There is more than enough clinical evidence to conclusively prove that a correlation (relationship) between low testosterone and stress exists.  However, said correlation then begs the question of which way this evidence is slanted.  That is to say, is stress a contributing factor in the condition of low testosterone, or does having low testosterone make a person more likely to experience stress to a greater degree?  As with many debates there are proponents on both sides, and one of the primary problems here rests with the truth that both low testosterone and stress share several symptoms.  Nevertheless, the vast majority of research-based evidence is clearly on one side of this debate, and this article will reveal it.

What Is Stress?

Prior to explaining a thing, it is often best to start with at clear definition on which to build.  According to the Mayo Clinic, stress is a physical, mental, and emotional response to a challenging event.  It is however, important to realize that stress is not the event itself, but rather one’s realistic or unrealistic response to the event.  Similar to the body’s fight-or-flight response, the body’s stress response occurs automatically when a real or imagined threat is believed to exist.  Stress can be either positive or negative depending on how the person perceives and deals with the event.  For example, learning that the company is about to downsize, and cut out several jobs often causes negative stress in employees, whereas hearing that an upper level job just became available can make one work harder, longer, or better resulting in positive stress.  Generally, when stress is spoken of generically the type of stress that’s implied is almost always negative stress.

Some of the symptoms of stress also happen to be characteristic of hypogonadism (low testosterone).  In particular, both conditions include:

• Diminished libido, a lack of interest in sex
• Chronic fatigue
• Sleep complications
• Feelings of depression, and disinterest
• Lack of energy and listlessness
• Irritability, moodiness, having a quick temper 

Physicians cite that it can be difficult to know if these symptoms are due to stress or low testosterone levels, which have a wide range of normalcy, and can vary throughout the day.  One theory is that if these common symptoms are present, then testosterone is necessarily a little low because such symptoms are generally accompanied by low testosterone. However, many older men experiencing andropause (male menopause) have varying levels of low testosterone but present none of the above symptoms at all. 

What Some Research Shows About Stress and Low Testosterone

One of the specialty institutes at the world famous Cleveland Clinic, is the Wellness Institute where the initiative is to prevent illness and foster health.  Among the program’s components is care in the holistic prevention and management of all types of life stressors from workplace/employee to interpersonal relationships to death and bereavement.  According to Dr. Daniel Shoskes, MD of the Cleveland Clinic, association is not the same as causality.  Dr. Shoskes, clarifies this by saying that there is very little evidence that stress lowers testosterone levels, and even less evidence for the inverse, namely that lowering stress will raise testosterone levels.  Based on current medical research, any effect stress has on testosterone levels is so small that it doesn’t register changes within the body.  This is not to say that acute and chronic stress doesn’t physiologically impact the body, because it does.  Thus lowering stress could help improve specific low testosterone symptoms like low libido, low energy, and depression.

Over the years, some studies have suggested that the stress hormone cortisol and the sex hormone testosterone work against each other.  This possibility led to the theory that stress may cause, or at least play a role in promoting low libido and even infertility in men by inhibiting testosterone secretion.  The Journal of Personality and Social Psychology published a 2008 study entitled ‘The Social Endocrinology of Dominance: Basal Testosterone Predicts Cortisol Changes and Behavior Following Victory and Defeat’. This study provides new evidence for what is called the cortisol-testosterone hormonal axis. In the study, researchers measured hormonal levels in subjects who were matched against each other in one-on-one competition.  Their cortisol (a stress released hormone) and testosterone levels were measured following competition, and those who lost were asked if they wanted to compete again.  All the subjects who declined to participate in a rematch had high cortisol levels, along with only a slight (statistically significant) drop in testosterone levels.

R. Aguilar, et al of Facultad de Psicología, Universidad de Málaga, Campus Teatinos, Málaga, Spain published a study in the July 2013 Journal of Physiological Behavior entitled, ‘Testosterone, cortisol and anxiety in elite field hockey players’.

The study’s expressed aim was to assess the change in testosterone and cortisol levels following victory and defeat in male field hockey players during an important tournament.  At the beginning of the games players were ranked very closely to create a high level of competitiveness.  The first game ended in a 7-4 victory, the second game ended in a 6-1 victory, and the third and final game ended in a 1-2 defeat.  Changes in testosterone levels were registered directly following competition, rising slightly in the two games that ended in victory, and dropping in the game that ended in defeat.  Correlational analyses were used as the form of measurement and congruently showed that defeats led to rises in cortisol (chemical indicators of stress and anxiety), whereas victories led to rises in testosterone (an opposite reduction in stress indicator).  Anticipatory somatic anxiety (a multi-system response to a perceived threat or danger) was related to cortisol levels prior to games, and physical exertion during competition was related to the change in testosterone levels (suggesting an inhibitory effect) but not to the change in cortisol levels.  R. Aguilar, et al were able to demonstrate a pattern of hormonal responses in a real life competitive challenge, (i.e. Mazur’s 1985 biosocial model of status and dominance motivation), by illustrating both cortisol and testosterone levels can be directly linked to defeat and victory in a theoretically predictable manner.

A Different Way to Gauge Correlation

Another way to measure the correlation between low testosterone and stress is through the treatment of hypogonadic patients.  Testosterone replacement therapy (TRT) consists of a variety of man-made, or synthetic testosterones that represent the primary medications used to treat low testosterone, a condition that often causes a variety of adverse hypogonadic symptoms.  Belonging to a class of medications called anabolic steroids, such synthetic testosterones provide support for deficient endogenous (natural) testosterone levels by either raising the total hormone levels back into the normal range, or elevating these levels high enough within the normal range (back into the optimal range) to reverse negative hypogonadic symptoms.  There are different variations (delivery mechanisms, blends, esters, etc.) of synthetic testosterone each with its own unique properties and mechanisms.  Several studies have illustrated how increasing testosterone levels counteract, or decrease stress, which manifests itself as anxiety, depression, and other psychological conditions. 

In November of 2012 the Chinese Medical Journal published a study by XW. Zhang, et al of the Department of Urology, Peking University People’s Hospital, Beijing, China entitled, ‘Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population’.  The aim of this study was to investigate the effects of testosterone replacement therapy on psychological well-being and quality of life, which was defined as the interrelationship among hypogonadic symptoms.  This 6-month, double blind, 160 male subject study compared initial baseline and end of study results for both total and free testosterone levels, along with the measures of four separate inventory scales which included:  1) the perceived stress scale (PSS); 2) the aging male’s symptoms (AMS) rating scale; 3) the short form health survey-12 (SF-12); and 4) the hospital anxiety and depression scale (HADS).  Randomly assigned to treatment and control groups, the subjects were administered either oral 120 – 160 mg of testosterone undecanoate capsules on a daily basis, or placebo capsules containing vitamin E and vitamin C.  Total experimental (treatment) group serum testosterone concentrations before and after the intervention were (7.98 ± 0.73) nmol/L and (13.7 ± 1.18) nmol/L.  XW Zhang, et al found that each of the hypogonadic symptom measures within the experimental group had significantly improved, with no significant changes in the control group.  They concluded that testosterone replacement therapy both improved a variety of hypogonadic symptoms, and comprehensively enhanced the improvement of psychological issues as well.

A cohort study from the Journal of Endocrinology in December of 2012 by Aydogan U, et al of the Department of Family Medicine, Gulhane School of Medicine, Ankara, Turkey, undertook research with the expressed aim of assessing associations between low testosterone levels and psychological symptoms (cited as depression, anxiety disorders, and antidepressant use).  The test subjects included 39 young males with congenital hypogonadotropic hypogonadism (CHH), while the control group was comprised of 40 age matched healthy males.  More specifically, Aydogan U, et al measured the impact of testosterone replacement treatment (TRT) on the patients’ anxiety and depression levels, as well as sexual function before and after 6 months of treatment using valid and reliable scales which included the Beck Anxiety Inventory (BAI), and Arizona Sexual Experiences (ASEX), Short Form-36 (SF-36), and Beck Depression Inventory (BDI).  After 6 months of treatment Aydogan U, et al found that subjects receiving testosterone replacement therapy, referred to as the post-treatment experimental group, had significantly improved test scores across the board as compared to the placebo group.  They concluded, as the findings suggest, that low testosterone levels are directly related to an increased incidence of hypogonadic psychological symptoms. 

Ways to Lower Stress 

Dr. Shoskes first advice for reducing stress, which includes a depressed mood, clinical depression, anxiety, irritability, sadness, tiredness/fatigue, and unexplained outbursts of anger, is to stop worrying about testosterone levels.  Let the physician determine if low testosterone is the culprit and address it accordingly.  Meanwhile, just as stress and low testosterone share some the same symptoms they also share many of the same lifestyle changes that may aid in lowering stress levels and improving health, such as:

• Learn and practice relaxation techniques designed to reduce stress
• Set realistic goals in stress reduction
• Ask for help when struggling
• Don’t use illicit drugs to relieve stress
• Eat a healthy diet
• Get enough sleep
• Exercise regularly
• Don’t smoke
• Avoid consuming excessive amounts of alcohol and caffeine 

Additionally, overweight people tend to be more prone to stress.  Thus, if appropriate, losing weight may both reduce stress and promote a healthier sex life.  A study published in The Journal of Sexual Medicine found that when 31 obese men with type 2 diabetes were put on weight reducing diets for eight weeks, both their stress levels (which were related to sexual frustration) and erectile dysfunction decreased, while sexual desire increased.  After eight weeks, their waist circumference and body weight had decreased by 5 to 10 percent.

As discussed, stress and low testosterone have many symptoms in common, and may be linked by the stress hormone cortisol.  There is a growing body of evidence that shows high cortisol levels may depress testosterone.  As for the evidence that taking testosterone treatments will reduce stress, this is only conclusively seen in individuals who have lower than normal testosterone levels.

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