Hormone-replacement therapy (HRT) is best known as a treatment for the physical symptoms of menopause---hot flushes, night sweats---that come when a woman's levels of oestrogen and progesterone drop. Only about 5% of menopausal women in America take it, owing largely to excessive worries about a small increase in breast-cancer risk that have dogged HRT since the early 2000s. HRT also brings health benefits, including cutting the risk of osteoporosis.
Evidence suggests that restoring hormone levels can sometimes ease symptoms of depression and schizophrenia that have resisted other treatments. Around a third of those seen by doctors for major depression are resistant to standard treatment. For some of these patients, hormonal deficiencies could be causing their conditions.
The sex hormones oestrogen, progesterone and testosterone are all produced by both men and women. Proteins sensitive to oestrogen are found scattered across many important regions of the brain; studies have shown that oestrogen can enhance memory formation, recall, decision-making and problem-solving. Progesterone and testosterone exercise a calming effect via interactions with the GABA-receptor complex. Other hormones, such as cortisol and those produced in the thyroid, also play a role in mood and behaviour.
Data from menopausal women, particularly from the past five years, have shown that HRT can relieve symptoms of depression and anxiety, reducing the need for antidepressants. Cardiff University researchers, analysing data on almost 130,000 post-menopausal women from UK Biobank who had no history of psychiatric disorders, found that the risk of major depression increased by 30% during perimenopause and the risk of bipolar disorder by 112%, compared with younger reproductive years. Some 1,133 women (0.88%) reported new psychiatric conditions during this period.
Perimenopause symptoms—low mood, anxiety, mood swings, aching joints and memory problems (often called brain fog)—may begin during a woman's 40s, long before the obvious signs of menopause such as night sweats, making correct diagnosis easy to miss. A new British study, Our Future Health, will examine the health of 5m Britons to better understand the extent of women's mental-health vulnerability during reproductive transitions.
The Endocrine Society says that about 35% of men over 45 have hypogonadism, a condition in which their testes produce little or no testosterone; it is rarer for those in their 20s and 30s. Hypogonadism is widely underdiagnosed and undertreated. Men with low testosterone often report symptoms of depression, irritability and cognitive impairment. A 2019 meta-analysis of studies on almost 2,000 men showed that testosterone-replacement therapy (TRT) was associated with a reduction in symptoms of depression.
In America the popularity of TRT has risen sharply since 2019, with many men with hypogonadism finding their mental health greatly improved. An industry has emerged to sell testosterone to middle-aged men, pitched as a fountain of youth: a way to pack on muscle, restore sex drive and turn back the clock on ageing. Less is said about the downsides, including that testosterone causes infertility and that high doses are bad for the heart.
Never lend your car to anyone to whom you have given birth.