Why Are Males Less Likely Than Women To Get Depression?

Does testosterone protect males from depression? Is it a new treatment?

Posted Dec 17, 2018

Depression is about twice as common in women as in men.  Why is this?

Is it true? Women are known to admit to a mental problem and seek medical help for many illnesses more readily than men.  This could be the reason why depression seems more common in women. But community surveys, which are supposed to rule out this reporting bias, confirm the greater incidence of depression in women. It seems to be true.

Most first episodes of depression first occur in adolescence or early adulthood.  They are often preceded by a stress, usually some form of loss (a friendship, money, a job, or even a pet, etc.).  Women report such negative ‘life events’ more frequently than men. Again, there are a variety of possible reasons for this.  Women may regard more events as stressful and negative than men, or they may actually experience greater amounts of adversity.  Many feminists would agree with the second interpretation, and there is evidence to support them. Childcare, for example, offers occasions for stress, and this has a greater impact on mothers than fathers, in general.  Whilst it is true that most first episodes of depression are preceded by an adverse life event, the converse is not true: most negative events are not followed by depression.  So maybe women are more vulnerable to such events.  But there’s another possibility: maybe men have some way of being more resilient.  Here’s where hormones come in.

The first hormone we need to discuss is cortisol. This is the ‘stress’ hormone that your adrenal glands release when you face an unusual demand or have to cope with a loss. We know that it’s involved in depression. People treated with high doses of cortisol or related compounds risk becoming depressed. There are a lot of these treatments, and they are widely prescribed for conditions such as arthritis or immune disorders.  One way of reducing this risk is to stop the treatment from time to time or reduce the dose. There are tumors that secrete cortisol and this causes a condition called Cushing’s syndrome.  About 70 percent of patients with Cushing’s are depressed, and they recover when they are treated.  However, they may also have cognitive problems, and these may be more persistent. Finally, women have slightly more cortisol in their blood on average than men, and we know that higher cortisol, even within the normal range, adds to the risk for subsequent depression. Since women seem to experience more adverse life events (which we know increases cortisol) and have higher levels anyway, this may be one reason why they suffer from depression more often than men.  But it’s not the only reason.

There is gathering evidence that testosterone may provide some protection from depression. As men age, their testosterone levels decline, though this varies individually. Those with lower testosterone have more depression (note that this also works the other way round: depression will lower testosterone).  But giving men testosterone helps them recover.  In fact, testosterone is as good as traditional anti-depressants (which aren’t that good, as it happens). Higher doses were more effective than lower ones, which would be expected if testosterone is really having an effect on depression. Interestingly, older men make up a larger than expected proportion of those who do not respond to anti-depressants and become chronically depressed.  Testosterone treatment has been shown to help some of them to recover.

Why should testosterone protect men (to a degree) from depression?  There is no clear explanation, though plenty of speculation. This is because we don’t know what happens in the brain to cause depression (which is not a single illness, so may have several causes), so we can’t understand how testosterone might be helpful in some cases, either as a therapy or as risk reduction.  Testosterone has many actions on the brain, principally in areas that we know are closely concerned with motivation, emotion, and mood.  The male brain is exposed to high levels of testosterone not only in adulthood, but also during embryonic life, and this may provide some protection.  Many anti-depressants act on serotonin, but testosterone doesn’t work in this way.  It’s not yet a standard treatment for depression, though careful analysis of individual cases might point to those who could benefit.

And what about women?  They also secrete testosterone, though only about a tenth as much as men.  But there are some who think they are more sensitive to testosterone than men.  Testosterone plays an important role in the sexuality of women (see a previous blog of mine), but whether it also has a part to play in depression is not yet known. But there’s a lot more to sex hormones than sex!

If you combine the roles of cortisol and testosterone as predisposing and protective elements for depression, you can see how hormones seem to play quite a large part in gender differences in depression, though we should not forget the influence of lifestyle and life events. The combination may tell us quite a lot about why women get depressed more often than men. Now we need to know how this happens, and what to do about it.

References

Walther A, Breidenstein J, Miller R. (2018) Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018 Nov 14