Testosterone concentration and incident depression in older men: a longitudinal cohort study.

Forbes, M., Lotfaliany, M., Tran, C., Mohebbi, M., Woods, R. L., McNeil, J., & Berk, M. (2025). Testosterone concentration and incident depression in older men: a longitudinal cohort study. The journals of gerontology. Series A, Biological sciences and medical sciences, glaf019. Advance online publication. https://doi.org/10.1093/gerona/glaf019

Depression in older adults isn’t my area of expertise! My usual patient cohort is between the ages of 15 and 55, but during locum or outreach work, I occasionally see older patients. Funnily enough, my dad wasn’t too pleased to learn that he falls outside my usual scope—maybe in the future, as I gain more life experience, I’ll develop a better understanding of mental health across different generations.

That said, an article I recently came across piqued my interest. I have a soft spot for men’s mental health, particularly because mental healthcare often seems to have an overtly feminine aesthetic—think flowers, pastel colors, and delicate artwork—which I sometimes find a bit off-putting. Maybe that’s just me! But back to the article.

To provide some context, depression is a debilitating disease. In older men, it can be particularly serious, carrying a higher risk of mortality and poorer physical health outcomes. This makes it not only devastating for the individual but also for their loved ones.

We already know that menopause can trigger psychiatric symptoms in women, so some have proposed that andropause (the so-called male equivalent of menopause) might contribute to mood disturbances and depression. This theory has, in part, driven the rise of testosterone clinics. In the U.S., about 4% of testosterone prescriptions are written specifically for depression—an intriguing statistic given that testosterone’s role in mental health hasn’t been extensively studied compared to traditional treatments.

Naturally, testosterone levels decline by approximately 0.8% per year starting at age 55. Interestingly, just a decade after testosterone’s discovery in 1938 (a Nobel Prize-winning achievement, by the way), researchers were already exploring its potential as a treatment for depression. Some studies suggest it has a positive effect, while others find no consistent response.

This is where Dr. Forbes and his team come in. Using data from an existing clinical trial, they collected blood samples from participants at baseline and again three years later, measuring depression using standardized scales. Their study included a whopping 4,000 participants!

So, what did they find? Lower testosterone levels are NOT associated with depression. There is only a weak link between lower testosterone and feelings of loneliness or fearfulness. This is a significant finding because it contradicts some epidemiological studies and, more importantly, tracks patients over time rather than relying on cross-sectional data. The researchers suggest that low testosterone may actually be a byproduct of being physically or psychologically unwell rather than a direct cause of depression. This aligns with recent studies indicating that testosterone supplementation does not consistently improve mood or emotional well-being.

What does this mean for clinical practice? Well, we shouldn’t be recommending treatments that don’t work! Testosterone therapy comes with risks, including obstructive sleep apnea, acne, and prostatic hyperplasia, which may not be worth the trade-off if the treatment isn’t truly effective for depression.

Another key takeaway is that depression in older men is not purely biological. Framing their mental health struggles as a chemical imbalance may actually be a disservice to this vulnerable group. Men of this age are not immune to the psychological and social challenges of the world around them, and mental health interventions that go beyond biology—such as therapy, social connection, and purpose-driven activities—shouldn’t be dismissed or stigmatized.

From a developmental perspective, this age group falls into Erikson’s stage of Generativity vs. Stagnation (ages 40–65). This is a critical life phase where people focus on building wealth, contributing to family and society, and leaving a legacy. If they don’t feel productive or valued, they may experience stagnation—feeling stuck, purposeless, and, in some cases, depressed. Perhaps this stage of life, rather than declining testosterone, is the true underlying cause of depression in many older men.

Ultimately, treating patients holistically is essential. When it comes to men’s mental health, we need to look beyond the physical and address the deeper psychological and social factors at play.