Do men need therapy, or more testosterone?

Women use psychotherapy substantially more than men.

Researchers have spent decades trying to explain the gap through depression rates, stigma, masculinity, self-reliance, and attitudes toward asking for help.

But there is one surprisingly obvious variable that does not appear to have been tested directly:

Testosterone.

Not "does testosterone cure depression?"

A simpler question:

Among men experiencing similar psychological distress, are men with higher testosterone less likely to use psychotherapy?

Or flipped around: are men with lower testosterone more likely to end up in therapy?

Science cannot answer that yet.

But there is enough evidence around testosterone, mood, age, and male therapy use to make the experiment worth running.

Quick Answer

There is currently no evidence that men with higher testosterone use less therapy.

There is also no evidence that men who go to therapy generally have lower testosterone.

The case for testing it is indirect.

Men use psychotherapy less than women, especially when they are young. Some studies have linked very low testosterone with later depression, although a much larger 2025 study found no relationship. Randomized trials also show that raising testosterone can produce small changes in mood.

What appears to be missing is the direct test:

Measure testosterone in men, measure how distressed they are, and see who actually uses psychotherapy.

Men Really Do Use Psychotherapy Less

A recent U.S. study compared psychotherapy use among adults with depression and anxiety.

Among adults with depression, about 43% of women received psychotherapy compared with 34% of men. For anxiety, it was about 36% of women versus 27% of men.

The gap was especially large among younger adults.

Among 18- to 25-year-olds with depression, women were about 22 percentage points more likely to receive psychotherapy. The difference fell to 12 points among adults 26 to 49 and nearly disappeared after age 50.

Another U.S. epidemiological study looked specifically at people who already met criteria for a mood, anxiety, or substance-use disorder.

Men still had substantially lower odds of consulting a professional.

The Age Pattern Makes Testosterone Worth Asking About

There is an interesting pattern hiding in the age data.

Male testosterone is generally higher in young adulthood and declines with age, although lifestyle factors can influence levels. These factors are covered in more details in this evidence-based guide to increasing testosterone naturally. 

The male-female psychotherapy gap follows the same broad direction: it is largest among younger adults and becomes much smaller later in life.

That does not prove testosterone causes the therapy gap.

Age also changes healthcare use, attitudes, relationships, income, work demands, physical health, and many other factors.

But the pattern is compatible with a testosterone hypothesis.

It gives researchers a reason to measure the hormone rather than assuming the entire gap is social.

Has Anyone Actually Tested Testosterone Against Therapy Use?

Researchers have studied testosterone and psychological treatment, so it would be wrong to say the two fields have never crossed.

For example, a 2023 registered clinical-trial protocol proposed studying 144 men with major depression, separating them by testosterone status, and comparing different psychological treatments.

But those men already had depression and had already entered a treatment study.

That does not answer the question here:

Does a man's natural testosterone level predict whether he uses psychotherapy in the first place?

A search using combinations of testosterone, low testosterone, psychotherapy, therapy utilization, and help-seeking did not identify a published observational study that measured testosterone in men and tested whether it predicted psychotherapy use after accounting for psychological distress.

That is the research gap.

Very Low Testosterone Has Predicted Depression Before

One reason to suspect testosterone might matter is its possible relationship with depression.

A 2016 study followed 3,179 older men who did not have clinically significant depression when the study began.

Over about nine years, 135 developed depression.

Men whose total testosterone was below 6.4 nmol/L had an 86% higher adjusted risk of developing depression.

But the result came with an important complication.

Calculated free testosterone did not predict depression. Neither did dihydrotestosterone, another androgen made from testosterone, or estradiol.

Total testosterone means all the testosterone measured in the bloodstream, including testosterone attached to carrier proteins. Free testosterone is the much smaller fraction circulating without being bound to those proteins.

If lower testosterone activity were straightforwardly driving depression, it would be more convincing if several testosterone-related measures pointed in the same direction.

They did not.

Only very low total testosterone showed the association.

That could mean total testosterone captured something biologically important. It could also mean it was partly acting as a marker for other differences in health, hormone-binding proteins, or metabolism.

The study suggests a possible connection. It does not establish that low testosterone itself causes depression.

Then a Much Larger Study Found Nothing

This is the strongest challenge to the low-testosterone theory.

A 2025 study followed 4,107 men age 70 and older for a median of 8.4 years.

Researchers measured total testosterone when the study began and again three years later.

During follow-up, 1,449 men crossed the study's threshold for elevated depressive symptoms.

Baseline testosterone did not predict who later developed elevated depressive symptoms.

Changes in testosterone did not predict them either.

The researchers also examined the 102 men whose total testosterone was below 6.4 nmol/L, the same cutoff that produced the striking result in the earlier study.

Their adjusted risk was 1.02.

A value of 1 would mean no difference at all.

The confidence interval was wide, so the study could not rule out every possible effect in that small low-testosterone subgroup. But the best estimate was essentially zero difference.

This seriously weakens the claim that low total testosterone generally predicts future depression in older men.

Does That Kill the Testosterone and Therapy Hypothesis?

It kills the simplest version:

low testosterone → more depression → more therapy.

The evidence is not strong enough to make that argument.

But the 2025 study does not answer whether testosterone predicts psychotherapy use.

First, every participant was at least 70 years old. The largest male-female psychotherapy gap appears decades earlier, among young adults.

Second, the researchers were studying depressive symptoms, not treatment behavior.

They defined their main depression outcome using the CES-D-10, a 10-question screening tool. Crossing its cutoff does not necessarily mean someone received a clinical diagnosis of major depression.

Most importantly, the researchers did not ask whether testosterone predicted who went to therapy.

So the study gives us strong evidence against a broad claim that low testosterone commonly causes future depression in older men.

It does not tell us whether testosterone has any relationship with psychotherapy use.

Depression Can Also Lower Testosterone

There is another reason these studies are difficult to interpret.

The arrow can point both ways.

Stress, illness, poor sleep, obesity, metabolic disease, medications, and other health problems can affect testosterone.

A man may therefore have low testosterone partly because he is unhealthy or depressed.

The authors of the 2025 study specifically raised the possibility that low testosterone can sometimes be a marker of depression and poor health rather than the original cause.

This makes a testosterone test taken after someone is already depressed difficult to interpret.

But Giving Men Testosterone Can Change Mood

Randomized trials give us another way to look at the question.

Instead of observing men who naturally have different testosterone levels, researchers give one group testosterone and another group placebo.

A 2019 JAMA Psychiatry meta-analysis combined 27 randomized trials involving 1,890 men.

Testosterone produced a statistically significant improvement in depressive symptoms.

The effect size was 0.21, which is small.

Older, smaller analyses suggested the effect might be stronger in men who started with medically low testosterone.

A 2009 analysis of seven randomized trials found stronger results among testosterone-deficient men and certain medically ill groups.

A 2014 analysis of 16 trials found a significant mood benefit among men with medically low testosterone but not among men whose testosterone was already normal.

The larger 2019 analysis complicated that story. Starting testosterone level was not the main factor that explained who benefited. Higher testosterone doses were a clearer predictor of the effect.

The Largest Modern Trial Found a Small Effect Too

One of the largest testosterone trials ever conducted provides a useful reality check.

The TRAVERSE trial enrolled 5,204 men ages 45 to 80. The study was originally designed mainly to test the cardiovascular safety of testosterone treatment.

To enter, the men needed symptoms associated with testosterone deficiency plus two fasting testosterone tests below 300 ng/dL.

Researchers randomly assigned them to testosterone gel or placebo and also tracked mood and energy.

Across the full study population, testosterone produced small improvements in mood and energy.

Among the much smaller group with rigorously diagnosed persistent depressive disorder, however, testosterone did not significantly improve the measured outcomes.

So testosterone can affect mood.

The effect is much smaller and less reliable than a simple "low T causes depression" story would suggest.

Why Therapy Use Is Still Worth Testing Directly

Depression and psychotherapy use are not the same outcome.

Two men can experience similar psychological distress and make different decisions about what to do about it.

Researchers have spent years studying whether beliefs about masculinity, stigma, self-reliance, and attitudes toward professional help explain those decisions.

Yet testosterone itself appears largely absent from that research.

That is why measuring it would be useful.

If testosterone predicts nothing once distress, health, and access to care are taken into account, that would argue strongly against a hormonal explanation.

If testosterone still predicts psychotherapy use, then male help-seeking research has been missing a biological variable.

How to Test It Properly

A useful study would recruit a large group of men before they enter psychotherapy.

Testosterone should be measured more than once, preferably in morning blood samples, because levels change throughout the day and from day to day.

Researchers would also need to measure factors that could otherwise create a false testosterone effect:

• Depression and anxiety severity
• Anger, substance use, risk-taking, and other outward signs of distress
• Sleep
• Physical health and medications
• Body composition
• Stress
• Self-reliance and attitudes toward therapy
• Insurance, cost, work schedules, and access to care

Then researchers could follow who actually uses psychotherapy.

The central question is straightforward:

After accounting for psychological distress and the obvious social and health factors, does testosterone predict psychotherapy use?

The Bottom Line

There is no evidence yet that higher-testosterone men use less therapy.

There is no evidence that men who see therapists generally have low testosterone.

And the evidence connecting naturally low testosterone with future depression is much weaker than a simple hormone story would suggest.

A 2016 study found almost twice the later depression risk among men with very low total testosterone, but the signal did not appear for free testosterone or other sex hormones.

A much larger 2025 study found no relationship between total testosterone and later depressive symptoms at all.

Randomized trials add one important piece: changing testosterone can change mood, but the average effect is small.

Meanwhile, men use psychotherapy less than women, especially during younger adulthood, and research explaining that gap has focused heavily on social beliefs and help-seeking attitudes.

That leaves a narrow but legitimate unanswered question:

Does testosterone predict psychotherapy use among men once their actual level of psychological distress is taken into account?

Until that question is tested directly, claims that testosterone either does or does not contribute to the male therapy gap are ahead of the evidence.

Future research on male help-seeking should measure testosterone alongside the social and psychological variables researchers already track.