Most men don't realise how testosterone levels and depression connect as they age. Research shows that all but one of these men over 60 have normal testosterone levels. The decline starts around 50 when the body produces less of this key hormone. The impact goes beyond physical changes and can deeply affect mental health.
Research points to a strong link between low testosterone and depression, especially when you have older males. Men's depression looks different from women's depression, which makes it harder to spot. Men who are depressed tend to become irritable and tired. They also lose interest in activities they used to enjoy. People often miss these signs or brush them off as normal ageing. A systematic review of 27 clinical trials revealed that testosterone therapy helped reduce depression symptoms. However, some studies tell a different story.
This piece dives into how falling testosterone levels and depression affect men over 60. You'll learn about testosterone's role in mood regulation and what science tells us about this connection. We'll also cover treatment options that work and ways to open up about a condition that impacts countless older men. This knowledge helps both men going through these changes and their loved ones understand what's happening.
Understanding Testosterone Decline After 60: Testosterone, Depression, and Men’s Health
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Testosterone, known as the male hormone, follows a predictable pattern throughout a man's life. Men need to understand how this vital hormone changes with age. They should also recognise symptoms of its decline to address problems linked to low testosterone and depression.
How testosterone levels change with age
Most men don't realise their testosterone production starts dropping much earlier than expected. Men's hormone changes differ from women's experience during menopause. The drop in testosterone happens slowly but steadily. This natural decline starts between ages 30-40, with testosterone falling at an average rate of 1-1.6% per year for total testosterone [1].
The body's most active forms - free and bioavailable testosterone - drop even faster at 2-3% each year [1]. This happens partly because ageing raises sex hormone-binding globulin levels, which cuts down the amount of active testosterone available [1]. By age 70, a man's testosterone production sits about 30% below its peak [2].
The numbers paint a clear picture of testosterone decline in male populations:
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20% of men over 60 have total testosterone levels below the normal range [1]
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This number jumps to 50% in men over age 80 [1]
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All but one in four older men keep their testosterone within normal range despite the decline [2]
Each man's story is different - some keep higher levels throughout life while others see bigger drops [3]. The decline doesn't always lead to noticeable testosterone deficiency, which doctors call late-onset hypogonadism (LOH) [1].
Several health issues can speed up testosterone decline [4]:
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Type 2 diabetes (affecting 24.5% of men with diabetes vs 12.6% without) [5]
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Obesity (affecting 30% of overweight men vs 6.4% with normal weight) [5]
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Chronic conditions like kidney and liver diseases [4]
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HIV/AIDS (affecting 30-50% of patients) [5]
High stress levels and cortisol also play a big part in reducing testosterone production in men over 60.
Common symptoms of low testosterone in older men
Spotting low testosterone can be tricky because many symptoms look like normal ageing [1]. Doctors usually group symptoms into two categories: specific (directly tied to testosterone deficiency) and non-specific (possibly caused by other conditions) [5].
Specific symptoms that point more clearly to low testosterone include:
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Less interest in sex and erectile problems [3]
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Thinner body and facial hair [3]
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Muscle loss and weakness [3]
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More tiredness and low energy [3]
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Growth of breast tissue (gynecomastia) [3]
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Hot flashes (like those women get during menopause) [1]
Non-specific symptoms that might mean low testosterone but could have other causes include:
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Signs of depression in men, including bad moods and irritability [3]
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Brain fog: poor focus, memory problems, trouble finding words [5]
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Poor sleep and feeling sleepy during the day [2]
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Weight gain, especially around the belly [3]
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Weaker bones (osteoporosis) [6]
Depression symptoms in men often overlap with low testosterone signs. Many men don't realise their mood changes might stem from hormone levels.
Men over 70 might notice stronger symptoms as their testosterone keeps dropping. You can learn more about this age group in our piece on low testosterone in men over 70.
If you notice these symptoms, you might want to learn about natural remedies for male andropause and low testosterone while getting checked by a doctor.
Recognising Depression in Older Men
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Depression in older men looks different from textbook descriptions. This creates substantial challenges in diagnosis and treatment. Knowing how to spot depression's signs in men over 60 is a vital part of providing proper care and support.
Typical vs atypical symptoms of depression in men
Clinical descriptions of depression usually focus on persistent sadness, crying, and feelings of worthlessness—symptoms women report more often. All the same, older men's depression often takes a different shape.
Traditional depression symptoms include:
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Feeling sad, hopeless or empty
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Losing interest in previously enjoyed activities
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Experiencing sleep disturbances
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Having difficulty concentrating
Men often show "male-type" or atypical depression symptoms that may include:
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Irritability, anger or aggression rather than sadness
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Physical complaints such as headaches, digestive problems and chronic pain
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Substance use as self-medication
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Risk-taking behaviours
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Escapist activities like excessive working or watching sports
"Mood reactivity" stands out as a defining feature of atypical depression—knowing how to feel temporarily better when good things happen. This trait, along with increased appetite and heightened rejection sensitivity, sets atypical depression apart from usual patterns [2].
Research shows atypical depression affects 15% to 36% of people with depressive disorders [2]. Men tend to show their underlying depression through external behaviours instead of expressing sadness [4].
Why signs of depression in men often go unnoticed
Depression in men often remains undiagnosed despite affecting millions. About 5-10% of older adults in primary care have clinical depression [7]. Yet older men are nowhere near as likely as women to get depression treatment [7].
Several factors create this diagnostic gap:
Men struggle to recognise depression in themselves. They don't realise that irritability, anger, and physical ailments can signal depression. Instead, they blame these problems on stress or ageing.
Men describe their depression through physical rather than emotional terms. One depression care manager notes [8], "They will not say, 'I feel sad' or 'I feel depressed.' They'll say, 'I have a stomachache.'"
Some men maintain high-functioning depression and continue their daily responsibilities while suffering chronically [4]. This "masked depression" makes it hard for healthcare providers and loved ones to spot the problem.
The symptoms that overlap between stress, sleep disturbances, and low testosterone make accurate diagnosis even harder in men over 60.
The role of masculinity and stigma
Traditional masculine norms substantially affect how older men experience and express depression. The "strong, silent type" stereotype emphasises self-reliance, emotional control, and toughness. These create powerful barriers that prevent men from acknowledging psychological distress [8].
Depression contradicts what many older men see as core elements of traditional masculinity. A study participant said it well: "My role (as a man) is to be strong. It's weak to be depressed and sad and cry" [5].
This masculine identity develops over decades and clashes with depression symptoms. Many men see these symptoms as personal failures [6]. This directly opposes their socialised beliefs about staying stoic and invulnerable.
Research shows that men who follow traditional gender roles more closely tend to resist seeking help [8]. This reluctance comes from years of social conditioning that discourages emotional expression [6], not from any emotional shortcoming.
Older men's depression often stems from physical decline and money problems [8]. They lose their ability to fulfil long-held roles as providers and workers. This creates what experts call "biographical disruptions" where their sense of self faces a crisis [7].
The good news is attitudes are changing. Groups like Men's Sheds report an 89% drop in depression among members [8]. This suggests the right environment helps men overcome stigma and find relief from depression symptoms.
The Link Between Low Testosterone and Depression
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The link between testosterone and mood regulation is one of the most fascinating yet complex areas of men's health research. Men over 60 face this reality as their hormone levels naturally drop, which can affect their mental well-being in unexpected ways.
How testosterone affects mood and brain function
Testosterone shapes our brain function through multiple pathways. This neuroactive steroid hormone influences mood and behavioural responses. The hormone controls several neurotransmitter systems that regulate emotions. It affects the serotonin system—the same one that antidepressant medications target [2]. These hormonal changes explain why testosterone levels can trigger shifts in mood.
In the brain, testosterone:
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Makes neuroplasticity easier in the hippocampus [2]
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Raises serotonin release in the dorsal raphe nuclei [2]
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Controls dopamine transmission to emotional centres [1]
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Works through conversion to oestrogen on oestrogen receptors in the limbic system [1]
Research using voxel-based morphometry shows positive links between testosterone levels and grey matter volume in key mood-regulating brain areas like the hippocampus, amygdala, and hypothalamus [1]. This connection helps explain why testosterone protects the brain as men age.
Testosterone also plays a key role in maintaining energy, confidence, and mental clarity—factors that shape mood and psychological well-being [9]. Lower levels can harm both cognitive and emotional function.
What research says about testosterone depression in men
Studies that analyse the connection between testosterone and depression reveal a complex picture. Many observational studies show older men with depression symptoms often have lower testosterone [3]. About 35-50% of male patients with hypogonadism show depression symptoms in cross-sectional studies [1].
A revealing 2016 study found that low serum testosterone led to an 86% increased risk of depression [10]. The relationship isn't simple though. Some research suggests both low and high testosterone might increase depression risk [11].
Men with major depressive disorder had much lower plasma testosterone than healthy men, according to a systematic review [1]. Depression severity showed strong inverse links with bioavailable and free testosterone levels [1].
Treatment research gives more insights. A 2019 meta-analysis of 27 randomised controlled trials found testosterone treatment helped reduce depression symptoms in men [10]. The effectiveness varied among different groups:
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Best results for hypogonadal men
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Good results for men with mild depression
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Possible benefits for treatment-resistant depression
Differences between hypogonadism and age-related decline
The difference between pathological hypogonadism and normal age-related testosterone decline matters for proper treatment. True hypogonadism means the testes produce few or no hormones, which often leads to worse symptoms [12].
Late-onset hypogonadism—sometimes called "male menopause"—can develop in men who are obese or have type 2 diabetes [12]. This condition is different from the gradual, natural decline most men experience.
Depression doesn't affect all men with age-related testosterone decline. Several factors affect vulnerability:
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Individual androgen receptor genotype [13]
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Stress levels and cortisol production [1]
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Weight changes and physical activity levels [14]
Depression and testosterone have a two-way relationship—depression can lower testosterone by disrupting the hypothalamic-pituitary-testis axis [1]. This happens through weight loss, poor sleep, overactive stress hormones, and reduced physical activity [1].
Men over 70 need a full assessment beyond hormone testing to determine if their symptoms come from normal ageing or true hypogonadism.
What the Science Says: Studies and Conflicting Evidence
Scientists trying to understand the link between testosterone and depression in men face a complex puzzle. Research has shown both strong connections and conflicting results, which leaves doctors without clear guidelines.
Findings from observational studies
Large studies have broken down the relationship between testosterone levels and depression with mixed outcomes. The Rancho Bernardo Study, with 856 men aged 50-89, showed a clear inverse correlation between bioavailable testosterone and depression scores [1]. Men who showed signs of depression had bioavailable testosterone levels 17% lower than those without depression [15].
The Veterans' Experience Study of 4,393 men revealed a small but important link between depression and testosterone levels [15]. The Health in Men Study in Australia showed that men with free testosterone below 60 pg/ml were three times more likely to experience depression compared to those with levels above 100 pg/ml [16].
In spite of that, other studies paint a different picture. The Massachusetts Male Ageing Study of 1,709 men aged 40-70 found no connection between serum testosterone and depression [1]. Some research suggests that both low and high testosterone might increase depression risk [11].
Insights from clinical trials and meta-analyses
A major 2018 systematic review and meta-analysis of 27 randomised controlled trials with 1,890 men showed that testosterone treatment reduced depressive symptoms more than placebo (Hedges g, 0.21; 95% CI, 0.10-0.32) [17]. The treatment showed an efficacy odds ratio of 2.30 (95% CI, 1.30-4.06) [17].
Results varied among different groups. Meta-regression models revealed important interactions between treatment effectiveness, dosage and baseline symptom variability [17]. Higher-dosage treatments worked best in carefully selected patients [2].
A meta-analysis of seven studies with 1,452 participants confirmed that low testosterone levels had a strong connection with major depressive disorder [16]. Yet a 2018 systematic review found that testosterone treatment doesn't work broadly for depression, though it showed promise in specific groups like men with dysthymic disorder or treatment-resistant depression [18].
Why results are still inconclusive
Research continues to produce conflicting evidence for several reasons. Problems with study methods, including poor measurement techniques, affect many studies. Single measurements from saliva or serum might not show true testosterone status because of large variations between individuals [19].
Genetics plays a role in the results. Research shows that polymorphic CAG repeats in androgen receptor genes affect how testosterone influences psychology [20]. This explains why similar testosterone levels might affect mood differently in different people.
Many studies don't distinguish between total, bioavailable, and free testosterone—each might relate to depression in its own way [15]. Sleep quality, stress, and age could all affect the results.
Depression itself comes in many forms, which makes interpretation harder. Different types of depression might have unique relationships with testosterone. Atypical depression might have stronger links to hormone levels [11].
Treatment Options: Is Testosterone Therapy the Answer?
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Men who have both low testosterone and depression need careful treatment planning. Their medical treatment options vary based on their specific situation. Testosterone therapy is just one of several possible treatments.
The right time for testosterone therapy
Doctors look at testosterone therapy as an option if men show clinical symptoms and their blood tests confirm low testosterone levels at least twice [21]. They check for total testosterone below 275 ng/dl along with symptoms like tiredness, depression, and sexual problems [22].
Medical guidelines tell us this therapy works best for men who clearly lack testosterone and show consistently low levels [4]. Treatment candidates usually fit two groups: men with true hypogonadism (their testes make little or no hormones) and those whose symptoms really hurt their quality of life.
How well testosterone works for depression
Studies about testosterone's effect on depression show good but mixed results. A review of 27 controlled trials found that testosterone helped reduce depression symptoms better than placebo [2]. People's Beck Depression Inventory scores dropped by about 2.2 points [2].
The benefits work better for certain groups:
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Men with late-onset depression saw a 53% drop in symptoms compared to 18% in early-onset depression [23]
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People who got higher doses [4]
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Men whose depression resisted other treatments [24]
Age doesn't seem to matter - young and older men both get similar benefits from the treatment [2].
Understanding risks and side effects
Like any medical treatment, testosterone therapy has possible complications. Common side effects include acne, tender breasts, swelling, and higher red blood cell counts [21]. More serious risks involve heart health and prostate function [25].
Yearly checkups usually include complete blood count, liver tests, testosterone levels, and prostate-specific antigen screening [21]. If red cell count or haematocrit rises too much, doctors might need to change or stop the treatment [21].
Other ways to treat depression in older men
Older men have several effective non-hormonal options to deal with depression:
Psychological treatments like cognitive behavioural therapy and interpersonal therapy often work as first choices [7]. Antidepressant medications can also help manage symptoms, though they usually take 4-6 weeks to start working [7].
Exercise, natural remedies, and fixing underlying sleep problems or stress can help with both depression symptoms and testosterone levels. This approach works especially well for men over 70 [7]. Some men might benefit from brain stimulation treatments like transcranial magnetic stimulation [7].
Breaking the Silence: Getting Help and Support
Getting proper mental health care remains a vital challenge for men who experience testosterone-related depression. Men over 60 need to know about these roadblocks and practical ways to get vital support.
Why older men avoid seeking help
Older men face special challenges with mental health issues. Many men see mental health struggles as weakness because of traditional masculine values [8]. This "strong, silent type" mindset stops many older men from getting professional help [26].
Research shows older men get diagnosed and treated for depression much less often than women [8]. This gap comes from how differently men and women look for care, which ties back to gender roles and beliefs [8].
Real-world obstacles also get in the way. More than half of older adults worry their mental health problems aren't serious enough to need treatment [27]. About 40% say they don't have a regular doctor to talk about these issues [27].
How to talk to your doctor or loved ones
You need good preparation to talk about mental health. Taking notes about your symptoms helps you remember everything during doctor visits - write down when they happen, how long they last, and what might trigger them [28]. This stops you from drawing a blank during appointments.
Starting with clear statements works best: "I've been feeling very down and think I might be depressed" or "I don't enjoy my usual activities anymore" [28].
Doctors need to build good relationships with their older male patients [8]. Some doctors start by talking about physical symptoms and then slowly bring up depression [8].
Support groups and mental health resources
Peer support groups are a great way to get help for men with low testosterone depression. These community networks let men share their stories, learn how to ask for help, and find new ways to express their masculinity [29].
The NHS has several ways to help. Their Talking Therapies for Anxiety and Depression programme works well for older adults [6]. You might also want to try natural remedies along with professional care, while working on root causes like stress and sleep problems.
Men over 70 have found soaring wins with groups like Men's Sheds. Members feel better mentally when they stay active in meaningful activities [5].
Conclusion
The link between testosterone depression and hormonal decline in men represents a serious health concern that doesn't get enough attention. Research shows that dropping testosterone levels affect all but one of five men above 60. These changes can trigger or worsen depression through complex brain mechanisms. Many men keep suffering in silence because of traditional masculine expectations and the stigma attached to both hormonal changes and mental health problems.
Doctors find it hard to spot depression in older men. These men rarely show typical signs of sadness. Instead, they become irritable and angry, complain about physical problems, or try to escape their feelings. This unusual mix of symptoms, combined with age-related testosterone decline, creates conditions where the problem often goes unnoticed and untreated.
Research paints a mixed but meaningful picture of how low testosterone and depression connect. Studies show that testosterone replacement therapy might help certain men, especially those with confirmed hypogonadism or depression that resists standard treatment. But this treatment comes with potential risks and needs careful monitoring by doctors.
Men can try various natural remedies for male andropause and low testosterone along with psychological treatments like cognitive behavioural therapy. It also helps to tackle issues like sleep disturbances and stress to improve both hormone levels and mood naturally.
Men should know that asking for help shows courage, not weakness. Support groups created specifically for men offer safe places where they can share their stories without judgement. Men over 70 may face unique considerations but can still benefit from the right kind of help.
Breaking the silence around testosterone depression starts with accepting it as a real health issue. Better awareness, less stigma, and proper medical care can help men who struggle silently to improve their well-being and enjoy their later years more fully.
Key Takeaways
Understanding the connection between testosterone decline and depression in men over 60 can help break the silence around this widespread but often overlooked health issue.
• 20% of men over 60 have low testosterone levels, with natural decline beginning around age 30-40 and accelerating to 1-3% annually, potentially triggering mood changes alongside physical symptoms.
• Depression in older men manifests differently through irritability, anger, and physical complaints rather than sadness, making diagnosis challenging and contributing to widespread undertreatment.
• Scientific evidence shows testosterone therapy can reduce depressive symptoms by approximately 2.2 points on depression scales, particularly effective for men with confirmed deficiency or treatment-resistant depression.
• Breaking masculine stigma is crucial for seeking help - viewing mental health support as strength rather than weakness enables access to effective treatments including therapy, medication, and peer support groups.
• Multiple treatment options exist beyond hormone therapy, including cognitive behavioural therapy, addressing sleep and stress factors, and natural remedies that can improve both hormonal balance and mood.
The key to addressing this silent struggle lies in recognising symptoms early, overcoming societal barriers to help-seeking, and working with healthcare providers to develop comprehensive treatment plans that address both hormonal and psychological aspects of wellbeing.
FAQs
Q1. How can men over 60 naturally boost their testosterone levels? Regular exercise, particularly a combination of aerobic and resistance training, can help increase testosterone production in older men. This not only supports hormonal balance but also helps prevent common age-related health issues like heart disease and cancer.
Q2. Is there a link between low testosterone and mental health issues like anxiety and depression? Yes, low testosterone can contribute to or worsen symptoms of anxiety and depression in men. These may include irritability, persistent sadness, lack of motivation, and social withdrawal. Low testosterone can also cause physical changes that may impact mental well-being.
Q3. What are the common symptoms of low testosterone in older men? Common symptoms include decreased libido, erectile dysfunction, reduced muscle mass and strength, increased fatigue, mood changes, and difficulty concentrating. Some men may also experience weight gain, particularly around the abdomen, and decreased body hair growth.
Q4. How can partners support men dealing with low testosterone? Open communication is crucial. Set aside time each week to discuss feelings, frustrations, and appreciations. Be patient and understanding of the physical and emotional changes your partner may be experiencing. Encourage them to seek medical advice and consider joining them for appointments if they're comfortable with that.
Q5. Are there non-medical approaches to managing testosterone-related depression? Yes, several non-medical approaches can help. These include regular exercise, stress reduction techniques like meditation, improving sleep habits, and maintaining a healthy diet. Cognitive behavioural therapy and support groups can also be beneficial for managing mood symptoms associated with low testosterone.
References
[1] - https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1198437/full
[2] - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976
[3] - https://pubmed.ncbi.nlm.nih.gov/9919317/
[4] - https://pmc.ncbi.nlm.nih.gov/articles/PMC6583468/
[5] - https://qicn.org.uk/resources/mental-health-older-men/
[6] - https://www.england.nhs.uk/mental-health/adults/older-people/
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[8] - https://pmc.ncbi.nlm.nih.gov/articles/PMC2981127/
[9] - https://www.psychiatryredefined.org/the-crucial-link-between-testosterone-and-depression-why-it-matters-for-both-men-and-women/
[10] - https://www.bodylogicmd.com/blog/the-connection-between-low-testosterone-and-depression-opens-up-treatment-options-for-men/
[11] - https://pmc.ncbi.nlm.nih.gov/articles/PMC9216439/
[12] - https://www.nhs.uk/conditions/male-menopause/
[13] - https://www.tandfonline.com/doi/full/10.1080/13685530601040679
[14] - https://academic.oup.com/biomedgerontology/article/80/6/glaf019/8010479
[15] - https://pmc.ncbi.nlm.nih.gov/articles/PMC3376477/
[16] - https://link.springer.com/article/10.1007/s11154-022-09767-0
[17] - https://pubmed.ncbi.nlm.nih.gov/30427999/
[18] - https://pmc.ncbi.nlm.nih.gov/articles/PMC9704723/
[19] - https://pubmed.ncbi.nlm.nih.gov/32657193/
[20] - https://psychiatryonline.org/doi/full/10.1176/appi.ajp.160.1.105
[21] - https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/Testosterone-replacement-therapy
[22] - https://www.nejm.org/doi/full/10.1056/NEJMoa1506119
[23] - https://www.psychiatrist.com/jcp/testosterone-therapy-late-life-major-depression-males/
[24] - https://www.sciencedirect.com/science/article/pii/S0165032797001687
[25] - https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge
[26] - https://www.ucdavis.edu/news/stereotypes-hinder-older-men-depression-care
[27] - https://www.tandfonline.com/doi/full/10.1080/00050067.2023.2282540
[28] - https://www.verywellmind.com/how-do-i-tell-a-doctor-im-depressed-1067387
[29] - https://www.sciencedirect.com/science/article/pii/S2212657023000296
