Men’s Health and Psychiatry

Abstract

Prevalent mental health conditions vary significantly between men and women. Men have more substance use disorders, autism, and ADHD, while women have twice the prevalence of depressive and anxiety disorders as men. These differences in prevalent mental health conditions may be mediated in part by androgens. Testosterone has effects on brain structure and function including increased cerebral blood flow, serotonergic neural firing, neurogenesis, and neurotransmitter regulation. With aging, testosterone levels decline, and depressive illness and medical morbidity increase. Most cross-sectional and prospective studies have reported an association between low serum testosterone levels and depressive symptoms. This association may be due to a physiologic effect of low serum testosterone, but also could be related to confounders such as medical morbidity. The results of testosterone treatment trials on mood have been conflicting with particular subgroups of men appearing to be more responsive to testosterone treatment. Men who were more likely to respond to testosterone treatment were hypogonadal, middle-aged men with less severe depressive disorders or treatment refractory depression. Men who were less likely to respond were eugonadal or older than 60 years. Due to conflicting findings from prior studies, testosterone cannot be recommended as routine treatment for men with depressive illness, particularly for major depression. However, in men diagnosed with hypogonadism, potential beneficial mood effects could be considered when assessing the overall benefits and risks of treatment. Further studies are needed to clarify the effects of testosterone on mood and to identify subgroups of men who may be more responsive to it.