Do Antidepressants Lower Testosterone? What the Evidence Shows

By Noophoric Editorial Team Updated August 31, 2026

Short answer: Antidepressants can cause changes in libido, arousal, erections and orgasm, but that does not necessarily mean they have lowered your testosterone. Research directly measuring testosterone during antidepressant treatment is limited and mixed. Some people may experience hormonal changes, while others develop sexual side effects even when their testosterone remains within the normal range.

If symptoms begin after starting or changing an antidepressant, speak with the clinician who prescribed it. Do not lower the dose, skip doses or stop treatment on your own.

Key takeaways

Sexual side effects are a recognized problem with several antidepressant classes, particularly selective serotonin reuptake inhibitors (SSRIs).
Low libido or erectile difficulties during treatment do not, by themselves, prove that testosterone is low.
Studies examining antidepressants and testosterone have produced inconsistent results.
Low testosterone should be diagnosed from symptoms plus consistently low blood-test results, not symptoms alone.
Medication changes should always be made with the prescribing clinician.

Can antidepressants lower testosterone?

Possibly in some people, but there is not enough consistent human evidence to say that antidepressants as a group reliably lower testosterone.

Antidepressants include several different drug classes, and even medications within the same class can have different effects. Study results can also be influenced by the underlying condition being treated, treatment duration, dose, age, sleep, body composition, other medications and pre-existing hormone levels.

One clinical study followed 44 men with major depressive disorder during 12 weeks of fluoxetine treatment. Average testosterone levels did not change significantly, and none of the men developed low testosterone during the study. Prolactin increased in some participants, illustrating that one hormone can change without producing a corresponding fall in testosterone.^[2]

Other research has reported changes in reproductive hormones among some antidepressant users. However, much of that evidence comes from small observational studies, laboratory research or studies that were not designed specifically to determine whether an antidepressant causes clinical testosterone deficiency. The most accurate conclusion is that the effect may vary by medication and individual, and that better human research is still needed.

Sexual side effects are not the same as low testosterone

This distinction is important. Antidepressants can affect sexual function through pathways involving serotonin, dopamine, arousal and orgasm without necessarily lowering testosterone.

A 2026 systematic review and meta-analysis of randomized trials found that SSRIs were associated with a higher risk of orgasmic dysfunction and reduced sexual satisfaction. That evidence establishes a connection between SSRIs and sexual side effects, but it does not establish that low testosterone is the cause.^[1]

Low testosterone and depression can share several symptoms, while depression itself can also reduce sexual desire and function. That makes it difficult to determine whether a new symptom comes from the illness, the medication, a hormone change or a combination of factors.

Which antidepressants are more likely to affect sexual function?

Sexual side effects have been reported with many antidepressants, but they are most commonly associated with medications that strongly affect serotonin.

SSRIs

SSRIs include medications such as fluoxetine, sertraline, escitalopram, citalopram and paroxetine. Possible sexual side effects include reduced desire, difficulty becoming aroused, erectile difficulties and delayed or absent orgasm. Current FDA labeling for escitalopram specifically warns that SSRIs may cause sexual dysfunction in both men and women.^[3]

SNRIs and other antidepressants

Serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and monoamine oxidase inhibitors can also affect sexual function. The likelihood and type of side effect vary by medication and person.

Bupropion and mirtazapine have been associated with more favorable sexual side-effect profiles than many serotonin-focused antidepressants. That does not make either medication the right choice for everyone, and switching medications involves other benefits, risks and discontinuation considerations.^[4]

Symptoms that can overlap

Antidepressant side effects, depression and testosterone deficiency can produce some similar symptoms, including:

Lower sexual desire
Erectile difficulties
Fatigue or reduced energy
Changes in mood or motivation
Difficulty concentrating

Because these symptoms are not specific to low testosterone, a symptom checklist cannot determine the cause. Timing can still be useful: note whether symptoms were present before treatment, appeared after starting medication or changed after a dose adjustment. Share that timeline with your clinician.

When should testosterone be tested?

Routine testosterone screening is not recommended for every person taking an antidepressant. Testing may be reasonable when a man has persistent symptoms that could be consistent with testosterone deficiency, especially when there are additional risk factors or physical signs.

The Endocrine Society recommends diagnosing male hypogonadism only when compatible symptoms are accompanied by unequivocally and consistently low testosterone concentrations. It also recommends confirming an initially low result with a repeat morning fasting total-testosterone measurement. If testosterone remains low, clinicians may order additional testing to determine the cause.^[5]

A single result should not be interpreted in isolation. Testosterone varies during the day and can be temporarily affected by illness, inadequate sleep, calorie restriction and other health factors.

What to do if symptoms begin after starting an antidepressant

Do not stop the medication abruptly. Suddenly stopping an antidepressant can cause withdrawal symptoms and may allow depression or anxiety symptoms to return.
Document the change. Note the symptom, when it began, any recent dose changes and whether it is improving or worsening.
Talk with the prescribing clinician. The clinician can review the medication, the underlying condition and other possible causes.
Ask whether testing is appropriate. Depending on the symptoms, evaluation might include testosterone or other laboratory tests rather than assuming the cause.
Discuss treatment options. A clinician may consider waiting for symptoms to improve, adjusting treatment, switching to a medication with a different side-effect profile or treating a specific sexual symptom. Evidence supports some approaches, but the right choice depends on the individual.^[6]

Should testosterone therapy be used for antidepressant side effects?

Testosterone therapy is not a general treatment for antidepressant-related sexual dysfunction. It is normally considered only when a person has symptoms and properly confirmed testosterone deficiency, followed by an evaluation of the cause and the potential benefits and risks.

If testosterone is normal, adding testosterone may not address the actual mechanism behind an antidepressant-related symptom. Testosterone treatment can also affect fertility and requires medical monitoring.

Frequently asked questions

Do SSRIs lower testosterone?

SSRIs may influence reproductive hormones in some people, but studies have not shown a consistent testosterone-lowering effect across all medications and patients. SSRIs are more clearly associated with sexual side effects than with confirmed testosterone deficiency.

Does low libido while taking an antidepressant mean testosterone is low?

No. Low libido can result from depression, medication effects, stress, relationship factors, poor sleep, other health conditions or low testosterone. Blood testing and a clinical evaluation are needed when testosterone deficiency is suspected.

Can sexual side effects continue after stopping an SSRI?

Most discussions focus on effects that occur during treatment, but persistent symptoms after discontinuation have been reported. Their frequency, causes and best treatment remain incompletely understood.^[4] Anyone experiencing persistent symptoms should speak with a qualified clinician.

Should everyone taking an antidepressant have testosterone tested?

No. Major endocrine guidelines recommend testing and diagnosis based on compatible symptoms and consistently low measurements rather than routine screening of everyone.

Can I change antidepressants if sexual side effects are bothersome?

A prescriber may consider a dose adjustment, a different medication or another management strategy, but the decision must account for how well the medication controls the underlying condition. Do not make the change without medical supervision.

The bottom line

Antidepressants can affect sexual function, but sexual symptoms do not automatically indicate low testosterone. Research directly connecting antidepressant use to clinically low testosterone remains limited and inconsistent. If symptoms are persistent or concerning, the safest next step is a conversation with the prescribing clinician and, when appropriate, properly timed and repeated hormone testing.

Sources

Evidence reviewed August 2026. This article is for educational purposes and is not a substitute for diagnosis or treatment from a qualified healthcare professional.