Psychological and Psychiatric Effects of Testosterone Therapy in Men: A Narrative Review
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Abstract
Testosterone is a key androgen with significant influence beyond reproductive physiology, extending to mood regulation, cognition, motivation, and overall psychological well-being. Age-related decline in testosterone and hypogonadism have been associated with depressive symptoms, anxiety, fatigue, and reduced quality of life, underscoring the importance of hormonal balance in mental health. This narrative review aimed to synthesize the current evidence on the psychological and psychiatric effects of testosterone therapy (TRT) in men, with emphasis on its role in depression, anxiety, cognition, aging, and psychiatric disorders. A comprehensive literature search was conducted using PubMed, Embase, PsycINFO, and Cochrane Library, covering studies from 1990 to 2025. Eligible publications included clinical trials, systematic reviews, and meta-analyses evaluating the impact of TRT on psychological or psychiatric outcomes in adult men. Evidence suggests that TRT improves vitality, self-confidence, sexual function, and quality of life in hypogonadal men. Significant reductions in depressive symptoms and enhanced cognitive performance have been reported, particularly in older men and those with clinically low testosterone levels. While TRT appears to reduce fatigue and improve mood, results regarding anxiety remain mixed, and its role in conditions such as schizophrenia and bipolar disorder is still exploratory. Importantly, physiological TRT is generally not associated with increased aggression, distinguishing it from the psychiatric risks of supraphysiological anabolic steroid abuse. Testosterone therapy may confer substantial psychological and psychiatric benefits in men with hypogonadism, particularly in mood and cognitive domains. However, limitations such as heterogeneity in study design, diagnostic criteria, and lack of long-term data warrant caution. Future large-scale, multidisciplinary trials are essential to establish standardized guidelines and clarify the long-term psychiatric safety of TRT.
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