By Andrew J. Hewitt, PMHNP-BC
What Is “Functional Depression”?
Have you ever felt like you’re running on empty—but still getting everything done?
You go to work, take care of your family, and meet your responsibilities, but inside, you feel flat, tired, or disconnected. People might even describe you as “doing fine,” but you know something’s off.
That experience is often called functional depression—sometimes referred to as high-functioning depression. It’s not an official diagnosis in the DSM-5 (the manual mental health professionals use to classify disorders), but it’s a very real experience for many men.
Functional depression means that while you’re technically functioning—going through the motions of daily life—you’re not feeling emotionally well. You might describe it as:
- Waking up exhausted even after a full night’s sleep
- Feeling little enjoyment in things you used to love
- Constant irritability or restlessness
- Trouble concentrating or “brain fog”
- Feeling emotionally numb, disconnected, or guilty for not being “grateful”
Many men experiencing these symptoms assume it’s just stress, age, or burnout. But sometimes, there’s something deeper at play—both psychologically and biologically.
Why Men Often Hide Depression
Depression in men often looks different than in women. Instead of sadness, men might show:
- Anger or frustration
- Withdrawal from relationships
- Overworking or over-exercising
- Substance use to “take the edge off”
Social conditioning plays a big role here. Men are often taught to “tough it out” or “handle it themselves.” This makes it harder for men to talk about depression or to recognize it when it’s happening.
But bottling things up takes a toll—emotionally, mentally, and even physically.
The Testosterone Connection
Here’s something that surprises many people: testosterone, the primary male sex hormone, plays a major role not just in muscle mass or libido—but in mood regulation, motivation, and mental clarity.
Low testosterone, known as hypogonadism, can produce symptoms that look a lot like depression:
- Low mood or irritability
- Fatigue
- Brain fog or poor concentration
- Sleep changes
- Reduced libido or erectile difficulties
- Loss of confidence
A growing body of research over the past few years shows that low testosterone levels can contribute to or worsen depressive symptoms in some men (Walther et al., JAMA Psychiatry, 2020).
It’s not the case for everyone—but for certain men, particularly those with “functional” or milder depression, testosterone replacement therapy (TRT) can make a real difference.
How Testosterone Affects the Brain
Testosterone interacts with your brain chemistry in powerful ways. It can:
- Support dopamine activity (motivation and pleasure)
- Regulate serotonin, which affects mood and anxiety
- Reduce inflammation in the brain (linked to depression)
- Help maintain cognitive sharpness and energy levels
When testosterone is low, these systems don’t work as smoothly—which may explain why you feel “foggy,” unmotivated, or emotionally flat.
Can Testosterone Therapy Help with Depression?
Research over the last few years suggests that TRT may help reduce depressive symptoms—especially in men who already have low testosterone.
A major review of 27 clinical trials found that men receiving testosterone reported significant improvements in mood and energy, particularly when given moderate-to-high therapeutic doses (Walther et al., JAMA Psychiatry, 2020).
Another recent review in Frontiers in Endocrinology (2023) found similar results, emphasizing that TRT seems most beneficial when combined with therapy or lifestyle changes—not used alone.
However, it’s not a universal fix. Some men don’t experience mood benefits from TRT, especially if their testosterone levels were normal to begin with. That’s why proper testing and evaluation are so important.
When to Ask About Testosterone Testing
If you’re a man experiencing ongoing symptoms of fatigue, irritability, or emotional flatness—especially if you’ve already tried therapy or antidepressants without much success—it might be worth checking your hormone levels.
Your clinician can order a morning total and free testosterone test, along with other labs (like thyroid function, vitamin D, and blood count).
Low testosterone is usually defined as below 300 ng/dL, though symptoms and clinical context matter just as much as numbers.
If your levels are low—and no medical contraindications exist—your clinician might discuss testosterone replacement therapy (TRT) as part of a broader treatment plan.
What TRT Looks Like
TRT can be administered in several ways:
- Injections (weekly or biweekly)
- Gels or creams (applied daily to the skin)
- Patches or pellets (less common)
The goal is to bring testosterone into a normal physiologic range—not to “supercharge” levels.
You’ll need regular monitoring (every 3–6 months) to check hormone levels, blood count, prostate health, and cardiovascular risk.
Important: TRT is not appropriate for everyone. It may not be safe for men with certain heart conditions, untreated sleep apnea, or prostate cancer. Always discuss risks and benefits with your provider.
TRT Is One Piece of the Puzzle
While testosterone can help, depression—especially functional depression—is rarely caused by hormones alone.
Men benefit most from a holistic plan that may include:
- Therapy
- Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT) can help you identify unhelpful thoughts and behaviors and build emotional awareness.
- Lifestyle changes
- Regular exercise, quality sleep, and good nutrition all boost mood and hormone balance.
- Social connection
- Men with strong social support networks experience less depression and faster recovery.
- Medication when appropriate
- If mood symptoms remain, antidepressants or other targeted treatments can complement TRT.
Think of TRT as part of your mental health toolkit, not a magic cure.
A Real-World Example
“Mark,” 48, came to my clinic after months of feeling “off.” He was productive at work and keeping up with family life, but described constant fatigue, low libido, and irritability.
His bloodwork showed testosterone levels below 250 ng/dL—clinically low.
We started a holistic plan: moderate-dose TRT, therapy focusing on burnout and perfectionism, and simple lifestyle changes (better sleep hygiene, cutting caffeine late in the day, and light exercise).
Four months later, Mark reported more energy, clearer focus, and improved mood. He said, “I finally feel like myself again.”
Every man’s journey is different—but this story shows how intertwined mood, hormones, and identity can be.
What to Watch Out For
TRT has potential risks, including:
- Increased red blood cell count (which can raise clot risk)
- Prostate enlargement
- Acne or hair loss
- Fluid retention or mild blood pressure changes
This is why regular lab monitoring is essential. Your provider will also track how your mood, energy, and cognition respond over time.
If there’s no improvement after several months—or if side effects outweigh benefits—your provider may adjust or discontinue treatment.
Breaking the Stigma
Functional depression thrives in silence. Men are often expected to be strong, self-sufficient, and stoic—but emotional pain doesn’t make you weak. It makes you human.
Reaching out for help—whether through therapy, lifestyle change, or medical evaluation—is an act of strength, not surrender.
For some men, that may include looking at testosterone levels. For others, it might mean tackling perfectionism, stress, or burnout.
The key is to recognize that “functioning” isn’t the same as thriving.
The Takeaway
If you’re:
- Feeling persistently low or unmotivated
- Experiencing fatigue, irritability, or brain fog
- Losing interest in things you used to enjoy
- Not responding to standard treatments
…it may be time to take a closer look at your hormonal health along with your mental health.
Functional depression in men is treatable—and recovery often begins with self-awareness and honest conversation.
Whether the solution includes testosterone replacement therapy, psychotherapy, or both, the goal is the same: to help you feel like yourself again—fully alive, not just functioning.
References (Simplified)
(For readers who want to explore further.)
- Walther, A., Breidenstein, J., & Miller, R. (2020). Association of testosterone treatment with alleviation of depressive symptoms in men: A systematic review and meta-analysis. JAMA Psychiatry.
- Hauger, U. G., et al. (2022). The role of testosterone and hypothalamic regulation in depression. Reviews in Endocrine & Metabolic Disorders.
- Forbes, M. et al. (2025). Testosterone concentration and incident depression in older men: A longitudinal cohort study. The Journals of Gerontology: Series A.
- Schroder, H. S., et al. (2023). Framing depression as a functional signal, not a disease. Social Science & Medicine.
- Harvard Health Publishing (2023). Is testosterone therapy safe? Take a breath before you take the plunge.
