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Encountering a sudden episode of depression, anxiety, mild to moderate loss of memory, or frequent inattention is quite common in middle-aged and aged men amid an otherwise everyday life. 

Though these may seem like some common psychological issues, they might be the mental effects of low testosterone (T) levels. 

Apart from creating sexual health-related issues, Low T is also associated with various changes in our central nervous system that can affect the quality of life significantly. 

Thankfully, with the support of clinical evidences, recovery from Low T is possible with TRT (testosterone replacement therapy) for mental health issues. 

TRT is one of the best testosterone booster so far, and one of the most promising TRT benefits are recovery from low testosterone mental symptoms. 

The Link between Low Testosterone and Mental Health

Testosterone is a male reproductive hormone primarily released from the gonads and adrenal cortex of most vertebrate species. Although T is available in both male and female bodies, its level is ten times higher in the male body than in the females. Low testosterone levels in serum are an indication of hypogonadism often observed in the advanced age of males with common symptoms like sexual health problems, hot flushes, decreased muscle mass, visceral fat gain, tiredness, insomnia, mood fluctuation, and lack of concentration. 

Apart from the other functions, this hormone in the brain acts as a precursor of neurosteroids like dihydrotestosterone or androstanediol, which participates in neurotransmitter release excitabilities of neurons and thus have some significant associations with mood disorders.

It is evident from various investigations that Low t and anxiety or depression are highly correlated, and it has a direct impact on day-to-day decision-making and stress response in a regular manner. This correlation might be due to its association with the release and uptake of some of the most vital neurochemicals (or neurotransmitters) in our brain that closely control the mood and behaviour of individuals.  

Testosterone can increase dopamine release (a neurotransmitter that helps to keep someone motivated and rewards with a desirable outcome) and give protection against the depression-induced inability to perform work. 

Low T and its neurosteroid derivatives also affect the “happy neurotransmitter” serotonin, which has well-established anti-depressant activity. Some studies show that serotonin neurons have high firing rates when administering testosterone supplements. Testosterones' metabolites can interact with serotonin receptors and increase the serotonin level, providing anti-depressant activities.

Some preclinical data give evidence that testosterone treatment for depression is effective. If injected in adult or aged animals, T or its metabolites can reduce depression dose-dependently. T controls chemical messengers of CNS, like GABA, that inhibit the action-taking process of the brain and reduce the chances of depression. Furthermore, multiple studies have shown that the anxiolytic effect of testosterone is mediated through the GABA-A receptor. It is pretty evident from various studies that lower serum T levels have more tendency to have depression than normal testosterone levels male. In such cases, testosterone treatment for depression demonstrated a promising result.

Common Mental Health Symptoms of Low Testosterone

In our day-to-day lives, the level of anxiety often determines our decision-making and stress-management capabilities. It is pretty evident from various clinical and preclinical research that low T and anxiety are most closely related among all other mental effects of low testosterone in both genders. The probable mechanism behind the connection between low T and anxiety is that testosterone-induced anxiolysis might be the blockage of androgen receptors in the CNS. In addition, lower testosterone metabolites in the hippocampal area correlate with age-related cognitive decline. In preclinical or clinical studies in both genders, it is evident that a low level of endogenous testosterone induces socially submissive, avoidant behaviour. In contrast, a high basal testosterone level ensures approaching quality and dominance in behaviour. In otherwise healthy participants, administering testosterone supplements prior to threat exposure shows less fear. 

In men, the tendency to get depressed increases with age as the level of bioavailable testosterone drops. Low T and depression both increase the risk of falls and reduce the life expectancy in older age. It is still a question whether depression leads to low testosterone levels or low testosterone levels lead to depression, as evidence for both exists. However, there is no doubt that in a person with hypogonadism-induced depression, testosterone administration shows an anti-depressant effect. This anti-depressant effect is often dose-dependent. 

Declining spatial cognitive abilities and memory with age are some of the mental effects of low testosterone. The ability to rotate mental representations of 2D and 3D image and testosterone level are connected, and a increase testosterone level is associated with better mental rotation. However, factors like genetic factors or the size of the corpus callosum may affect the observation. Some reports suggest that testosterone supplements to the aged population improve spatial abilities.

Testosterone positively attenuates memory in both male and female individuals. Testosterone supplement improves learning and memory formation after menopause in women and andropause in men. Moreover, such improvement in spatial and verbal memory formation is visible after only short-term (6 weeks) treatment regimens. In some research, it has been observed that both men and women may be susceptible to low estradiol levels, leading to cognitive decline. However, these results are not always linear and sometimes depend on genetic or epigenetic factors. The genotype interactions sometimes influence the testosterone function on age-related decline in cognition. Although the exact mechanism by which testosterone aids in memory formation is unknown, research has found that testosterone has an organizational effect on the hippocampus, the prime region of the brain responsible for forming memories. Most likely, T and estradiol play some physiological and pathological roles in the brain, ultimately affecting the mechanism of memory formation in the brain.

How TRT Benefits Low Testosterone and Mental Health Symptoms

Increase testosterone level up to a level as good as normal testosterone levels male is the ultimate goal to reduce hypogonadism and its associated symptoms. Among the popular therapies for hypogonadism, TRT (Testosterone replacement therapy) is the best testosterone booster to combat hypogonadism with a target to increase testosterone levels to normal. The therapy effectively induces endogenous production of testosterone and its active metabolites and alleviates the low testosterone mental symptoms. TRT for mental health will further ensure the highest quality of life, which will be as good as any normal testosterone levels male.

TRT helps to reduce the various low testosterone mental symptoms during hypogonadism and reverses life towards normalcy by reducing depression, uplifting mood, increasing energy and creating a sense of well-being. This effect of TRT for mental health during hypogonadism is supported by a series of scientific evidence. Randomized control trials of testosterone supplements on middle-aged and aged men with low T levels have proven their efficacy in managing fatigue and well-being in general. In hypogonadal men with major depressive disorder, TRT acts partially as an anti-depressant. Studies have shown that using TRT as a gel formulation gives more significant results than selective serotonin reuptake inhibitor (SSRI) in hypogonadal men. One has to keep in mind that testosterone supplements work when the T level is only below the level of T as observed in normal testosterone levels male. Once achieving an increase testosterone level or its derivative, further administering TRT may not improve mood disorders. One more thing that needs to be addressed is that some of the investigations show contradictory results of TRT, which may not be effective on the low testosterone mental symptoms in men. This discrepancy might result from genetic polymorphism associated with testosterone metabolism and epigenetic variability in populations, which might require a variation in the dose duration of therapy.

Various research studies have found a correlation between normal testosterone levels and cognitive abilities, including spatial reasoning and mathematical skills. The bioavailable concentration of T is correlated with memory processing, formation, and cognition in aging males. It should be noted that trials on testosterone supplementation are typically evaluated over short durations, making the effect on cognitive improvement mixed in nature. However, short-duration TRT treatment on older men has improved some cognitive deficits, such as improvement in verbal fluency and spatial cognition and, to some extent, working memory errors.

Testosterone is available as intramuscular injection in the form of Testosterone cypionate or Testosterone enanthate and in topical cream or gel formulation. The treatment choice will be based on the patient's safety, efficacy, contraindication and tolerability. TRT must be taken by the patient in the presence of healthcare professionals so that any contradiction or side effects can be ruled out. TRT benefits patients with low T levels along with stable cardiovascular conditions, candidates with no history of prostate cancer or those who are successfully treated for prostate cancer. Further regular monitoring to observe the clinical response or any contraindication to TRT is essential through the first year of medication.

Here are some frequently asked questions regarding Testosterone level, mental health and TRT.

FAQs

Q. Does a low T level can affect your mental health?

A. It is a fact that testosterone levels and brain functions are physiologically connected. Therefore, changes in testosterone levels can have an impact on brain functions.

Q. Does depression and anxiety in aged men mean low T level?

A. Not all psychological issues are caused by a deficiency in testosterone. Therefore, it's not always the case that such issues are related to T levels.

Q.  Can TRT improve mental health?

A. Yes, TRT can improve mental health if a low T level accompanies the condition.