Dare had been told he was depressed and needed antidepressants. His wife pushed for a hormone check. His testosterone was severely low — a treatable medical cause of every symptom he had been having for nearly a year.
Civil servant, Magboro. Referred by wife after 11 months of low mood, fatigue, reduced libido, poor concentration, and loss of motivation. Initially thought to have clinical depression. Testosterone found to be 5.2 nmol/L (severely low).
Hypogonadism (Low Testosterone) Presenting as DepressionDare had been struggling since his father died in January. His family and his own GP attributed everything to grief. When the grief should have begun to lift and it didn't — when Dare was still dragging himself through every day eleven months later — his wife became concerned.
The GP had suggested antidepressants at the last appointment. His wife asked: "Has anyone done blood tests? Proper ones?" The GP had checked haemoglobin and thyroid. She asked specifically about testosterone. The GP said it was not a routine check for depression. His wife asked for it anyway.
The testosterone came back: 5.2 nmol/L — severely deficient (normal: 10–35 nmol/L). His wife found Mascot Healthcare and brought Dare in with the result.
Male hypogonadism and depression share many overlapping symptoms. In men, low testosterone is a common and under-screened medical cause of low mood, fatigue, and cognitive difficulties.
Flat, joyless affect for over 11 months — not responding to a "just stay positive" approach.
Exhaustion disproportionate to activity — needing to rest after tasks he had previously found effortless.
Complete loss of sexual desire for over 8 months — causing significant marital strain.
Difficulty focusing at work — described as "brain fog," making writing reports difficult.
Noticeable reduction in upper body muscle — despite no change in diet or exercise.
Lifestyle advice ("eat better, exercise more") — appropriate but insufficient when testosterone is this low.
Vitamins B12 and D — supplements; addressed potential deficiency but not the core hormone issue.
Grief counselling (two sessions) — appropriate for bereavement but did not address the physiological component.
Nearly started antidepressants — deferred after wife requested hormone testing.
Mascot Healthcare confirmed the result with a repeat morning testosterone (6.1 nmol/L on repeat — still severely low), LH, FSH, prolactin, and pituitary hormones. LH and FSH were low-normal — suggesting secondary hypogonadism (pituitary level problem rather than testicular failure). Prolactin was normal.
An MRI pituitary was arranged to exclude a prolactinoma or other pituitary pathology — result: normal pituitary. Diagnosis: functional secondary hypogonadism likely precipitated by the stress of bereavement and weight gain (BMI 31.2 — adipose tissue converts testosterone to oestrogen).
Testosterone replacement therapy was initiated (testosterone undecanoate injections). Dare was also counselled on weight loss, which independently raises testosterone. A 3-month review was arranged.
Hypogonadism — secondary (testosterone 5.2 nmol/L; LH/FSH low-normal; MRI pituitary normal; functional secondary hypogonadism)
Testosterone undecanoate injections; weight loss programme; repeat testosterone + LH at 3 months; libido and mood monitoring
At 3 months: testosterone 14.8 nmol/L. Mood, libido, energy, and concentration all significantly improved. Wife reported "I have my husband back."
Three months after starting testosterone replacement, Dare's levels normalised and every symptom improved substantially. He has lost 6 kg and his energy and libido have returned. No antidepressants were ever needed.
Low testosterone (hypogonadism) is a common, underdiagnosed condition in men over 35 — presenting as low mood, fatigue, reduced libido, and cognitive fog. It is frequently mistaken for depression.
A simple blood test — morning serum testosterone — can identify this in 24 hours. When the cause is hormonal, the treatment must be hormonal.
A man with low mood, no energy, and zero libido deserves a testosterone check before an antidepressant prescription.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.