pmc.ncbi.nlm.nih.gov/articles/PMC6583468/
- Snyder PJ, et al. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016;374(7):611-624. https://pubmed.ncbi.nlm.nih.gov/26886521/
- Bhasin S, et al. Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy. J Clin Endocrinol Metab. 2024;109(7):1814-1826. https://pubmed.ncbi.nlm.nih.gov/38205962/
- Aydogan U, et al. Increased frequency of anxiety, depression, quality of life and sexual life in young hypogonadotropic hypogonadal males and impacts of testosterone replacement therapy on these conditions. Endocr J. 2012;59(12):1099-1105. https://pubmed.ncbi.nlm.nih.gov/22972022/
- National Institute of Mental Health. Depression. https://www.nimh.nih.gov/health/topics/depression
- 988 Suicide & Crisis Lifeline. https://988lifeline.org/
- MedlinePlus (National Library of Medicine). Generalized anxiety disorder. https://medlineplus.gov/ency/article/000917.htm
- MedlinePlus (National Library of Medicine). Fatigue. https://medlineplus.gov/ency/article/003088.htm