We have written before about escalating depression and suicide rates in Men. We have also highlighted that there has been a steady drop in Male Testosterone levels for the last two generations at least.
Is there some mechanism that links the falling Testosterone levels of modern Men, with the increase in Male depression and suicide?
This gets heavy, but stay with me. The conclusions of this dive into the literature are profound for anyone wrestling with the black dog of depression.
Anxiety and depression are the most common and frequently undiagnosed psychological problems associated with low Testosterone (T) males. (Aydogan 2012)
Depression is a complex interplay between social and physiological factors. A myriad of stressors and lists of exotic brain chemicals combine into the mental state that you could call ‘mood’.
Perhaps that is why the link between Testosterone and Depression is not always noted in the medical literature. Non-the-less, several studies associate low T levels and depressive symptoms, and several more demonstrate an improvement in depressive symptoms in hypogonadal (reduced testicular function) men who are given T (Westley 2015, Seidman 2013, McHenry 2014, Kera 2013, Johnson 2013, Ayodgan 2013, Aziz 2009).
Unfortunately, this is a topic that is not on the radar of most doctors. In many countries, T levels in Men are just not medically fashionable. Unless you are in America, when your physician may well reach for the Testosterone gel after nothing more than a quick questionnaire!
Hence, when you go to see your medical professional, as a depressed male, it is highly unlikely they will give this essential male hormone a second thought before reaching for the SSRI’s, the usual first choice Antidepressants.
SSRI’s or Selective Serotonin Reuptake Inhibitors (anti-depressants) increase the levels of Serotonin, an important neurotransmitter, in the brain.
Interestingly, whilst there is some good evidence that these SSRI’s are effective in certain types of depression, NICE (the National Institute for Clinical Excellence) recommend against their use in individuals with mild depression.
Surely, just adding more Serotonin into the brain is a crude way of trying to help, especially given that there is no commonly available way to even test levels of Serotonin in your brain. This is a bandage approach, which may be useful in managing symptoms temporarily, but long term use of such medication is not conducive to good health, nor synonymous with evidence based practice (Cartwright 2016).
Women are twice as likely to suffer from depression and anxiety (McHenry 2014). Since Men have plasma Testosterone concentrations 7 to 8 times higher than those of Women (Johnson 2013) Could this (a protective effect of T against depression) be one of the reasons for the lower overall rates of anxiety and depression seen in males? Depression rates in men increase as they age, corresponding with a time in life when Testosterone levels are falling, with around a quarter of middle aged men having Testosterone levels below deficiency thresholds (Seidman 2013).
Why do we see depression in some Men with low T? Or conversely, why does low T precede depression in some Men?
The HPG axis, or the Hypothalamic-Pituitary-Gonadal axis, may hold the answers to these questions.
The HPG axis is central to the mammalian reproductive system (Sam 2010). The ultimate expression of an organism’s fitness is its ability to reproduce. From a biological perspective, it is why you are here, and the drive to reproduce is the strongest you will ever experience. The Hypothalamus in the brain secretes molecules, that tell your Pituitary Gland to secrete molecules, that tell your Testes to produce Testosterone (Asimakopoulos 2012). That Testosterone then circulates in your system and gives you the many Masculine characteristics that we associate with this hormone.
In times of stress, the HPG axis is supressed (Toufexis 2014). This makes complete sense. You don’t want to be trying to create offspring when existential survival is at stake. Hence, the subjective experience of stress can lead to reproductive dysfunction in many species, including humans (Kirby 2009). It is the HPA axis, or the Hypothalamic-Pituitary-Adrenal Axis, that is key here. Cross talk between the HPG and HPA axis is a well documented occurrence (Viau 2002). The Hypothalamus in your brain secretes molecules, that tell your pituitary gland to secrete molecules, that tell your adrenal glands to produce glucocorticoids. This allows you to adapt to stress and maintain health in the face of difficulty.
Stress or acute challenge often precipitates the onset of depressive episodes (Heim 2008) and it is clear from the literature that hyperactivity of the HPA axis is one of the most prominent findings in depression (Pariante 2008). The glucocorticoids produced by the HPA axis supress HPG activation (and thus Testosterone secretion). Conversely, Testosterone produced by the HPG axis inhibits the HPA axis (Viau 2002, Toufexis 2014).
In fact, animal studies have shown that Testosterone even inhibits HPA response to inflammatory molecules (Papadopolous 2008). This is important, because there is an inflammatory component to depression alongside HPA axis dysregulation (Lamers 2013).
Summary: The HPG axis ultimately produces T. Stress can increase the HPA axis activity and inhibit T
There is one more factor worth including here. Body fat.
White Adipose Tissue (WAT) is most certainly not an innocent spare few pounds sitting around your waist. Your WAT secretes Leptin. Leptin is a hormone controlling appetite, energy expenditure and weight maintenance. Interestingly, it also acts as a reproductive permissive factor in the function of the HPG axis. That is, Leptin tells the HPG to get secreting Testosterone. Again, this makes evolutionary sense. You don’t want to have children when you are literally starving.
Since Leptin is secreted in proportion to the amount of body fat stores present, you may think it would be wise to get fatter. Not so. Excess Leptin may contribute to hypogonadism (diminished activity of the Testes) through a variety of mechanisms (Sam 2010). So, your Leptin levels need to be optimal, not chronically high.
Additionally, WAT also secretes Aromatase. Aromatase is an enzyme that converts Testosterone into Oestrogen, the female sex hormone. Man boobs anyone?
Summary: Body fat secretes Leptin. Leptin stimulates the HPG axis. Secrete too much Leptin however, and you stop responding to it.
From this information it is clear that taking action to drive up HPG axis expression, and minimise HPA axis activity, is essential in tackling the symptoms of low T in depression.
To be able to do this, we need to know what inputs alter HPG function. This is where things get really interesting.
Nerve cells at the very top of the Hypothalamus in the brain effectively act as master regulators to the HPG axis. These neurons are controlled by several molecules which are activated by reproductively relevant social signals. Fascinatingly, these modifications can occur at a genomic level. Yes, your social situation and your behaviour is literally switching on and off your genes.
In vertebrates, numerous studies demonstrate HPG activation by auditory, olfactory and tactile social signals. In addition to sensory channel specific signals, social interactions such as courtship, exposure to the opposite sex, opportunities to rise in social rank and dominant social positions influence the HPG axis (Maruska 2011).
The situation is no different in humans. You can drive up your HPG axis simply by being in the presence of an attractive female. Smelling the scent of an ovulating woman will activate your HPG axis and increase testosterone (Miller 2010). Yes, you read that right!
Even adopting a dominant body posture will increase your T within minutes (Bohns 2012)
Depressed people often withdraw from social situations. Just visualise the stereotypical body posture of a depressed Man. Hunched shoulders, hands in pockets, chin down staring at the floor. This is submissive posturing, and the neuroendocrine system responds accordingly. Add to it implied low social rank by being put down by his boss, or his wife, or his friends, and it is easy to see how this can lead a Man on a self-perpetuating downward spiral. His stress hormones high and prone to over reacting, whilst at the same time his Testosterone levels plummeting.
Summary: Simple sensory queues like smell and touch activate the HPG axis. Social queues also activate or suppress it. Even your posture affects it!
A simple strategy for Men to start to reverse this trend would be to begin adopting dominant body postures. Stand up straight, stick your chest out, look people in the eye. Take up physical space whenever reasonably possible.
Then get into the presence of other people. Talking to an attractive Woman, smelling her perfume, debating with some other guys and getting your point across, engaging in some competitive activity. All this will start to bolster your HPG axis which will in turn supress your HPA axis.
As this happens you will become more and more resistant to stress. Testosterone increases your resistance to stress by downregulating the HPA axis. It increases motivation and promotes social status seeking and dominance (Eisenegger 2008).
In short, you start to become a completely different animal.
It may not be politically correct to be so blunt, but this is your mental health we are discussing. While you are doing this, sort out your body composition! If you are holding high levels of body fat, it is a recipe for Leptin resistance. If your Leptin levels have been too high for too long, your brain will no longer respond to it. Remember, Leptin signals to the HPG axis to produce Testosterone.
We can see that there are clear physiological mechanisms driving down Testosterone levels in depression. Unlike medication, simple strategies like social and postural techniques work to reverse this. Alongside the assertive use of diet and exercise, these have very few negative side effects. (Note, I will publish a full T boosting protocol, including an in depth analysis of diet, supplements, exercise et cetera in the near future)
Perhaps the most profound message from this information is that you are not a helpless victim of your mental state.
Check your T levels and if they are in the low range, address it immediately, starting with some of the suggestions above.
The knowledge that you can directly control, within minutes, your own endocrine system is empowering. Understanding that adapting your behaviours and habits can switch on genes that will work to help you in your situation is nothing short of amazing.
If you are reading this and the black dog of depression is upon you, reach out to someone, and take positive action.
The future will not be easy and there will be tough days ahead.
Would you rather face them with head held high and healthy levels of Testosterone coursing through your system?
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Aziz ZF et al (2009) Testosterone and Depression: Systemic Review and Mate-Analysis, J of Psych Practice, 15;4, 289-305
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