There’s a phrase that Dr. Haleem Mohammed said he hears often in his practice: “I don’t feel like myself.” He shared that this phrase it’s very telling and may indicate that a patient has low testosterone levels. Whereas depression can make a mad feel sad, low testosterone can “make a man feel erased”. It’s a distinction, he said, that the American healthcare system has largely failed to make, and millions of men are living with the consequences.
About Our Expert: Dr. Haleem Mohammed is a board-certified physician and healthcare executive based in Miami Beach, Florida who specializes in hormone optimization, longevity medicine, and men’s health.
Why so many men get the wrong diagnosis
The symptoms of low testosterone and clinical depression read like they were written by the same hand. There might be fatigue, low motivation, poor concentration, reduced libido, or sleep that doesn’t feel restorative. When a man walks into a primary care office carrying those complaints, the path of least resistance is familiar: a PHQ-9 questionnaire, a diagnosis of depression, a prescription pad, and an SSRI.
Dr. Mohammed said he thinks that path gets taken far too often and far too quickly. “The standard insurance-based primary care visit is seven to twelve minutes and a PHQ-9 takes 90 seconds,” he shared. “Prescribing an SSRI is fast and reimbursable. Ordering a proper hormonal workup, interpreting it, and having a real conversation about Testosterone Replacement Therapy (TRT) is none of those things. The system rewards speed, not accuracy.”
In his Gameday concierge practice, he estimated that 3 to 4 out of every 10 men who walk in carrying a depression diagnosis actually have underlying hormonal dysfunction driving or amplifying their symptoms.
But how does a physician tell the difference? Dr. Mohammed said the clues aren’t found in the DSM. They show up in the first ten minutes of a real conversation when a patient discusses erectile dysfunction, a drop in competitive drive, muscle mass disappearing despite a consistent gym routine, and irritability that feels out of character.
“Depression is a disorder of mood and cognition,” he said. “Low testosterone is a disorder of vitality.” A depressed man, he explained, describes emotional pain and hopelessness. A man with low testosterone describes feeling physically flat and disconnected from his own drive — without the cognitive distortions that typically accompany depression.
The blood tests most doctors aren’t ordering
According to Dr. Mohammed, one of the most significant failure points happens before a man ever sits down with a doctor. A standard annual blood panel, which is the kind most men get from a general practitioner, typically covers a complete blood count, a metabolic panel, lipids, and maybe an A1C test. Dr. Mohammed remarked that testosterone is not on it. A man has to know to ask for it. Even then, many physicians only order total testosterone, which he said can completely miss the diagnosis.
“A man can have a normal total testosterone of 500 but a rock-bottom free testosterone,” he noted, “and that man is clinically hypogonadal even though his lab slip says otherwise.”
Total testosterone measures every molecule in circulation, both bound and unbound. Free testosterone measures the biologically active fraction that’s actually available to the body’s tissues. The distinction matters enormously. Dr. Mohammed said men who suspect hormonal dysfunction should request the full picture by name: total testosterone, free testosterone, estradiol on a sensitive assay, LH, FSH, prolactin, TSH with reflex to free T4, a complete blood count, a comprehensive metabolic panel, and a lipid panel.
He’s equally concerned about how testosterone results get interpreted once the labs do come back. The current reference ranges, which are typically somewhere between 200-300 and 1,000-1,200 ng/dL, are population averages, not optimal targets.
“They tell you where you fall compared to other men, many of whom are themselves symptomatic, overweight, sleep-deprived, and metabolically unwell,” he said. “That’s not a standard of health. That’s the standard of the average American male, which is a low bar today unfortunately.”
Dr. Mohammed said he’s treated patients with total testosterone in the 400-500 range, which are numbers that would appear normal on paper, who were clearly hypogonadal, and whose symptoms resolved with treatment once their free testosterone was properly evaluated. His philosophy is direct: “Treat the patient, not the labs.”
When depression and low testosterone exist at the same time
One of the more nuanced points Dr. Mohammed makes is that low testosterone and clinical depression aren’t mutually exclusive. In his experience, men carry both simultaneously more often than they carry either condition alone.
“The treatment isn’t either-or,” he said. “You address both, in the right order, with the right sequencing.”
His typical approach, when hypogonadism is significant, is to optimize testosterone first and then reassess mood at the 8-to-12-week mark. In a meaningful subset of men, he asserted, restoring physiologic testosterone substantially lifts depressive symptoms without ever introducing an antidepressant. When depression is severe, or when there’s any safety concern, he doesn’t wait. Instead, he co-manages with a psychiatrist or therapist alongside hormonal optimization. “The mistake is treating them as competing diagnoses instead of coexisting ones,” he explained.
How the healthcare system is failing men with hormonal health
Dr. Mohammed doesn’t soften his assessment of the broader medical community. “Men are underserved, under-screened, and undertreated across the board when it comes to hormonal health and mental health,” he cautioned.
He said the reasons are structural. Insurance doesn’t reimburse time, and this diagnosis requires time. Men are culturally conditioned to avoid seeking care, meaning that by the time they show up, the easiest route, the prescription pad, is the one most physicians take. TRT has been stigmatized for decades by a conflation of therapeutic testosterone replacement with athletic abuse. Also, men’s health as a specialty, Dr. Mohammed pointed out, has long been treated as optional rather than essential.
“If we’re comfortable putting a man on a medication he may take for the rest of his life, we should be comfortable spending a couple hundred dollars in labs first,” he insisted. “The fact that this isn’t guideline-level care in 2026 is a failure of the field.”
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Note: I am a journalist, not a medical professional. This article is intended for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider regarding any health concerns.
More About Our Expert: Dr. Haleem Mohammed is a board-certified physician and healthcare executive based in Miami Beach, Florida. He serves as the Chief Medical Officer at Gameday Men’s Health. He specializes in hormone optimization, longevity medicine, and men’s health.
Source: creators.yahoo.com
