Mental Health or Hormones? Understanding the Overlap in Symptoms

Mental health and hormone dysfunction can cause surprisingly similar symptoms. Anxiety, depression, irritability, fatigue, poor sleep, brain fog, and difficulty concentrating can occur with mental health conditions, hormonal changes, or sometimes both at the same time.

With a clinical background as a psychiatric nurse practitioner and my current work in hormone management at Axios Health & Wellness in Longmont, Colorado, I have seen how similar mental health and hormone-related symptoms can appear. Patients often know that something has changed in how they feel, but identifying what may be contributing to those changes is not always straightforward.

Why Mental Health and Hormone Dysfunction Can Cause Similar Symptoms

Hormones influence much more than reproductive health. Estrogen, progesterone, testosterone, and thyroid hormones interact with systems involved in energy, sleep, cognition, sexual function, and emotional regulation.

This is one reason hormonal changes can sometimes resemble symptoms associated with depression, anxiety, or other mental health conditions.

Common overlapping symptoms include:

• Anxiety or increased worry
• Depressed or low mood
• Irritability
• Mood changes
• Fatigue or low motivation
• Difficulty concentrating
• Brain fog
• Sleep disturbances
• Changes in appetite or weight
• Decreased libido
• Reduced interest in activities

The presence of these symptoms does not automatically mean someone has a hormonal imbalance. Likewise, having abnormal hormone levels does not exclude a mental health condition.

That distinction matters.

Perimenopause Can Affect More Than Your Period

Perimenopause is one of the clearest examples of the connection between hormonal changes and mental health.

During the menopause transition, estrogen and progesterone levels fluctuate before eventually declining. While many women expect changes in their menstrual cycle or hot flashes, they may be less prepared for changes in mood, sleep, concentration, and anxiety.

The American College of Obstetricians and Gynecologists (ACOG) notes that approximately 4 in 10 women experience mood symptoms during perimenopause that can include irritability, low energy, tearfulness, mood changes, and difficulty concentrating. Research also indicates that the risk of depression increases during the menopause transition.

For some women, these symptoms feel very different from their previous baseline.

A patient may tell me, “I’ve never been an anxious person, but suddenly everything makes me anxious,” or describe feeling overwhelmed by situations she previously managed without difficulty.

That change deserves evaluation rather than an assumption that it is “just stress” or “just hormones.

Thyroid Dysfunction Can Also Mimic Mental Health Symptoms

Thyroid function is another important consideration when evaluating changes in mood, energy, and cognition.

Hypothyroidism can be associated with fatigue, depressed mood, difficulty concentrating, sleep changes, and cognitive complaints. Hyperthyroidism may contribute to symptoms such as anxiety, restlessness, irritability, and difficulty sleeping.

The overlap can make determining the source of symptoms difficult based on symptoms alone.

Importantly, not every person experiencing depression or anxiety has thyroid dysfunction, and treating a thyroid abnormality does not necessarily resolve an underlying mental health disorder.

This is why appropriate laboratory testing and a complete clinical history can be valuable when symptoms suggest more than one possible cause.

Low Testosterone and Mental Health Symptoms in Men

Hormonal symptoms are not limited to women.

Men with testosterone deficiency may experience reduced energy, difficulty concentrating, irritability, depressed mood, decreased libido, and changes in physical performance.

These symptoms are also nonspecific. Fatigue and low motivation, for example, can occur with depression, chronic stress, inadequate sleep, sleep apnea, medication effects, thyroid disorders, and many other medical conditions.

Low testosterone should therefore not be diagnosed from symptoms alone. Current Endocrine Society guidance recommends diagnosing hypogonadism when compatible symptoms are accompanied by consistently and unequivocally low testosterone levels on appropriate laboratory testing.

Sometimes It Really Is Both

One of the most important concepts I discuss with patients is that identifying a hormonal contributor does not invalidate a mental health diagnosis—and having a mental health condition does not mean physical contributors should be ignored.

A woman with a history of anxiety may notice significantly increased symptoms during perimenopause. Someone with depression may also develop hypothyroidism. A man experiencing low energy and motivation may have low testosterone while simultaneously dealing with significant stress or depression.

Human physiology rarely fits neatly into one category.

The goal should not be to prove that symptoms are either psychological or hormonal. The goal is to understand all of the factors contributing to how someone feels.

A More Complete Evaluation

When patients come to our clinic with overlapping symptoms, I believe the most useful question is not simply, “Are your hormones normal?”

Instead, we look at the larger clinical picture.

That may include when symptoms began, whether they fluctuate with the menstrual cycle, changes in sleep, menstrual history, medications, previous mental health diagnoses, sexual symptoms, energy levels, physical symptoms, lifestyle factors, and appropriate laboratory testing.

Laboratory results are important, but they are only one part of the evaluation. Hormone levels should be interpreted alongside symptoms, medical history, and other possible causes.

Treatment Should Match the Cause

If a hormonal disorder is identified, appropriate treatment may improve some associated symptoms. Menopausal hormone therapy, for example, can be effective for appropriate candidates experiencing bothersome menopausal symptoms. Thyroid disorders and confirmed testosterone deficiency also have established treatment approaches.

But hormone therapy is not a universal treatment for depression, anxiety, or other psychiatric disorders.

Some patients benefit from mental health treatment. Others benefit from addressing hormonal or medical contributors. Many benefit from a combination of approaches that may include medication, psychotherapy, hormone management when appropriate, improved sleep, exercise, nutrition, and stress reduction.

Looking at the Whole Person

If you have recently developed anxiety, irritability, fatigue, brain fog, sleep problems, decreased motivation, or changes in mood, it may be worth looking beyond a single explanation.

At Axios Health & Wellness in Longmont, Colorado, our approach is to evaluate symptoms in context rather than assuming they come from one source. Understanding the potential relationship between mental health and hormone dysfunction can help identify contributing factors and guide a more individualized treatment plan.

Feeling different does not automatically mean you have a psychiatric disorder or a hormonal disorder. Sometimes the most important first step is simply asking the right questions.

Wondering whether hormones may be contributing to changes in your mood, energy, sleep, or concentration? Axios Health & Wellness provides individualized hormone evaluations in Longmont, Colorado. A comprehensive evaluation can help identify potential hormonal and medical contributors and determine appropriate next steps.

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About the Authors

This article was co-written by Jay Griffin, FNP-C, CRNFA, and Lacey Fisher, FNP-BC, PMHNP-BC.

Jay and Lacey are board-certified Family Nurse Practitioners and hormone optimization specialists at Axios Health & Wellness. Together, they bring decades of clinical experience in hormone replacement therapy, thyroid optimization, peptide therapy, medical weight loss, and regenerative medicine.

Their goal is to help patients better understand the science behind their health and make informed decisions through evidence-based, personalized care.

Jay Griffin, FNP-C, CRNFA

Board-Certified Family Nurse Practitioner
Hormone Optimization Specialist
Founder, Axios Health & Wellness

Lacey Fisher, FNP-BC, PMHNP-BC

Board-Certified Family Nurse Practitioner
Board-Certified Psychiatric Mental Health Nurse Practitioner
Hormone Optimization Specialist
Axios Health & Wellness