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For people with low testosterone, bringing their levels back to normal can have a positive impact on their mental health. When they start testosterone therapy, some of these symptoms improve, leading to a decrease in anxiety. Many people who have low testosterone (low T) experience symptoms like fatigue, low energy, poor concentration, and anxiety.
Others, however, may experience increased nervousness, restlessness, or panic attacks. Some men find that their anxiety improves because they feel more energetic, confident, and emotionally stable. While mood swings are often temporary, they can be frustrating and may affect relationships and daily life. When levels are too high, they may feel irritable, aggressive, or restless. It affects neurotransmitters such as dopamine, serotonin, and GABA, which regulate mood, emotions, and cognitive function. The duration of these effects depends on several factors, including dosage, how long someone has been on TT, and individual body responses.
Conversely, SNRIs but not SSRIs presented higher OR of erectile dysfunction, suggesting a specific effect of SNRIs on this phase of sexual cycle possibly related to dose-dependent noradrenaline-mediated vasoconstriction at peripheral sympathetic level (113). In a recent systematic review and meta-analysis considering only randomized controlled studies, Trinchieri and coll. As described above, activation of 5-HT2 receptors results in the central inhibition of sexual circuits likely due to decreased dopaminergic transmission (110). Antidepressant drugs can affect all 3 phases of normal sexual response in males by reducing libido, causing arousal disturbance or delaying orgasm. The mesolimbic system plays a primary role in sexual motivation and dopamine is the most important neurotransmitter in this context. Variation in Beck Depression Inventory was proportional to severity of pre-existing erectile dysfunction, increase in body mass index and reduction of testosterone concentrations.
We’ll examine the science behind the therapy, its potential benefits, and the considerations men should keep in mind when contemplating this treatment option. Even with an abnormally low level that is replicated on a repeat test, the decision to begin testosterone replacement therapy and the proper dose requires a careful conversation with your doctor. Men and women need the proper amount of testosterone to develop and function normally.
While these findings are promising, not everyone on TT experiences improved memory or focus. In this section, we will explore how TT affects memory, cognitive function, and overall mental clarity. Testosterone plays a key role in brain function, especially in areas related to memory, focus, and thinking skills. It is important to note that serious cases of depression from TT are rare. Low testosterone can also make it harder to enjoy activities, concentrate, or feel emotionally stable. These changes are usually temporary and can be managed with proper hormone monitoring, dosage adjustments, and lifestyle changes. Some testosterone is naturally converted into estrogen in the body through a process called aromatization.
Atypical (or second-generation) antipsychotics (AAPs) are frequently prescribed as augmenting agents in patients with major depression in case of incomplete clinical response to monotherapy with antidepressants (116). In addition to confirming the association between sexual dysfunction and therapy with SSRIs, SNRIs, TCAs and MAOI phenelzine, the study focused on some antidepressants having a more favourable profile on sexual function. Another meta-analysis including data from 63 studies (58 randomized controlled trials, 5 observational studies) with more than 26,000 patients confirmed that second-generation antidepressants are related to an increased risk of sexual dysfunction. Among SNRIs, the balance between the degree of serotonin and norepinephrine reuptake inhibition changes the impact of these drugs on sexual function (namely, the greater the inhibition of serotonin reuptake, the greater the incidence of sexual effects). Inhibition of peripheral autonomic sympathetic and parasympathetic nervous systems can also contribute to the onset of sexual side effects. Serotoninergic activity in turn interferes with dopaminergic signal in the mesolimbic system and can also lead to an increase of prolactin levels with subsequent hypogonadotropic hypogonadism (114–116).

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