Dr. Andrew De Pieri
If you're a man with symptoms of depression or chronic fatigue, and have been offered an antidepressant, you may want to consider checking your homone levels.
If you’re a man with symptoms of depression or chronic fatigue, and have been offered an antidepressant, you may want to consider checking your hormone levels first. Recent evidence shows symptoms of depression and fatigue in men may be linked to declining adrenal, thyroid, and sex hormones, namely testosterone.
After about the age of 40, men increasingly experience symptoms of fatigue and depression. Irritability, weight gain, loss of confidence, and social isolation often result in a diagnosis of depression. Severe fatigue is often attributed to burnout.
For many men, vacations, counselling, and medication fail to produce sustained improvement. They may find themselves on a raft of medications aimed at controlling their symptoms, rather than addressing the root cause of hormone decline. In addition, these same men may be diagnosed with hypertension, obesity, elevated cholesterol, heart disease, elevated blood sugar, or erectile dysfunction, all of which may be managed separately.
Andropause, or male menopause, is related to the decline in testosterone as men age, which begins after about age 25. Because of the slow onset, andropause can go unaddressed. The faster and deeper the decline in testosterone, the faster a man ages, resulting in increased heart attacks, strokes, diabetes, dementia, arthritis, osteoporosis, and cancer. Recent research shows men with low testosterone have anywhere from 57 to 88 percent increased risk of death from all causes.
Andropause, however, is only part of the bigger picture of hormonal decline. When testosterone begins to wane, thyroid, adrenal, and growth hormone output are also affected. Antiaging health practitioners often refer to this interaction as the thyroid-adrenal-gonadal axis.
The thyroid-adrenal-gonadal axis
Alteration in function of the adrenals, thyroid, and gonads can have tremendous effects on energy, mental function, mood, and metabolism. I often describe these three glands as three legs of a barstool: if even one is not in balance, the barstool will not stand, to the detriment of physical and emotional health.
The adrenal gland
In my practice, I consider the most important of the three glands to be the adrenal, since it supplies the cortisol that the other hormones require to access cells. Symptoms that suggest adrenal deficiency include poor productivity, decreased energy, anxiety, poor stress tolerance, poor memory, depression, irritability, dizziness, allergies, frequent chest colds, or bronchitis. If low adrenal output is not identified and addressed, treatment with testosterone and thyroid hormones can be marginally effective or completely ineffective.
The thyroid gland
If cortisol is inadequate, a person with a normal thyroid test, called a TSH, may have symptoms of hypothyroidism, such as dry skin, constipation, sluggishness, hoarse or weak voice, and depression. Many men will be given antidepressant medication for their symptoms because their thyroid is considered to be normal, based only on the TSH test, though testing active thyroid hormone (T3 and T4) tells us what the thyroid is actually producing.
This oversight can have negative consequences, since sluggish thyroid function has been identified as a risk factor in heart disease, hypertension, cancer, metabolic syndrome, and diabetes. Low T3 levels have also been shown to be associated with poor outcomes in cardiac patients.
The gonads (testicles in men) produce testosterone in response to signals from the pituitary gland. Testosterone travels throughout the body, stimulating muscle growth and strength, improving mood and libido, and strengthening bones. Low cortisol levels from the adrenal can impair the ablity of cells to absorb testosterone, making the testosterone less effective.
Low thyroid hormone levels can impair the cell from responding to testosterone, again making it less effective. Without all three glands functioning properly, testosterone does not work, even if the blood level is within the normal range.
Pitfalls of testosterone replacement
Of course, testosterone replacement is important in maintaining optimal male hormone levels. There is now medical evidence supporting the safety of testosterone therapy, even after prostate cancer surgery. However, simply supplementing with testosterone may not result in higher tissue levels and may actually increase estrogen production.
As men age, their visceral fat produces larger amounts of an enzyme called aromatase, which converts testosterone into estrogen. This is undesirable for two reasons. First, in the body’s effort to control estrogen levels, it also binds testosterone, making it unavailable. Second, estradiol (a form of estrogen) causes a reduction in testosterone production.
Taking this hormone interplay into account, we can understand why some men have an adverse response, or no response at all, to testosterone therapy. They may experience weight gain, worsening of erectile dysfunction, or breast enlargement—all from the aromatase activity that produces high estrogen levels. Or they may experience no effect at all, which can be related to poor adrenal function.
Recent medical studies have shown that simply by blocking conversion of testosterone to estradiol, we can restore testosterone production. Natural aromatase blockers should especially be considered in overweight men with metabolic syndrome or diabetes, since treating them with testosterone may only increase their estrogen and worsen their condition.
A healthy adrenal-thyroid-gonadal axis can provide renewed energy and sense of well-being to men with symptoms of depression. Hormone augmentation should be the last step in a pyramid of changes that start with a base of proper nutrition, stress reduction, exercise, and natural health supplements. If these changes are not effective, the final point of the pyramid is testosterone replacement balanced with thyroid and adrenal hormones.
Help for hormones
Keys to improving adrenal function
Keys to boosting thyroid function
Keys to balancing gonadal function
Always consult with your health practitioner before starting new medications or supplements.
* available by prescription at Canadian compounding pharmacies