However, besides the affective, psychomotor and cognitive symptoms, depression can bring about vegetative manifestations which encompass unintentional weight loss or gain, insomnia or hypersomnia, and sexual dysfunction. Depressive symptoms have been reported in 35-50% of male patients with hypogonadism in cross-sectional studies (6–8). While the most specific symptoms are the sexual ones, i.e. low libido, erectile dysfunction, diminished frequency of morning erections (4) and orgasmic disorders (5), other non-specific manifestations are included in the syndrome, like fatigue, cognitive impairment and depressed mood (1, 3). In the present study, we used data from the repeated National Health and Nutrition Examination Studies (NHANES) to examine the cross-sectional association between testosterone and specific symptoms of depression in men and women. However, some studies have suggested that both low and high levels of testosterone might be related to elevated depression risk . They can also evaluate whether other factors or conditions could be contributing to your low testosterone levels and whether those conditions need to be addressed. While most men do not experience these severe side effects, some individuals, particularly those with a history of mental illness, may be at risk. To prevent mood-related side effects, it is important to follow medical advice, maintain a healthy lifestyle, and monitor emotional well-being while on TT. The idea of "roid rage" is linked to the abuse of anabolic steroids, not to controlled testosterone therapy. In TT, doctors prescribe controlled doses of testosterone to help people with low levels. However, testosterone therapy is different from anabolic steroid abuse. These drugs flood the body with extremely high levels of testosterone, which can cause severe mood swings, paranoia, and aggression. A balanced testosterone level is essential for mental well-being, and both too much and too little can cause problems. The key to avoiding these negative effects is careful monitoring by a healthcare provider. However, if mental side effects last longer than expected or become severe, medical help may be needed. Some mental side effects happen in the short term, while others last longer. While some men sleep better on TT, others experience insomnia, frequent wake-ups, or poor sleep quality. This can change the body’s natural hormone rhythm, sometimes affecting sleep patterns in ways you may not expect. However, some people who start TT notice changes in their sleep patterns. The conversion of testosterone by the enzyme aromatase results in the production of estrogen, which acts in target tissues through estrogen receptors α and β. Animal studies have demonstrated that the preoptic area, the hypothalamus and the amygdala are targets of potent, non-aromatizable androgens (51, 52). These observations were confirmed in castrated animals, ruling out the involvement of peripheral sex hormones in the anxiolytic and antidepressant actions of GnRH. The dysfunction in serotoninergic neurotransmission has been implicated in mood disorders (46). Consistently, Kisspeptin receptors expression has been documented in several regions of human brain, which include hippocampus and amygdala (45). Neuronal fibers containing kisspeptin and GnIH/RFRP are found not only in the hypothalamus, but also in amygdala, hippocampus, habenula, periaqueductal gray, and ventral tegmental area in mammals (44). Finally, neuronal circuits involved in the physiopathology of mood disorders, may be directly responsible for HPT axis deregulation.
