Exploring the Link Between Low Testosterone and Anxiety in Men

Introduction

Testosterone is a hormone that plays a major role in a man’s body. It helps with many physical and mental functions. Testosterone is made mostly in the testicles and is important for building muscle, keeping bones strong, producing red blood cells, supporting sex drive, and keeping energy levels stable. It also affects how the brain works, especially in areas that deal with mood, confidence, and stress. When testosterone levels are too low, it can cause changes in how a man feels physically and emotionally. One of the emotional effects that may happen with low testosterone is anxiety.

Anxiety is a common mental health condition. It can make people feel nervous, worried, or uneasy. While everyone feels anxious sometimes, people with anxiety disorders feel these emotions often, and the feelings can interfere with daily life. Anxiety can show up in the body through symptoms like a racing heart, tense muscles, sweating, or feeling lightheaded. It can also affect sleep, concentration, and appetite. Anxiety can come from many causes, including genetics, brain chemistry, trauma, and stress. In recent years, doctors and researchers have been looking more closely at how hormones like testosterone might also play a role.

Men with low testosterone sometimes report feeling more anxious or stressed than usual. Some also say they feel sad, tired, or less interested in doing things they used to enjoy. These feelings may not always be caused by low testosterone alone. However, changes in hormones can have real effects on how the brain works. Testosterone affects chemicals in the brain, such as serotonin and dopamine, which help control mood. When testosterone drops, these chemicals may also change, leading to symptoms like anxiety or depression.

Low testosterone can happen for many reasons. It can be caused by aging, medical conditions, injury to the testicles, or problems with the pituitary gland, which helps control hormone levels. It can also result from certain medicines, including those used to treat cancer or chronic diseases. Sometimes, men do not know they have low testosterone until they start feeling symptoms like fatigue, trouble sleeping, low sex drive, or emotional changes.

More men today are getting tested for low testosterone because they feel something is off with their energy, mood, or mental clarity. Some of these men are also being treated with testosterone replacement therapy, often called TRT. TRT is a treatment that raises testosterone levels in men with diagnosed low testosterone. It can be given in different ways, such as through injections, skin patches, gels, or pellets placed under the skin. The goal is to bring testosterone back into a normal range to help improve the symptoms linked to low levels.

There is growing interest in whether TRT can help reduce anxiety in men who have both low testosterone and anxiety symptoms. Some research shows that testosterone treatment may help improve mood and lower anxiety in some men. However, not all men respond the same way, and the medical community is still studying how strong the connection is between testosterone and anxiety. Some doctors are cautious and want more research before recommending testosterone therapy as a main treatment for anxiety.

It is important to understand that testosterone does not work alone. The human body is complex, and many factors can affect mental health. These include sleep, diet, exercise, stress levels, medical problems, and life events. Hormones are just one piece of the puzzle. Still, for some men, treating low testosterone may help improve how they feel both physically and emotionally.

More attention is now being given to men's mental health and the role hormones may play. For years, topics like anxiety or depression in men were not always openly discussed. But awareness is growing, and more men are seeking help for emotional and physical health problems. This has led to more interest in how testosterone and anxiety may be linked—and whether improving hormone levels could help with mental well-being.

What Is Testosterone and Why Is It Important?

Testosterone is a hormone found in both men and women, but it plays a much bigger role in the male body. It is part of a group of hormones called androgens. Testosterone is made mainly in the testicles. A small amount is also made by the adrenal glands, which sit above the kidneys.

Testosterone helps boys develop male features during puberty. These features include a deeper voice, more muscle mass, facial and body hair, and the growth of the penis and testicles. In adults, testosterone keeps these features in place and supports overall health.

Main Functions of Testosterone

Testosterone affects many systems in the body. It plays a role in:

• Muscle Mass and Strength: Testosterone helps build muscle. It supports the repair of muscle tissue after exercise or injury. Low levels of testosterone may lead to muscle weakness or reduced muscle size.

• Bone Density: Strong bones are important for balance and movement. Testosterone helps keep bones dense and strong. Low testosterone can lead to bone loss, also called osteoporosis.

• Fat Distribution: This hormone helps control where fat is stored in the body. Low levels may lead to increased body fat, especially around the belly.

• Red Blood Cell Production: Testosterone supports the bone marrow in making red blood cells. These cells carry oxygen throughout the body. Low red blood cell levels can lead to fatigue and poor endurance.

• Sex Drive and Reproductive Health: Testosterone is key for libido, also known as sex drive. It also helps with sperm production. Men with low testosterone may have a reduced interest in sex or problems with fertility.

• Mood and Mental Function: Testosterone may affect how the brain works. It is linked to confidence, motivation, and mood stability. Lower levels are often connected with mood changes, including irritability or sadness.

How Testosterone Is Controlled

The body keeps testosterone levels in balance using a system that involves the brain and the testicles. The hypothalamus in the brain releases a hormone called gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to release two other hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH then tells the testicles to make testosterone.

If testosterone levels are too low or too high, the brain senses this and adjusts the signals to restore balance. This system is called the hypothalamic-pituitary-gonadal (HPG) axis. Any problem in this system can lead to a hormone imbalance.

Normal Testosterone Levels by Age

Testosterone levels are highest during the late teenage years and early adulthood. After age 30, levels start to fall slowly each year. This is part of the natural aging process. However, in some men, levels drop too much or too soon. This can lead to symptoms of low testosterone, also called hypogonadism.

Normal total testosterone levels in adult men are usually between 300 and 1,000 nanograms per deciliter (ng/dL). Levels below 300 ng/dL are often considered low, but symptoms and health risks are also important factors.

Free testosterone, the form not bound to proteins in the blood, can also be measured. Some men have normal total testosterone but low free testosterone. This may still cause symptoms.

Doctors check testosterone levels with a blood test, usually done in the morning when levels are highest. Two separate low results along with symptoms may confirm a diagnosis of low testosterone.

Why This Matters for Health

Testosterone supports many parts of the body. It affects physical strength, energy, mental focus, and emotional well-being. When testosterone levels are low, several areas of health can suffer. These effects may happen slowly, making them easy to miss or blame on aging or stress.

Understanding what testosterone does helps explain how low levels may contribute to anxiety, depression, and other emotional issues. It also shows why treatment needs to look at the full picture—not just lab numbers, but also how a person feels and functions.

What Are the Symptoms of Low Testosterone in Men?

Testosterone is a hormone made mostly in the testicles. It plays an important role in a man’s body. It affects energy, muscles, bones, mood, and even thinking. When testosterone levels drop too low, it can lead to a group of symptoms. These symptoms can affect both the body and the mind.

Physical Symptoms of Low Testosterone

Many men with low testosterone first notice changes in their body. These symptoms may appear slowly and can be hard to link to hormones at first. Common physical signs include:

1. Fatigue and Low Energy

Low testosterone can cause tiredness even after a full night of sleep. This type of fatigue is more than just feeling sleepy. It often feels like a constant lack of energy. Daily tasks may seem harder, and motivation to exercise or be active may drop.

2. Loss of Muscle Mass and Strength

Testosterone helps build and keep muscle. Men with low levels may see their muscles shrink or feel weaker over time. Lifting weights may become harder, and muscle tone may reduce even without a big change in lifestyle.

3. Increase in Body Fat

Some men gain fat, especially around the belly area. Low testosterone can affect how the body burns and stores fat. This may also lead to a condition called gynecomastia, which is the growth of breast tissue in males.

4. Decreased Bone Density

Testosterone helps keep bones strong. When levels drop, bones may become thinner and weaker. This makes fractures and bone pain more likely, especially in older men.

5. Sexual Symptoms

One of the most known signs of low testosterone is reduced sexual desire, or low libido. Men may also have fewer spontaneous erections or trouble keeping an erection firm enough for sex. This condition is called erectile dysfunction (ED). While ED can have other causes, testosterone plays a clear role.

Psychological and Emotional Symptoms

Besides physical changes, low testosterone can also affect mental and emotional health. Hormones like testosterone help regulate how the brain works. When levels are low, it may cause:

1. Mood Changes

Many men report feeling sad, down, or irritable when their testosterone is low. These mood shifts are often hard to explain. Men may lose interest in things they once enjoyed. Others may feel more impatient or have a shorter temper than usual.

2. Anxiety and Nervousness

Low testosterone has been linked to anxiety in some men. It may cause restlessness or constant worry. These feelings can affect sleep, concentration, and everyday activities.

3. Depression or Depressed Mood

Some men with low testosterone may show signs of depression. These may include feelings of hopelessness, loss of interest, trouble sleeping, or thoughts of worthlessness. Not all men will have full depression, but many report a constant low mood.

4. Trouble Concentrating and Memory Problems

Men may find it hard to focus or remember things. Some call this “brain fog.” It may feel like slow thinking or confusion. This mental cloudiness can affect work performance, daily planning, and confidence.

5. Lack of Motivation

Even if life is going well, low testosterone can make it hard to feel driven or excited. Some men say they feel “flat” or emotionally dull. This lack of motivation can affect work, hobbies, and relationships.

How Low Testosterone Is Diagnosed

Because these symptoms can also come from other health problems, a proper diagnosis is important. A doctor will often start by reviewing a man’s symptoms and medical history. The next step is usually a blood test.

The blood test measures total testosterone, which includes both active and inactive forms. It is often done in the morning when testosterone levels are at their highest. Normal levels usually fall between 300 to 1,000 nanograms per deciliter (ng/dL). Levels below 300 ng/dL may be considered low, depending on lab standards and the patient’s symptoms.

In some cases, doctors also measure free testosterone. This is the form that is not bound to proteins and is active in the body. Low free testosterone can also cause symptoms, even when total testosterone appears normal.

Doctors may repeat the test on another day to confirm the results. Some medications, illnesses, or poor sleep can affect testosterone levels temporarily, so careful testing is needed.

Can Low Testosterone Cause Anxiety?

Testosterone is a hormone that plays many important roles in the body. It affects muscles, bones, red blood cell production, sex drive, and mood. When testosterone levels are too low, it can lead to a condition called hypogonadism. Men with hypogonadism often feel tired, lose muscle strength, and may feel down or anxious. Scientists have been studying whether low testosterone can cause anxiety in men. The answer is not simple, but there are clues that suggest a strong connection.

The Brain and Testosterone

The brain depends on many chemicals to help manage emotions, stress, and behavior. Testosterone affects how some of these brain chemicals work. In particular, testosterone interacts with systems in the brain that control mood and feelings of fear.

One of these systems is called the GABA system. GABA (gamma-aminobutyric acid) is a chemical that calms the brain. It helps reduce nervousness and prevents overstimulation. Testosterone is thought to improve the activity of GABA in the brain. This may help explain why low testosterone is linked to more anxiety in some men.

Another brain system affected by testosterone is the serotonin system. Serotonin is a chemical that helps balance mood and keeps people from feeling too sad or anxious. Some research shows that testosterone may increase serotonin levels or help serotonin work better in the brain. When testosterone is low, serotonin levels may also fall, leading to mood problems such as anxiety.

Testosterone also affects the amygdala. This is a part of the brain that handles fear and emotional responses. Some animal studies have found that low testosterone leads to increased activity in the amygdala, which could make the brain more sensitive to stress or danger. This may lead to more anxious feelings.

Research and Anxiety Risk

Several studies have looked at men with low testosterone and found that they are more likely to experience anxiety or other mood problems. For example, research shows that men with hypogonadism often report higher levels of stress, worry, and irritability compared to men with normal testosterone levels. These men also score higher on anxiety scales used in mental health clinics.

Other studies have examined older men. As men age, testosterone levels naturally decline. Some research has found that older men with lower testosterone levels are more likely to show signs of anxiety or depression. This suggests that hormones may play a part in mental health as men grow older.

However, it is important to understand that not all men with low testosterone feel anxious. Anxiety is a complex condition that can come from many different causes, including genetics, life events, sleep problems, and other health conditions. Still, when low testosterone is present, it may make anxiety worse or harder to treat.

Correlation vs. Causation

Even though low testosterone is often seen in men with anxiety, that does not prove that it causes anxiety. In science, this is called the difference between correlation and causation.

Correlation means two things happen together, like low testosterone and anxiety. But causation means one thing directly causes the other. For example, catching a virus causes a fever. In the case of testosterone and anxiety, scientists are still trying to find out whether low testosterone causes anxiety or if both come from another problem, like poor sleep or chronic illness.

In some men, anxiety may lower testosterone. Long-term stress increases a hormone called cortisol. High cortisol levels can reduce testosterone production in the body. So, anxiety might lead to low testosterone, not the other way around.

It is also possible that both low testosterone and anxiety feed into each other. A man with low testosterone may feel tired and down, which leads to anxiety. That anxiety may then lower testosterone levels even more. This creates a cycle that is difficult to break without treatment.

The link between low testosterone and anxiety is supported by research, but it is not fully understood. Testosterone affects brain chemicals like GABA and serotonin, which play a role in mood and anxiety. Studies show that men with low testosterone often experience more anxiety, but not always. It is unclear whether low testosterone causes anxiety or simply adds to it. More research is needed to fully understand how these two conditions interact.

How Does Anxiety Manifest Differently in Men With Low Testosterone?

Anxiety can show up in many ways. When testosterone levels are low, it can affect how anxiety feels and how it affects the body and mind. While anxiety may be caused by many different things, low testosterone can play a unique role in how symptoms appear in men.

Hormonal vs. Non-Hormonal Anxiety

Anxiety from low testosterone is often linked to physical changes in the body’s hormone balance. Hormonal anxiety may look different from anxiety caused by other sources, such as trauma, stress, or mental health conditions.

Hormonal anxiety may come with other signs of low testosterone like fatigue, poor concentration, low motivation, and loss of interest in activities. These symptoms may happen at the same time. The anxiety may feel more like a constant sense of unease rather than panic. It may also come with feelings of irritability, sadness, or hopelessness. This is because testosterone helps control the brain’s mood chemicals, including serotonin and dopamine.

Non-hormonal anxiety, on the other hand, often has different triggers. It may be related to social, emotional, or psychological causes, like worry about the future or fears of failure. It may also cause physical signs such as a racing heart or shallow breathing, but it is not usually linked to other signs of low testosterone like low libido or weak muscles.

When testosterone is low, it does not only affect the brain. It also affects the entire body. This makes hormonal anxiety harder to treat unless the hormone imbalance is also addressed.

The Role of Depression, Sleep, and Mental Function

Many men with low testosterone experience more than just anxiety. Other conditions can happen alongside it, and these can make symptoms feel worse.

Depression is common in men with low testosterone. Some studies show that low levels of this hormone are linked to a higher risk of depression. When depression and anxiety happen together, the symptoms can build on each other. A man may feel nervous, restless, sad, and hopeless all at once. The result is a deep emotional strain that affects daily life.

Insomnia or poor sleep is also a concern. Testosterone levels normally rise during sleep, especially during deep sleep. If sleep is disturbed, testosterone levels may drop even more. This can create a cycle: low testosterone can lead to poor sleep, and poor sleep can lead to lower testosterone. Sleep loss also raises stress hormones like cortisol, which can increase anxiety. This makes sleep quality very important in managing both hormone health and emotional health.

Cognitive problems are another issue. Men with low testosterone may notice brain fog, trouble focusing, and poor memory. These changes in thinking can feel very frustrating and add to feelings of worry or helplessness. Anxiety can also make it harder to focus or stay calm. When both happen at the same time, it can feel like the brain is not working well.

These extra problems—depression, poor sleep, and brain fog—do not just add to anxiety. They may be signs that testosterone levels are too low. Recognizing them can help doctors better understand the root cause.

Stress and Its Impact on Testosterone

Chronic stress affects the body in powerful ways. One of the key stress hormones is called cortisol. When stress is long-lasting, cortisol levels stay high. High cortisol can lower testosterone. At the same time, low testosterone can make stress feel worse. This two-way relationship can make anxiety stronger and longer-lasting.

For example, if a man is under constant stress from work or life, his body may produce more cortisol. If his testosterone is already low, this stress can further reduce it. As testosterone drops, the body becomes more sensitive to stress, and the anxiety becomes harder to control.

Exercise, healthy sleep habits, and stress management may help break this cycle. But if testosterone stays low, medical treatment may be needed to help restore balance.

Anxiety in men with low testosterone often comes with other physical and emotional symptoms. It may feel different than other types of anxiety because it involves hormonal changes in the brain and body. Depression, poor sleep, and trouble thinking clearly can make symptoms worse. Stress can also lower testosterone further, creating a loop that is hard to break. Understanding these patterns helps make the link between hormone health and emotional well-being clearer. When these signs are present together, checking testosterone levels may be an important step in finding the right care.

What Does the Research Say About Testosterone Therapy and Anxiety?

Studies have shown that low testosterone in men may be linked to higher levels of anxiety. Testosterone therapy has been studied as a way to reduce anxiety symptoms in some men. However, not all research has found the same results. The medical community continues to explore how testosterone levels affect mental health and whether therapy can help.

Human Studies on Testosterone and Anxiety

Researchers have looked at how testosterone replacement therapy (TRT) affects anxiety in men with low testosterone. Several small clinical studies show that men with low testosterone who receive treatment sometimes feel less anxious. Some men also report better mood, more energy, and improved sleep.

One study from 2013 followed older men who had low testosterone and were treated with testosterone gel for a year. Some of the men reported less anxiety and better mental well-being. Another study published in Psychoneuroendocrinology found that men treated with testosterone injections had reduced symptoms of both anxiety and depression.

These improvements may happen because testosterone affects brain chemicals. Testosterone helps regulate neurotransmitters like serotonin and GABA. These brain chemicals are involved in controlling mood and reducing stress. Low levels of testosterone may lower the activity of these calming chemicals, leading to feelings of nervousness, tension, or fear.

In younger men, the effects of testosterone therapy on anxiety are less clear. Some studies in men under 40 have shown mixed results. In these cases, the cause of anxiety may not be related only to hormone levels. Mental health, lifestyle, and other medical conditions may also play a role.

Animal Studies Support the Link

Research on animals helps to understand how testosterone may work in the brain. In lab studies with rats, scientists found that removing testosterone caused increased signs of anxiety. When testosterone was replaced, the anxious behavior decreased. These studies suggest that testosterone has a direct calming effect on the brain.

Animal studies are helpful, but results do not always match what happens in humans. Human mental health is complex and influenced by many factors. However, animal studies still support the idea that testosterone plays a role in controlling anxiety-like behavior.

Meta-Analyses and Reviews

To better understand the overall results of research, scientists often conduct meta-analyses. These are studies that combine data from many other studies to look for patterns.

A 2019 meta-analysis published in JAMA Psychiatry looked at 27 randomized controlled trials involving over 1,800 men. The study found that testosterone therapy led to a small but significant improvement in mood and quality of life. Some of the men also had a decrease in symptoms related to anxiety. However, most of the studies focused more on depression than anxiety alone.

Other reviews have found that while testosterone therapy may help reduce anxiety in some men, the results are not strong enough to make it a first-choice treatment for anxiety disorders. It may be more helpful in men who also have low testosterone levels confirmed by lab tests.

Research Limitations

There are several reasons why research results on testosterone therapy and anxiety are mixed:

• Small sample sizes: Many studies only include a small number of men. This makes it hard to apply the results to all patients.

• Short treatment times: Some studies only follow men for a few weeks or months. Long-term effects are not always known.

• Different types of therapy: Men in these studies may receive different forms of testosterone, such as injections, gels, or patches. The dosage and delivery method can affect results.

• Mixed health backgrounds: Some men in the studies have other medical problems that affect mood, such as diabetes, sleep apnea, or heart disease. These can make it harder to tell if testosterone alone caused the change in anxiety.

What the Evidence Suggests

So far, research suggests that testosterone therapy may reduce anxiety in some men—especially those with proven low testosterone levels. The treatment might work by helping the brain better regulate mood and stress. However, testosterone therapy is not a universal cure for anxiety. It may be helpful in certain cases, but more large and long-term studies are needed to confirm these benefits.

Doctors consider many factors before starting testosterone therapy. Blood tests, symptoms, and overall health all play a role in deciding if it is the right treatment. For men with both low testosterone and anxiety, therapy may be part of a larger treatment plan that includes mental health support, lifestyle changes, and regular follow-up care.

How Does Testosterone Therapy Work?

Testosterone therapy, also known as testosterone replacement therapy (TRT), is a medical treatment used to raise low levels of testosterone in men. This therapy is most often prescribed when a man has been diagnosed with hypogonadism, which means the body is not making enough testosterone. The goal of TRT is to bring testosterone levels back to a normal range so the body and brain can function properly.

Types of Testosterone Therapy

There are several ways to take testosterone. Each method works by getting the hormone into the bloodstream. The most common forms of TRT include:

1. Injections

Testosterone injections are often given in the muscle of the buttocks or thigh. These shots can be taken every 1 to 2 weeks, depending on the doctor’s plan. They are usually made with testosterone cypionate or testosterone enanthate. Injections give strong boosts in testosterone, but the levels may go up and down over time, which can sometimes affect mood or energy.

2. Gels

Testosterone gels are rubbed onto the skin, usually on the shoulders, upper arms, or abdomen. Popular brands include AndroGel® and Testim®. The gel is applied daily, and the testosterone is absorbed through the skin into the blood. Gels provide more stable hormone levels than injections, but care must be taken to avoid skin contact with others after application, especially women and children.

3. Patches

Testosterone patches stick to the skin like a bandage. They are applied once a day, often on the back, stomach, thigh, or upper arm. A brand name patch is Androderm®. The skin absorbs the hormone slowly over time. Patches may cause skin irritation at the site where they are worn.

4. Pellets

Testosterone pellets are small cylinders that are placed under the skin, usually in the hip area. This is done through a minor surgical procedure. The pellets slowly release testosterone over a period of 3 to 6 months. This method is convenient for men who do not want to take daily or weekly treatments.

5. Other Forms

Other less common forms include oral capsules and nasal gels. Oral testosterone is usually not the first choice because it can affect the liver. Nasal testosterone, like Natesto®, is applied inside the nose three times a day.

How TRT Raises Testosterone Levels

Once TRT is started, the testosterone in the chosen form enters the bloodstream. The therapy aims to bring testosterone levels into the normal range, which is usually between 300 to 1,000 nanograms per deciliter (ng/dL). A doctor monitors the hormone levels through blood tests to make sure they stay within this safe and effective range.

Balanced testosterone levels support many body functions. TRT may help restore energy, improve muscle mass, increase libido, and support mood regulation. In men with low testosterone, these effects can improve quality of life. It can also help with symptoms linked to anxiety and depression by supporting the brain’s normal chemical signals.

Monitoring and Adjusting Therapy

Testosterone therapy is not the same for every person. Doctors carefully adjust the dose and type of TRT based on blood test results and how a person responds to treatment. In the first few months, blood tests are done often to check testosterone levels, red blood cell count, and prostate health.

The doctor also watches for signs of side effects, such as acne, sleep problems, or swelling. If levels become too high, the dose may be lowered. If levels stay low, the dose may be raised or a different method may be used.

Over time, doctors may also check bone density, heart health, and mood changes to make sure the therapy continues to work safely. Stopping therapy suddenly can cause symptoms to return, so treatment changes should always be guided by a healthcare provider.

Can Testosterone Therapy Help Reduce Anxiety Symptoms?

Testosterone therapy is a treatment used to raise low testosterone levels in men. It is also known as testosterone replacement therapy (TRT). Many men with low testosterone feel tired, have low moods, and report feeling more anxious than usual. Some studies have found that testosterone therapy may help reduce anxiety in these men. However, the results are not the same for everyone, and not all studies agree.

How Testosterone Affects the Brain

Testosterone plays a role in how the brain works. It affects mood, memory, and how a person handles stress. The hormone connects with certain brain areas such as the amygdala and the prefrontal cortex. These areas help control emotions, fear, and anxiety. When testosterone levels drop too low, changes in brain activity may lead to higher levels of nervousness, worry, and even panic.

Testosterone also works with brain chemicals called neurotransmitters. These chemicals include serotonin and GABA (gamma-aminobutyric acid). Both help reduce stress and anxiety. Some research suggests that low testosterone levels may lead to lower GABA and serotonin activity. This can make the brain more sensitive to stress, which may lead to anxiety.

What Studies Show About TRT and Anxiety

Some clinical studies have looked at whether raising testosterone levels can help with anxiety symptoms. In several small studies, men with low testosterone who received TRT reported feeling calmer, more focused, and less anxious. Some showed improvements within a few weeks, while others took longer to notice any change.

A 2020 meta-analysis published in JAMA Psychiatry reviewed 27 studies with over 1,800 participants. The analysis found that testosterone treatment showed a small to moderate effect on mood, especially in men who were clinically diagnosed with low testosterone. While the main focus was depression, some studies in the review also noted reduced anxiety symptoms. However, not all studies included in the analysis looked at anxiety as a main outcome, which makes it harder to draw firm conclusions.

In another study published in the American Journal of Men’s Health, researchers tested men with low testosterone who were also showing signs of anxiety and depression. After 12 weeks of testosterone therapy, many of the men reported lower anxiety levels. These findings were encouraging but still limited by small sample sizes and short treatment durations.

Indirect Benefits That May Improve Anxiety

Some men who take testosterone therapy report that they sleep better, have more energy, and feel more confident. These improvements can indirectly lower anxiety. Poor sleep and fatigue can make anxiety worse. When testosterone levels return to normal, better sleep and increased energy can help the body and mind cope better with stress.

Low testosterone is also linked with low self-esteem and poor body image. Some men feel anxious in social settings or at work because they no longer feel strong, sharp, or capable. TRT may help improve physical strength, mental clarity, and overall sense of well-being. These changes may reduce worry and nervousness over time.

Why Results May Differ

Not every man with anxiety and low testosterone will benefit from TRT. Anxiety can have many causes. In some cases, low testosterone may not be the main reason for the symptoms. Men with a history of trauma, chronic stress, or other mental health conditions may need additional care like therapy or medication.

Some men may also be more sensitive to changes in hormone levels. When starting TRT, hormone levels can shift quickly. In rare cases, this may lead to mood swings or restlessness in the early stages of treatment. These effects usually settle as hormone levels become stable.

The way testosterone is given—through injections, gels, patches, or pellets—can also affect how well the therapy works. Some methods release the hormone steadily, while others can cause peaks and dips. Sudden changes in hormone levels may influence mood and anxiety in different ways.

Testosterone therapy may help reduce anxiety in men who have low testosterone. This happens by improving brain function, supporting mood-regulating chemicals, and helping the body handle stress. Many men also feel better because they sleep more soundly, think more clearly, and feel more like themselves again. While TRT is not a cure for all types of anxiety, it may be a helpful part of treatment for some men. The best results come when testosterone therapy is used as part of a full health plan, guided by a medical professional.

Who Might Benefit From Testosterone Therapy for Anxiety?

Testosterone therapy is sometimes used to help men who have low testosterone levels. Some of these men also experience anxiety. When anxiety and low testosterone appear together, doctors may consider testosterone replacement therapy (TRT) as part of the treatment plan. However, TRT is not for everyone. It is important to understand who may benefit from it and what steps doctors take before prescribing it.

Identifying Low Testosterone With Anxiety

The first step is identifying low testosterone levels through blood tests. This usually means having a total testosterone level below the normal range, often defined as less than 300 ng/dL (nanograms per deciliter), although exact thresholds can vary by lab. Alongside lab tests, men may report symptoms such as fatigue, low mood, reduced sex drive, and increased anxiety. When both lab results and symptoms are present, doctors may explore treatment options.

Not every man with low testosterone feels anxious. Also, not every man with anxiety has low testosterone. That is why careful testing and history-taking are important. Doctors need to see a clear pattern that shows both low testosterone levels and mental health symptoms, including anxiety.

Criteria for Considering Testosterone Therapy

Men may be considered for TRT if they meet several key criteria:

1. Consistent Low Testosterone Levels
   Blood tests must confirm low testosterone. Tests are usually done in the morning, when testosterone is highest. At least two separate test results are often required.

2. Symptoms of Hypogonadism
   Symptoms must match the condition known as hypogonadism. This includes both physical symptoms like reduced muscle mass or erectile dysfunction and mental symptoms like sadness, low energy, and anxiety.

3. No Contraindications
   Some men should not take testosterone therapy. These include those with prostate cancer, certain heart conditions, or very high red blood cell counts. Before starting TRT, doctors screen for these risks.

4. No Clear Alternative Cause for Anxiety
   Anxiety may have many causes. Stress, trauma, medication side effects, or thyroid problems can also lead to anxiety. Doctors must rule out other causes before deciding that low testosterone is a major factor in the person’s anxiety.

5. Psychological Symptoms Not Improved With Standard Treatment Alone
   Some men try therapy, medication, or lifestyle changes for anxiety. If those steps do not help and testosterone is low, TRT may be considered as a supporting treatment—not as a replacement for mental health care.

Testosterone Therapy as Part of a Broader Plan

Even if a man meets all criteria, testosterone therapy is usually one part of a bigger health plan. Anxiety often requires a mix of treatments. This can include talking to a therapist, using anti-anxiety medications, improving sleep, exercising more, and eating healthier.

Testosterone therapy may help improve mood, energy, and focus. These improvements can make it easier to cope with anxiety. However, TRT is not a cure for anxiety. It works best when combined with other strategies.

Doctors who prescribe TRT often recommend regular mental health support alongside hormone treatment. Anxiety can still occur even if hormone levels return to normal. That is why most treatment plans include ongoing counseling or support.

Guidelines From Endocrine and Medical Societies

Several expert organizations have issued guidelines on testosterone therapy. These include the Endocrine Society, the American Urological Association (AUA), and the European Academy of Andrology (EAA).

Most of these guidelines agree on a few key points:

• TRT should only be used when low testosterone is confirmed through testing and symptoms are clearly linked.

• The main reason to start TRT is physical symptoms of hypogonadism, such as low sex drive, reduced strength, and fatigue.

• Mood and mental health benefits may occur, but these should not be the only reason to start TRT.

• Men with anxiety or depression should receive full mental health evaluation before TRT begins.

• Ongoing follow-up is important to watch for side effects or changes in mood.

These guidelines help ensure that TRT is used safely and only when it is truly needed. Doctors use them to make careful decisions that balance the risks and benefits.

Testosterone therapy may help some men with anxiety, but only when testosterone levels are low and other causes of anxiety have been ruled out. It is not meant to be a first step in treating anxiety, but it may be helpful as part of a wider treatment plan. A thorough medical check-up, lab tests, and a review of symptoms are all required before starting therapy. Following expert guidelines ensures that the right patients receive the right treatment in the safest way possible.

What Are the Risks and Considerations of Testosterone Therapy?

Testosterone therapy (also known as testosterone replacement therapy or TRT) can help raise low testosterone levels in men. Some men feel better after treatment, especially if they had symptoms like low energy, low mood, or reduced sex drive. However, there are also risks and side effects that must be understood before starting therapy. Doctors usually weigh the benefits and the risks carefully before recommending TRT.

Common Side Effects of Testosterone Therapy

Testosterone therapy is generally safe when monitored correctly, but it can lead to some common side effects. These may include:

• Acne and Oily Skin: Extra testosterone can increase oil production in the skin. This can lead to acne, especially on the back or shoulders.

• Fluid Retention: Some men may retain water, leading to swelling in the ankles or feet. In rare cases, this can make high blood pressure worse.

• Sleep Apnea: Testosterone therapy may make existing sleep apnea worse. Sleep apnea is a condition where breathing starts and stops during sleep. It can lead to poor sleep and daytime tiredness.

• Breast Enlargement (Gynecomastia): Higher levels of testosterone can sometimes be converted to estrogen in the body. This may cause breast tissue to grow in men.

• Increased Red Blood Cell Count: Testosterone signals the body to make more red blood cells. This is helpful in some men, but too many red blood cells can thicken the blood and raise the risk of blood clots or stroke.

• Fertility Problems: Testosterone therapy can lower sperm production. This happens because extra testosterone from outside the body tells the brain to reduce signals to the testes. As a result, natural sperm production slows down. TRT is not recommended for men who want to have children soon.

Mental Health Effects

Testosterone therapy may improve mood in some men, but it can also lead to unwanted mental health effects in others.

• Irritability and Mood Swings: Some men report feeling more irritable or quick-tempered after starting testosterone. Mood swings can also happen, especially if the therapy is not well-balanced.

• Mania or Aggression: In rare cases, very high testosterone levels may lead to aggressive behavior or manic symptoms. This is more likely when testosterone is misused or taken in very large doses, such as in anabolic steroid abuse.

• Emotional Numbness: A few studies suggest that some men may feel emotionally flat or less sensitive to emotions while on TRT. This effect is still being studied and is not fully understood.

Long-Term Health Considerations

Long-term use of testosterone therapy needs close monitoring. There are still open questions about how it may affect the heart, prostate, and other organs over time.

• Heart Health: Some studies suggest that TRT might increase the risk of heart problems like heart attacks or strokes, especially in older men or those with existing heart disease. Other studies show no risk or even a benefit. Because of this uncertainty, doctors check blood pressure, cholesterol, and heart function before and during treatment.

• Prostate Health: Testosterone therapy may enlarge the prostate. This can cause problems with urination, such as needing to urinate more often or having a weak stream. There is no strong proof that TRT causes prostate cancer, but it may cause an existing prostate cancer to grow. Men receiving TRT usually have regular prostate exams and PSA (prostate-specific antigen) blood tests.

• Liver Effects: Oral testosterone (now rarely used) has been linked to liver damage. Newer methods like injections, gels, and patches avoid this problem.

Monitoring and Medical Supervision

Testosterone therapy should only be started after proper testing and diagnosis. It is not meant for men with normal testosterone levels. Before starting therapy, doctors usually check:

• Total and free testosterone levels (with blood tests taken in the morning)

• Medical history, including prostate or heart problems

• Current symptoms

Once therapy begins, regular checkups are important. These usually include:

• Monitoring testosterone levels to make sure they stay in the normal range

• Checking blood pressure, cholesterol, and red blood cell count

• Watching for side effects

• Prostate exams and PSA testing

Testosterone therapy can be helpful for men with proven low testosterone and bothersome symptoms. But it is not without risks. Some side effects are mild, like acne or fluid retention. Others, such as fertility loss or changes in mood, can have a bigger impact. Long-term health risks, especially involving the heart and prostate, must be considered. For safe use, testosterone therapy requires regular testing, careful follow-up, and guidance from a healthcare provider. Treatment decisions should be based on a full review of symptoms, lab results, and personal health risks.

Are There Other Factors Influencing Anxiety in Men With Low Testosterone?

Anxiety is a common mental health condition that affects how a person feels, thinks, and acts. For men with low testosterone, anxiety may be part of a larger picture. Hormone levels do play a role in mood, but they are only one part of a complex system. Several other health conditions and lifestyle factors can make anxiety worse in men who already have low testosterone. Understanding these factors helps healthcare providers create a more complete plan for treatment.

Sleep Apnea and Anxiety

Sleep apnea is a condition where breathing stops and starts many times during sleep. Obstructive sleep apnea (OSA) is the most common type. It is more common in men, especially those who are overweight or have low testosterone levels. Sleep apnea leads to poor-quality sleep, which can raise stress levels and increase anxiety.

Low oxygen levels during sleep affect the brain’s ability to regulate mood. Men with untreated sleep apnea often report feeling tired, irritable, or anxious during the day. Studies show a strong link between sleep disorders and mood disorders. In some cases, testosterone replacement therapy (TRT) can make sleep apnea worse, especially at high doses. This is why men considering TRT need screening for sleep apnea before starting therapy.

Metabolic Syndrome

Metabolic syndrome is a group of conditions that include high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. These problems increase the risk for heart disease, diabetes, and stroke. Metabolic syndrome is also linked to both low testosterone and anxiety.

Men with metabolic syndrome often have inflammation in the body. Chronic inflammation can affect the brain and lead to changes in mood. Fat tissue also produces substances that can interfere with hormone balance. In many cases, improving metabolic health through diet and exercise can help lower anxiety levels and improve testosterone levels at the same time.

Thyroid Dysfunction

The thyroid is a gland in the neck that controls metabolism by releasing hormones. If the thyroid makes too much or too little hormone, it can cause mood changes, including anxiety. Hyperthyroidism (overactive thyroid) can cause restlessness, irritability, and a racing heartbeat—symptoms that may look like anxiety.

Thyroid disorders can also lower testosterone levels. For example, hypothyroidism (underactive thyroid) may reduce testosterone by affecting how hormones are made and used. Because of this connection, blood tests for thyroid function are often part of a full hormone check when men report both low testosterone and anxiety.

Chronic Stress

Stress is the body’s response to pressure or threat. Short-term stress is normal and can even help performance. But long-term stress, also called chronic stress, can harm the body in many ways. One key system affected is the hypothalamic-pituitary-adrenal (HPA) axis, which controls how the body responds to stress. When this system is overactive for too long, it can reduce testosterone production.

High stress also raises cortisol, a hormone that helps the body respond to danger. Chronically high cortisol can lower testosterone and increase anxiety at the same time. This creates a cycle: stress lowers testosterone, and low testosterone leads to more anxiety, which causes more stress.

Finding ways to manage stress—such as mindfulness, therapy, or regular exercise—can help break this cycle. Addressing stress is an important part of any treatment plan for men with anxiety and hormone imbalance.

Lifestyle Factors

Daily habits also influence both testosterone levels and anxiety. Poor diet, lack of exercise, smoking, and alcohol use can all make hormone levels worse and increase feelings of anxiety.

• Lack of exercise: Physical activity helps reduce anxiety and improves testosterone. Resistance training and regular cardio workouts are shown to boost mood and hormone levels.

• Poor diet: Diets high in processed foods, sugar, and unhealthy fats can lead to weight gain, blood sugar problems, and inflammation. These factors reduce testosterone and increase risk for anxiety.

• Alcohol use: Drinking too much alcohol lowers testosterone and interferes with sleep. Alcohol may seem to relax the body in the short term, but it increases anxiety over time.

• Smoking: Tobacco use reduces blood flow, lowers testosterone, and affects brain function. It is also linked to higher rates of depression and anxiety.

A Whole-Person Approach

When treating anxiety in men with low testosterone, it is important to look beyond hormones alone. Sleep quality, physical health, stress levels, and lifestyle choices all play a role. Many of these factors are connected. Improving one area—like exercise or sleep—often helps other areas too.

Doctors often recommend a full health evaluation before starting TRT. This helps identify other problems that could be adding to anxiety or lowering testosterone. Treating all these factors together offers a better chance of long-term success.

Conclusion

Testosterone is a hormone that plays a major role in men’s health. It helps control many body functions like muscle strength, fat distribution, sex drive, and mood. When testosterone levels drop too low, it can affect both physical and mental health. One area of growing interest in medical research is how low testosterone may be linked to mental health conditions, especially anxiety.

Anxiety is a feeling of worry or fear that does not go away and can get worse over time. It can make it hard to concentrate, sleep, or handle daily activities. While many factors can cause anxiety, such as stress, trauma, or genetics, research now shows that hormone levels, including testosterone, may also play a role.

Low testosterone, also called hypogonadism, can cause several symptoms that are also common in anxiety. These include low energy, poor sleep, difficulty focusing, irritability, and a constant feeling of unease. These shared symptoms can make it hard to tell which problem started first. For example, someone with anxiety may start to experience hormone changes, while a person with low testosterone might begin to feel anxious due to how their body and mind are affected.

Studies show that men with low testosterone often have higher rates of anxiety disorders than men with normal levels. Scientists believe this could be due to how testosterone affects brain chemicals such as serotonin and GABA. These chemicals help regulate mood and reduce feelings of fear and worry. When testosterone is low, these calming effects may be reduced, and anxiety symptoms may become stronger.

To treat low testosterone, doctors often use testosterone replacement therapy (TRT). This therapy raises testosterone to healthy levels using medications such as injections, gels, patches, or pellets. As hormone levels increase, many men report improvements in energy, mood, and sleep—all of which can help reduce anxiety. Some clinical studies support this. They show that TRT may help lower anxiety symptoms in men with low testosterone, especially if the anxiety started around the same time hormone levels dropped.

However, testosterone therapy is not a treatment for anxiety on its own. It is most helpful when anxiety is linked to low testosterone levels confirmed by blood tests. A full medical check is needed to find out if hormone imbalance is the main cause. If anxiety comes from other reasons—like chronic stress, depression, or medical conditions—then treating the hormones alone may not be enough. In those cases, mental health therapies like cognitive-behavioral therapy (CBT), medication, or counseling may be needed along with or instead of hormone treatment.

Testosterone therapy also comes with risks. It may cause side effects like acne, fluid retention, increased red blood cell counts, and sleep issues. In some cases, it may lower sperm count or affect fertility. There are also concerns about heart health, especially in older men or those with certain medical conditions. Because of these risks, therapy must be closely watched by a healthcare provider. Blood tests and follow-up visits help make sure hormone levels stay in a safe range and that the body is responding well.

Low testosterone is not the only factor that affects anxiety. Other health problems, such as sleep apnea, thyroid disorders, obesity, and lack of exercise, can also increase anxiety and lower testosterone at the same time. These conditions can work together and make symptoms worse. This is why a full health plan—one that includes good sleep, physical activity, a balanced diet, stress management, and medical care—is often the most effective way to improve both hormone levels and mental well-being.

There is no one-size-fits-all answer when it comes to testosterone and anxiety. The relationship between the two is real but complex. Research shows that for some men, especially those with diagnosed low testosterone, therapy may help reduce anxiety symptoms. For others, the cause may lie elsewhere. What matters most is finding the root cause and working with a healthcare professional to choose the right treatment path. More studies are still needed to better understand how testosterone affects the brain and how best to use hormone therapy to support mental health in men.