Little was known until now that the sex hormone testosterone also has numerous effects on the male psyche. Male hypogonadism can manifest itself in symptoms such as dejection or sleep disorders through to depression.
On a physical level, testosterone is responsible for maintaining muscle strength and penile erection in men, among other things. If there is a symptomatic testosterone deficiency, i.e. male hypogonadism, this can manifest itself in typical symptoms such as a lack of libido, reduced sexual activity, or erectile dysfunction as well as a decrease in muscle mass or an increase in visceral fat tissue. But testosterone also plays a crucial role in men’s mental health. For one thing, the hormone is important in maintaining mental balance, which is perceived as a positive mood and generally good quality of life; on the other hand, testosterone also increases an individual’s motivation and ability to gain and defend social status.
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General motivation and striving for social status
The behavior patterns promoted by testosterone have often been summarized under the concept of “dominance behavior”. Today we know that they have to be viewed in a much more differentiated way. A higher testosterone level is expressed, for example, in a longer direct look at the other person, an increased proportion of speaking in a conversation, or in a self-confident posture.
The behavioral pattern in which a higher testosterone level is expressed also depends to a large extent on the personality structure or on the “self-conception” of the individual. The psychological concept of self-concept (self-construal) forms the basis for competitive behavior, social status, risk acceptance, and self-esteem. In a study with 400 participating men with pharmacologically increased testosterone levels and independent self-image (the focus is on distinguishing oneself from others), less willingness to cooperate, but at the same time more willingness to take risks. In contrast, testosterone-treated men with an “interdependent self-concept” (here the focus is on the relationship with others) were more likely to try to cooperate in order to get help.
The clinical evidence on the connection between testosterone and the psyche is still incomplete, but the data available to date make it clear that testosterone in men can have a strong influence on both the psyche and psycho-vegetative functions. If a man suffers from hypogonadism, this can have a correspondingly negative effect on psychological parameters. This can lead to mood swings and irritability, exhaustion, listlessness and tiredness, sleep disorders, a reduction in cognitive function, or even anxiety and depression. The distressing symptoms can severely limit the quality of life of those affected.
The psyche also benefits from a hormone balance
Conversely, testosterone therapy can not only improve the classic symptoms of hypogonadism but also have a positive effect on the psychological-psychiatric comorbidity. This is substantiated, among other things, by the data of a meta-analysis of a total of 23 randomized controlled studies with over 3,000 participants that dealt with the effect of exogenous testosterone versus placebo in hypogonadal men. Compared to placebo, testosterone significantly improved the patients’ quality of life (evaluated scales used included Aging Males’ Symptoms, MLHFQ [Minnesota Living with Heart Failure Questionnaire], and SF-36-sexual-function-domain).
Twelve of the included studies with over 800 patients directly examined the connection between testosterone deficiency and depression: Testosterone therapy showed an improvement in depression symptoms (measured using the Hospital Anxiety and Depression Scale and the Beck’s Depression Inventory, among others). Another meta-analysis evaluated 16 studies with a total of 944 subjects. A significant improvement in general mood was observed under testosterone therapy both in men < 60 years overall and in hypogonadal subjects.
The understanding of testosterone deficiency as a “depression driver” is also underpinned by current findings on the treatment of prostate cancer (PCa): It was shown that under androgen deprivation therapy (ADT) in men with PCa, depressive symptoms exacerbated significantly more frequently and more severely than after prostatectomy alone (in the case of the ADT reduces the testosterone level in the blood significantly or below castration level).
It is therefore important for therapists to keep not only the physical but also the psychological symptoms of testosterone deficiency in mind, to recognize them in good time, and if confirmed by laboratory tests, to consider testosterone therapy. Since hypogonadism often occurs in the context of other concomitant diseases, for example, diabetes Mellitus type 2, hypertension, or obesity, there is an increased suspicion of these indications.