An often-debilitating condition, depression can affect anyone and symptoms can range from low motivation and just feeling 'blah', to feelings of hopelessness and suicide ideation. In men, depression will often manifest as anger, irritability, fatigue, insomnia, low libido, a desire to withdraw from social life, a feeling of disconnect and a loss of pleasure from activities that used to be pleasurable. If a man walked into a doctor's office with these symptoms, it would be very likely that he would be given a prescription for an antidepressant. However, there is more to this story and it involves testosterone.
Testoterone is one of the most significant male hormones and responsible for male sexual characteristics, sperm production, body hair growth, muscle mass, bone health, as well as playing an important role in male libido, erectile function and male fertility health. Symptoms of low testoterone include low sex drive and erectile dysfunction, low sperm count, low energy levels, sleep disruption, obesity, reduced muscle mass and strength, loss of body hair, mood swings such as irritability and depression, and declinig cognitive function to name a few.
Testosterone like other steroid hormones, has an effect on certain neurotranmitters responsible for mood regulation in the central nervous system, such as serotonin and gammaminobutyric acid (GABA). There is a strong correlation between low levels of the hormone testosterone in men and symptoms of depression. In fact, low testosterone can be misdiagnosed as depression and prescribing a man an antidepressant can make symptoms worse. This is because not only do antidepressants not address the root cause of low testosterone but they exacerbate the sexual dysfunction symptoms such as poor libido, erectile dysfunction and decreased ability to orgasm. Furthermore, certain antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) have been shown to reduce male fertility due to their negative actions on testosterone production, sperm quality and quantity.
What causes low testosterone?
When talking about low testosterone there are two ways to describe what occurs: the first one arises when organs such as the pituitary, testes or enzymes responsible for making this hormone, are not working as they should and as such, there is a lowered output of testosterone. The second occurs when there is enough production of testoterone but certain factors affect its availability. Some of these factors are discussed below:
Oestrogen: the more oestrogen there is in the body, the higher the production of a protein called Sex Hormone Binding Globulin (SHBG). SHBG binds to testosterone, and even though a man may be making enough testosterone, it is bound up to this protein and as such, not available to exert its actions. Excess oestrogen can come from outside sources such as plastic bottles and personal grooming products (known as xenooestrogens) and from those discussed below.
Alcohol: this increases the activity and expression of a particular enzyme called aromatase that converts testosterone to oestrogen. This may lead to physical changes such as gynecomastia (also known as 'man boobs').
Obesity: the more fat a man has, the more of the enzyme aromatase is present and again, more conversion to oestrogentakes place.
Gilbert's syndrome: this genetic disorder which results in high amounts of bilirubin in the blood, is often categorised as benign but only 8% of those affected will be asymptomatic. The two biggest conditions associated with Gilbert's Syndrome are psychiatric and gastrointestinal disorders. Gilbert's syndrome affects a particular enzyme involved detoxification pathways known as glucoronidation. This pathway metabolises among other substances, oestrogen. Because this pathway is not working to its full capacity in Gilbert's syndrome, there is the potential for excess oestrogen to occur. Excess oestrogen, as already discussed, can lead to low testosterone.
Other factors affecting testosterone levels include a low functioning thyroid, cholesterol-lowering drugs, gut inflammation such as diverticulitis, insulin resistance, stress (emotional and physical), some cancers and cancer treatments (radiation and chemotherapy), injury to, or infection/inflammation of the testes, some antidepressants and antipsychotics. These latter two medications increase the hormone prolactin which, affects the production of testosterone from the testes.
What's the take away message?
As I see it, if a man is displaying symptoms of depression it is important to not automatically assume that it is purely depression and prescribe an antidepressant (be it pharmaceutical, or herbal for that matter). It is important to dig deep and find out if low testosterone may actually be the issue. There is a lot that can be achieved through modifications in diet and lifestyle, herbal and nutritional supplementation to address the issue of low testosterone and bring alleviation of symptoms. Incidentally, as popular as testosterone injections, creams or gels may be in an effort to address low testosterone, they can actually make things worse especially if certain underlying factors already discussed are not addressed. The wisest approach is to identify the underlying cause/s for low testosterone with appropriate testing, and focus on correcting these.
If you or someone you know suspect low testosterone may be the cause for depression symptoms, please seek a qualified health practitioner.
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