Men - Depression Sex And Age: Depression

Content provided by the Faculty of the Harvard Medical School

Men

Although there is considerable evidence that women are twice as likely as men to become depressed, some researchers question this statistic. They contend that if studies accounted for differences in how men and women express and cope with their emotions, this apparent gap in depression rates would diminish or possibly disappear.

Typically, men are more likely to shy away from talking about their feelings, and doctors may bring up emotional topics less often with men. In addition, many men don't feel comfortable acknowledging the need for help, making them less likely to seek assistance than women are. Men also tend to describe the experience of depression in less intense ways than women do.

Depression in men may be obscured behind a variety of physical complaints, such as low energy, aches and pains, a loss of appetite, or trouble sleeping. Or the problem may come out as substance abuse, anger, or belligerent behavior. Even if other symptoms of depression are present, some men may not feel sad. And if a loved one raises the subject, they may not be willing to admit the possibility that they are depressed. Yet when such men receive treatment for depression, their symptoms often disappear, and in retrospect they may concede that they were, in fact, depressed.

Changes in hormones

Some researchers have examined whether fluctuations in testosterone levels may promote depression. Later-life changes in sex hormones are not as clear-cut in men as they are in women, but testosterone levels do decrease gradually as men age (a change that is sometimes dubbed "male menopause"). A quarter to a half of men over 50 have testosterone levels that can be considered abnormally low. The problem is more likely to arise if they drink excessively or if they are overweight or under stress (either physical or psychological).

Physicians still have a lot to learn about this subject, but it's possible to offer a few guidelines. Any man in middle age or older who notices mild to moderate depressive symptoms for the first time may have a problem with low testosterone. A physician can check his testosterone levels, along with pituitary hormone levels and liver and thyroid function. If testosterone is low, it may be worthwhile for him to take a supplement, along with psychotherapy, an antidepressant drug, or both. The more severe the depression, the less likely it is to be related to testosterone deficiency, since low testosterone levels are not closely associated with major depression.

Bringing testosterone levels back into the normal range is relatively safe, but long-term treatment is not without its problems. Testosterone supplements can increase the risk of prostate cancer, spur benign prostate enlargement, and (by boosting the concentration of LDL or "bad" cholesterol) promote heart disease. Liver damage can also occur. Some men develop gynecomastia (breast swelling), headaches, rashes at the site of application, acne, baldness, or emotional instability. Long-term treatment may suppress natural testosterone production, creating problems if the supplement is abruptly withdrawn.

It's reasonable for older men to consider testosterone as a treatment for depressive symptoms, but only after a full endocrine or hormone evaluation has been done. Because of the many potential side effects, you should begin testosterone therapy only after careful consideration and an in-depth discussion with your doctor.

Work and relationships

In this culture, male self-esteem often depends on success at work, physical skill or power, and being physically or mentally active. If a man's capacity in any of those areas is diminished — especially if he loses a job or his marriage fails — it may help trigger depression.

Depression is so common that it should be considered as much a problem for men as it is for women. In fact, men are more at risk for the worst outcome of depression — suicide. Family members, friends, and caregivers may need to meet them more than halfway to see that they get the help they need (see "How to cope when a loved one is depressed, suicidal, or manic").

Last updated:	January 23, 2007