Suicide in Older Men is Often Triggered by Low Testosterone…Know How to Help the Men You Love (or Yourself)
My family is mourning the loss of Robin Williams today. With 5 boys, hardly a week would go by that a line from Robin’s comedy didn’t pop out of someone’s mouth. We honor his gift to us all.
Image credit: Eva Rinaldi
Suicide and Low Testosterone
I don’t pretend to know Robin’s health history, but I have had over 6 men in my life suddenly commit suicide after battling unresponsive depression in the fall or winter of their lives. Men who had worked hard for others their whole lives, suddenly quit on life when it was their turn to take care of themselves.
The past few years have seen Level 1 evidence (studies of all the studies, resulting in the strongest evidence based-medicine) that low testosterone levels in aging men are linked to anxiety and major depression that is often unresponsive to common therapies (such as SSRI antidepressants).
This consequence of andropause mirrors the same depression seen in many women during menopause.
Testosterone Regulates Serotonin
Sex steroids, like testosterone, help regulate serotonin receptors and levels in the brain. Without testosterone our brains don’t respond well to the serotonin that is present and in a double whammy, less serotonin becomes available.
This leads to the depressive symptoms, and may play a role in aging dementia.
Normal Aging, Longer Living
Testosterone levels begin declining in men after age 40. In fact, three quarters of older men have low testosterone, it is a normal part of aging in men.
However, since we are living longer, this also means men may spend half their lives with testosterone levels that are too low to support normal healthy brain, health, muscle and sexual function.
Low testosterone causes symptoms such as: muscle and bone density loss, lower sex drive, poor erection quality, fat accumulation in the “beer belly”, depression, irritability, fatigue and memory loss.
In contrast, evidence (again Level 1) suggests that testosterone therapy in older men decreases death rates from cardiac disease, improves quality of life and overall health, and decreases anxiety and depression.
Contrary to the “hormonophobia” headlines you have heard recently, taking testosterone for older men is not about vanity or clinging to youth. It is literally a choice for survival in many men, and a therapy for highest quality of life in most men.
In particular for older men, low testosterone can lead to depression, anxiety and poorer cognitive function. Low testosterone is also linked to an increased suicide rate in older men.
What Impacts Testosterone Levels?
Besides the natural aging decline, many factors further decrease testosterone levels:
- Gaining weight
- Taking statins
- Taking SSRI antidepressants
- Taking narcotics
- Having less sex
- Taking steroids for asthma or pain
- Consistent alcohol use
- A past vasectomy
Men with any of these factors may have extremely low testosterone.
Story of a Typical Man
Here is a typical aging man’s story that happens over and over again:
A successful, fit man with good libido (high normal testosterone) starts in their late 40s to early 50s to struggle with weight accumulation around the middle, a decreasing sex drive and erections that are easily lost with distraction during sex (frequency of morning erections begins to decline also).
These men may become irritable and anxious or depressed about life and have newly diagnosed diabetes. They are put on SSRI antidepressants for the depression, statins for their weight gain and Viagra.
They also hurt their back occasionally, so have narcotics around for those times.
Now a spiral begins…as the man and his physicians don’t realize they just sent his testosterone levels into a sonic crash.
The Viagra stops working, the SSRI stops working, he stops having sex and exercise. This man feels bad, his body strength is failing and he sees a lifetime of feeling worse ahead of him. Over time as he becomes a shadow of himself, and his risk for suicide increases.
But there is hope…
Many studies have demonstrated highly significant improvement in depressive symptoms for men with clinically low testosterone after going on testosterone therapy. This is especially seen in men who are not responding to SSRI antidepressants.
However, patients taking SSRIs also experience a significant improvement in depressive symptoms once treated with testosterone.
Aging men with depressive symptoms and testosterone deficiency syndrome should be given a trial of testosterone replacement therapy for at least 3 months (in collaboration with their doctor). This testosterone therapy has also been shown to impact a man’s response to Viagra, his muscle tone and weight loss, as well as his sex life and overall quality of life.
If you or your aging man are having changes in the body or mind it is important to complete the Aging Male Syndrome test. If these symptoms are found, find a physician who specializes in aging male medicine.
Find someone who is a member of one of these two medical groups for best again male care: International Society for the Study of the Aging Male or Sexual Medicine Society of North America. Many general practitioners are not up to speed on the safety of testosterone therapy. I run into men all the time who have been told they “can’t take it.”
Also remember many counselors and psychotherapists may not know to help a patient find a doctor to try testosterone therapy.
Do not risk an older man’s health on uninformed health care providers.
Find one who understands the benefit of hormone replacement so that they can discuss pros and cons with men.
In my opinion, most older men with depression and anxiety and low normal to low testosterone levels should try at least 3 months of testosterone therapy to see if it can turn their lives around (unless medically contraindicated).
Many men feel it is “weak” to admit they have low testosterone. Not admitting the mental and physical changes they are suffering is dangerous.
We are living longer with lowering natural testosterone levels. Replacing these for optimal quality of life isn’t weak it is grounded in reality and science; it is wise.
- Dr. E
Science can help us nurture and enjoy our sexual selves.
Dr. Ellington (“Dr E”) is an internationally recognized scientist in the area of sexual medicine and sperm physiology with over 75 publications.