Are You Actually Really Depressed - Or Just Experiencing Andropause?
Why GPs May Be Too Quick to Prescribe Antidepressants to Middle-Age Men
Across the UK, there is a growing mental health crisis among middle-aged men. According to data from the Office for National Statistics (2023), suicide rates among men aged 45–59 remain alarmingly high, and men in this age bracket are more likely to be prescribed antidepressants than women of the same age group. But is depression always the correct diagnosis?
An increasing body of evidence suggests that what many general practitioners (GPs) label as "depression" in middle-aged men may, in fact, be symptoms of andropause—also known as late-onset hypogonadism or testosterone deficiency syndrome. The unfortunate result? A potential over-reliance on antidepressants and an underdiagnosis of hormone-related health issues.
Understanding Andropause
Andropause refers to the gradual decline in testosterone levels that typically occurs in men between the ages of 40 and 60. Unlike the abrupt hormonal shift seen in female menopause, andropause tends to progress slowly and subtly. However, its symptoms can be profound, including:
Low mood and irritability
Fatigue and poor concentration
Reduced libido and erectile dysfunction
Sleep disturbances
Increased body fat and decreased muscle mass
A general sense of apathy or “loss of vitality”
These symptoms overlap heavily with those of clinical depression, which often leads to confusion for both patients and clinicians.
GPs and the Over-prescription of Antidepressants
GPs are often the first point of contact for men experiencing low mood or lethargy. With appointment times limited to 10–15 minutes in many NHS settings, it can be challenging for Doctors to take a comprehensive hormonal and lifestyle history.
According to a report by Public Health England (2021), more than 7.8 million people in England were prescribed antidepressants in a single year, with men in the 40–60 age group showing significant increases year on year. Yet, only a small proportion of these prescriptions followed a full mental health assessment or blood tests to analyse certain blood biomarkers, especially hormone levels.
The Science Behind Testosterone and Mood
Testosterone is not just about libido or muscle mass—it plays a critical role in cognitive function, mood regulation, and emotional resilience.
A 2017 meta-analysis published in JAMA Psychiatry reviewed 27 randomised controlled trials and concluded that testosterone therapy significantly reduced depressive symptoms in men with low testosterone levels (Walther et al., 2017).
Moreover, a 2021 study from the European Journal of Endocrinology found that men with testosterone deficiency were twice as likely to be diagnosed with depression than those with healthy hormone levels (Khera et al., 2021).
These findings support a re-evaluation of how primary care practitioners approach male patients with depressive symptoms; especially if they fall into the andropause age bracket.
The Dangers of Missing Andropause
Failing to identify and treat testosterone deficiency can have long-term health consequences, including:
Increased risk of type 2 diabetes
Higher incidence of cardiovascular disease
Bone density loss and increased fracture risk
Declining sexual and cognitive function
The British Society for Sexual Medicine (BSSM) recommends that all men over 40 presenting with depressive symptoms, sexual dysfunction, or unexplained fatigue undergo testosterone screening (BSSM Guidelines, 2022).
Why Antidepressants May Not Be the Answer
While antidepressants can be life-saving for those with major depressive disorder, they come with their own risks, particularly if prescribed without proper diagnosis:
Sexual dysfunction
Emotional numbness
Weight gain
Increased risk of relapse once medication is discontinued
Masking the real issue rather than addressing the underlying hormonal imbalance
Further, men are less likely than women to adhere to long-term antidepressant treatment, which may lead to discontinuation without follow-up support.
A New Approach: Holistic Men’s Health Screening
What’s needed is a shift in clinical culture—especially in primary care—towards a more nuanced understanding of male midlife health.
Recommendations:
All men aged 40+ presenting with low mood or fatigue should be screened for testosterone deficiency.
GPs should use validated (yet simple) tools like the ADAM questionnaire (Androgen Deficiency in Aging Males).
Blood tests should include total testosterone, free testosterone, DHEA, SHBG, and LH.
Treatment decisions should be collaborative and personalised—considering hormone therapy, lifestyle interventions, and mental health support where needed.
Conclusion
If you're a man in your 40s or 50s and you’ve been told you're "just depressed," it might be time to ask whether you're actually experiencing the natural but impactful hormonal changes associated with andropause.
Before accepting a prescription for antidepressants, ask your GP to consider a full blood test, with hormonal biomarkers; especially if your symptoms are accompanied by fatigue, sexual dysfunction, or loss of vitality. You might not be mentally ill. You might just be hormonally imbalanced and in need of targeted support.
.... and for our GP colleagues, the BSSM (British Society of Sexual Medicine) have a FREE e-learning package aimed at GP's and GP trainees regarding testosterone deficiency (https://bssm.org.uk/e-learning/)