Could a testosterone level of 10nmol/l contribute to mental health issues and chronic stress in a patient with a history of mental health disorders?

A Testosterone Level of 10 nmol/L is Borderline-Low and Could Contribute to Mental Health Issues, But the Evidence for Benefit from Treatment is Weak

A testosterone level of 10 nmol/L (approximately 288 ng/dL) falls just below the diagnostic threshold for hypogonadism (<10.41 nmol/L or 300 ng/dL), but the evidence shows testosterone therapy provides little to no benefit for mental health symptoms, even in men with confirmed low testosterone. 1

Understanding the Testosterone Level in Context

Your testosterone level of 10 nmol/L sits in a critical gray zone:

• The diagnostic threshold for hypogonadism is <10.41 nmol/L (300 ng/dL) on two separate early morning measurements 1
• Your level of 10 nmol/L is technically just below this threshold, but barely
• The largest testosterone trials enrolled men with levels averaging <9.54 nmol/L (275 ng/dL), suggesting more definitive hypogonadism 1

Critical point: Diagnosis requires BOTH low testosterone measurements AND specific symptoms—primarily sexual symptoms like diminished libido and erectile dysfunction 1, 2

The Evidence on Testosterone and Mental Health is Disappointing

The most recent and highest-quality evidence from the American College of Physicians (2020) demonstrates:

• Testosterone therapy has "little to no effect" on depressive symptoms, energy, vitality, or cognition in men with confirmed hypogonadism 1
• When depression was measured across 5 pooled RCTs (n=872), testosterone produced only a "less-than-small improvement" with a standardized mean difference of -0.19 2
• For energy and fatigue, the effect was minimal with an SMD of only 0.17 across 3 RCTs 2
• The quality of life improvements that were seen were primarily driven by sexual function improvements, not mood or energy 1

Why This Level Might Still Matter

Despite weak evidence for treatment benefit, your borderline-low testosterone could be a contributing factor:

• Low testosterone is associated with depression in some subpopulations, particularly men with HIV/AIDS, more severe testosterone deficiency, or those not responding to SSRIs 3, 4
• The relationship between testosterone and mood follows a parabolic curve in some research, with optimal levels around 0.4-0.6 ng/mL free testosterone 5
• Chronic stress itself can suppress testosterone production, creating a bidirectional relationship 6

However, many conditions independently cause both low testosterone AND depression—including obesity, chronic illness, medications, sleep disorders, and stress—making causality difficult to establish 1, 7, 4

Clinical Algorithm for Your Situation

Step 1: Confirm the Diagnosis Properly

• Repeat morning testosterone measurement (8-10 AM) to confirm persistent low levels 1, 2, 7
• Measure free testosterone by equilibrium dialysis and SHBG, especially important at borderline levels 2
• Measure LH and FSH to distinguish primary from secondary hypogonadism 1, 2
• If LH/FSH are low or low-normal, measure prolactin to screen for pituitary disorders 1

Step 2: Assess for Sexual Symptoms (The Primary Indication)

The evidence is clear that testosterone therapy's main benefit is for sexual function, not mental health 1, 2:

• Do you have diminished libido or reduced spontaneous erections? 1, 2
• Do you have erectile dysfunction, particularly if PDE5 inhibitors have failed? 2

If sexual symptoms are absent, the case for testosterone therapy becomes much weaker 2

Step 3: Address Alternative Causes First

Before attributing mental health issues to borderline testosterone, evaluate and treat 7:

• Obstructive sleep apnea (common and causes both low testosterone and depression)
• Thyroid dysfunction (TSH, free T4)
• Anemia (complete blood count)
• Vitamin D deficiency
• Metabolic syndrome and cardiovascular risk factors
• Medication effects (opioids, corticosteroids, SSRIs can all lower testosterone) 1

Step 4: Consider Weight Loss if Applicable

• Obesity-associated secondary hypogonadism can improve with weight loss through low-calorie diets and exercise 2
• This addresses both testosterone levels and mental health without medication risks 2

If You Decide to Trial Testosterone Therapy

Set realistic expectations based on the evidence:

• Primary benefit will be sexual function improvement (SMD 0.35), not mood or energy 1, 2
• Mental health improvements are minimal at best: depression SMD -0.19, energy SMD 0.17 2
• Reevaluate at 12 months and discontinue if no benefit, particularly for sexual function 2

Monitoring requirements:

• Testosterone levels at 2-3 months, then every 6-12 months, targeting 500-600 ng/dL 2
• Hematocrit monitoring—withhold if >54% (risk of erythrocytosis, especially with injections) 2, 8
• PSA monitoring in men over 40 2

Formulation considerations:

• Transdermal gel provides more stable levels and lower erythrocytosis risk 2
• Intramuscular injections are more economical but have higher cardiovascular and erythrocytosis risk 2

Critical Pitfalls to Avoid

• Do not start testosterone based solely on fatigue, depression, or stress without sexual symptoms—the evidence does not support benefit 2, 7
• Do not diagnose hypogonadism on a single measurement at borderline levels 1, 2
• Do not use screening questionnaires alone without laboratory confirmation 1
• If you desire fertility preservation, testosterone is absolutely contraindicated—use gonadotropin therapy instead 2
• Do not ignore other treatable causes of your symptoms (sleep apnea, thyroid, depression itself) 7

The Bottom Line

Your testosterone level of 10 nmol/L is borderline-low and warrants confirmation with repeat testing, but even if confirmed, testosterone therapy is unlikely to substantially improve your mental health symptoms or chronic stress. The highest-quality evidence shows minimal to no benefit for depression, energy, or cognition. The primary indication for testosterone therapy is sexual dysfunction, not mental health. Address other potential causes of your symptoms first, and if testosterone therapy is considered, maintain realistic expectations and close monitoring.