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April 6, 2026
Dr Ahmed Kamal Abdoun
Men often avoid seeking help for persistent low mood because they don't want to be told they're depressed. What many don't realise is that "low mood" and "clinical depression" are not the same diagnosis — and a doctor won't treat them identically.
Understanding the difference matters. Not because one is more serious than the other, but because the underlying cause determines what actually helps.
When a man presents with persistent low mood, a GP isn't immediately reaching for an antidepressant prescription. The first step is clinical assessment — and that means ruling in or out several overlapping causes before any diagnosis is confirmed.
According to NICE guidelines (CG90), a diagnosis of depression requires the presence of specific criteria over at least two weeks: persistent low mood, loss of interest or pleasure in activities (anhedonia), and several additional symptoms including disturbed sleep, fatigue, poor concentration, and changes in appetite or weight.
Low mood in isolation — particularly when it fluctuates, has identifiable triggers, or responds to positive events — is assessed differently. It may represent an adjustment response, a subclinical state, or the symptomatic expression of an underlying physical condition.
One area that is frequently missed in primary care is the relationship between testosterone and mood. Low testosterone doesn't just reduce libido and energy — it can profoundly affect emotional regulation, motivation, and resilience.
Men with testosterone deficiency often describe their low mood differently from those with depression. They may say they feel "flat" or "numb" rather than sad. They retain the capacity to feel pleasure in theory but lack the drive to pursue the things that used to bring them enjoyment. This distinction has clinical significance.
The bidirectionality of the relationship adds complexity: chronic low mood and psychological stress suppress testosterone production via the hypothalamic-pituitary-gonadal (HPG) axis, while low testosterone independently contributes to low mood. A GP needs to untangle which came first — and that requires blood testing and a detailed history, not just a symptom checklist.
A clinical perspective from Dr Ahmed Kamal Abdoun, GP at Menvate:
"When a man tells me he's been feeling low for several months, my first question is always: low in what way? The texture of the mood matters enormously. Men with hormone-driven low mood often don't cry — they disengage. They describe it as a dial being turned down. That's a very different presentation from a man who is grieving, or one who is experiencing the hopelessness and worthlessness characteristic of clinical depression. Conflating them leads to the wrong treatment."
Poor sleep, alcohol use, physical inactivity, and chronic work stress are each independently associated with low mood. In combination, their effects are compounding. A thorough assessment considers all of these — not to dismiss the problem as "just lifestyle", but to understand the full picture before reaching a diagnostic conclusion.
Addressing a sleep disorder that is driving cortisol dysregulation, for example, may resolve the mood symptom without any pharmacological intervention. That's only apparent if the assessment is comprehensive enough to surface it.
Antidepressants are effective for moderate-to-severe depression and have good evidence behind them. They are not, however, indicated for every presentation of low mood — and may be unhelpful or counterproductive in cases where the primary driver is hormonal or metabolic.
At Menvate, we don't discourage antidepressants — we ensure they're being considered in the right clinical context. If a man is on an SSRI but his testosterone is undetected and low, he may be getting only partial benefit from his treatment. The hormonal component will persist until it's addressed.
A GP-led assessment for persistent low mood at Menvate covers:
Only once this picture is complete can a confident clinical assessment be made — and an appropriate plan offered.
If you've been experiencing persistent low mood, don't wait until it becomes something harder to treat. And don't assume it's definitely depression — or definitely not. The only way to know is a proper clinical assessment by a doctor who takes the time to look at the full picture.
If you'd like to understand what's driving your mood changes, read more about how we assess low mood at Menvate, or book a private GP consultation.
