The Little-Known Cause of Fatigue and Depression in Men Over 60

Dr. Frank Shallenberger, MD

November 2, 2020



With winter and the holidays coming soon, I’m expecting the number of patients I see with depression to go up substantially. And as crazy as 2020 has been, this may be the worst year ever.

This is a tough time of the year emotionally. But depression isn’t just a product of less sun and holiday emotions. There are a number of reasons depression can hit. But one cause is a particular deficiency.

Fixing this deficiency can stop many cases of depression. And it works especially well for men.

You may remember that neurotransmitter deficiencies can contribute to depression for many people. Several years ago, I told you about the neurotransmitter serotonin and how to correct this deficiency.

However, serotonin is not the major neurotransmitter deficiency causing depression in men. So using serotonin therapy may not be effective with men at all. And even in women, it is very possible to correct a serotonin deficiency and still have depression. The reason? There’s another neurotransmitter besides serotonin you have to consider.

Let Me Tell You About Derrick

Derrick was 63 years old when I first saw him. Like so many of my male patients, when I asked him why he made the appointment, he said he didn’t know. “My wife Marcie made it,” he said. Thankfully, she had come with him, and this is what she told me.

“Derrick and I have been married for 37 years. I have known him ever since he was going to elementary school, which is where we first met. He is still the most wonderful man I have ever known. But he has changed. That’s why I told him he had to come in to see you.”

Marcie went on to say that for the first 30 years of her marriage, Derrick was his usual self. He was a hard worker, had a ton of energy, a great memory, and in general was, “Mr. Enthusiasm.” Nothing ever got him down. When she was depressed or upset about anything, it was always Derrick who pointed out the positive, and got her back on track.

“But all that’s changed now. I have to give him the pep talks. He gets discouraged over things that would have never bothered him 5-10 years ago. And, it seems that he’s just gotten lazy. He hardly ever plays golf anymore. He just lies around the house. He never, never did that before.

“The other thing is his mind. It’s just not nearly as sharp as it used to be. I find him with that blank look on his face, and when I ask about it, he tells me that he just suddenly forgot what he was doing. And the other thing that has really dropped off is his sex drive. That is a lot less than it used to be.”

What Marcie did not know is that she had just about given the perfect description of a man with a deficiency of the neurotransmitter dopamine.

Derrick confirmed it to me when he said, “Everything she said is right. I do get tired more easily. And I don’t have nearly the drive that I used to. But one thing she doesn’t know about is how hard it has been for me to concentrate recently. It seems I read a paragraph, and then I have to read it again one or two more times in order to remember what I just read. My mind and my disposition are just not what they should be.”

Dopamine Deficiencies Are Real!

And they are common. Take, for example, a report about decreasing levels of dopamine that appeared in the Journal of Neurochemistry. The researchers examined the postmortem brains of 23 people between the ages of 14 and 92 years old.

They found that the average dopamine levels in the 84-year-old group were 61% less than those in the 22-year-old group. This averages out to about a 10% drop in dopamine levels for every decade we live past 20. That’s a very significant deficiency in a very important neurotransmitter.

So I was glad that Derrick came to see me before he consulted with a conventional doctor. Because the conventional treatment for his symptoms is to condemn him to the side effects, and the endless expense of one of the many anti-depressant medications that Big Pharma has blessed us with.

Among the most common side effects of these medications is fatigue and decreased sex drive. So if Derrick wasn’t depressed before he took the drugs, I’m sure he would have been shortly thereafter.

Derrick wasn’t suffering from a medication deficiency — he had a dopamine deficiency. How do I know? Well, although there are tests for neurotransmitter levels, I have never found them to be nearly as helpful as just talking with the patient. And in Derrick’s case, his wife clearly spelled out the diagnosis.

As my old professor of medicine used to say to us back in the 1960s, “If you will just take the time to listen, your patient [or in this case his wife] will tell you what the diagnosis is.”

Derrick’s Treatment

The first thing I did was to test Derrick with Bio-Energy Testing. His test revealed that he also had hypothyroidism. I very rarely find that anyone over the age of 50 has optimal thyroid function. This was a very important finding. Optimal thyroid function is critical for optimal hormonal and neurotransmitter activity.

I didn’t test Derrick’s neurotransmitter levels or his hormone levels. For that matter, I almost never test vitamin or mineral levels. Why not? Testing the levels of natural/biological substances is usually not all that helpful. There is too much variation from one person to another. Three people can all have the same level that’s within the “normal” range. For one person, that level is just right. But it can be insufficient for another and excessive for the third person. That makes testing just about worthless.

And there’s really no need to test. Giving hormones and nutritional substances over a two to three-month trial period is very safe. So I’ve learned that the best way to determine if someone needs therapy is to do two things.

First, ascertain by talking with the patient if there are symptoms suggestive of a deficiency. And second, if the symptoms point to a likely deficiency, administer a two-to-three-month trial to see if the symptoms go away. If they do, then the diagnosis is assured. If not, then the diagnosis was incorrect to start with. This approach is known as a clinical trial.

In this day, many younger doctors think that the only way to discover what patients really need is through exhaustive and expensive testing. I would like to remind them all that in the end, good medicine demands treating patients, not lab tests.

Back to Derrick

Besides having a thyroid deficiency, Derrick also had other deficiencies. He was deficient in adrenal hormones, cortisol, and DHEA. These hormones often become deficient as a consequence of stress. And Derrick had suffered his share of stress lately.

Adrenal hormone deficiencies are easy to diagnose just by history. Whenever someone has decent energy levels in the morning, but starts to crash around 2:00-3:00 p.m., you can bet that this is their problem.

After evaluating Derrick, I placed him on a program of topical testosterone cream (10%, 1 cc a day); DHEA (25 mg twice a day — in the morning and at noon); cortisol (10 mg twice a day — in the morning and at noon); desiccated thyroid hormones (1 grain twice a day — in the morning and at noon), a targeted exercise program, a 25 gram/day carbohydrate diet, and the amino acid l-tyrosine.

L-tyrosine is the precursor amino acid for dopamine. That means that in the brain, l-tyrosine converts to l-dopa, and then l-dopa converts to dopamine. So, in the same way that taking 5-HTP raises serotonin levels, taking l-tyrosine increases the production of dopamine.

In order for l-tyrosine to work properly, though, you have to take it in the proper doses and at the proper times. This means taking between 500-2,000 mg on an empty stomach in the morning, at noon, and between 3:00 and 4:00 p.m. Since the conversion of l-tyrosine to dopamine requires many nutrients that we just can’t get an adequate amount of in our diets, I always make sure my patients take a scoop of my Super Immune QuickStart powder twice a day (morning and noon). And remember that you should not take l-tyrosine if you are taking an MAO inhibitor drug.

How Did the Treatment Work?

I saw Derrick back in two weeks. He was already starting to have more energy. This was because of the effects of the adrenal and thyroid hormones. Unlike testosterone and l-tyrosine (which can take 6-12 weeks to work), these hormones work very quickly. Derrick was starting to see a little daylight. He was beginning to understand what his wife had been telling him for months; that he did not have to feel this way just because he was getting older.

I could tell he was encouraged. I just told him to stay on track and come back in six weeks. By then, I said, he would begin to feel the effects of the testosterone and the l-tyrosine therapy.

The next time I saw Derrick, I could tell that something had dramatically shifted. He was smiling ear to ear, and he greeted me with a hearty command. Marcie told me that he was starting to become his old self once again. His mood and his ability to concentrate were definitely improving. These are the kind of appointments that doctors live for. The thrill of seeing someone get their life back is what it’s all about. And Derrick was definitely doing that.

Derrick stayed on his program for another six months. At that time he was completely free of all of his symptoms, and was feeling as good as he had ever felt in his life. I told him that he could reduce his intake of testosterone, thyroid, and l-tyrosine. Now that his body was functioning on a much younger level, the doses he was taking may no longer be needed. He called me back in three weeks and said that he was doing really well with the lower doses. I told him to stay with all of his healthy changes, and to check back with me in a year.

The last time I saw him, which was one year after I first started treating him, he reported that he was feeling great. He also said that by some trial and error, he had been able to figure out exactly what he needed to stay that way. He determined that although he still needed QuickStart, thyroid, and testosterone, he no longer required the l-tyrosine.

These Cases Are Not the Exception

Derrick’s case is typical. A six-to-nine month course of the amino acids that correct neurotransmitter imbalances, along with lifestyle changes, and individualized hormonal replacement will cure age-related depression every time — without exception. And the same approach also works for most cases of depression in younger people as well.

So if you’re depressed, don’t just submit to antidepressant drugs. There’s hope for a complete recovery without any of the nasty side effects these drugs cause.


“Economic Impact Unclear.” Psychiatric New. November 16, 2001, volume 36 number 22.

Kish, S.J., K. Shannak, A. Rajput, et al. “Aging Produces a Specific Pattern of Striatal Dopamine Loss: Implications for the Etiology of Idiopathic Parkinson’s Disease,” Journal of Neurochemistry, 1992 58 (2), 642–648.

Meltzer, C.C., G. Smith, S.T. DeKosky, et al. “Serotonin in Aging, Late-Life Depression, and Alzheimer’s Disease: The Emerging Role of Functional Imaging,” Neuropsychopharmacology, 1998, vol 18, no 6, 407-30.

Seeman, P., N.H. Bzowej, H.C. Guan, et al. “Human brain dopamine receptors in children and aging adults.” Synapse, 1987;1(5):399-404.

Wu, C.Y., et al. “Age-related testosterone level changes and male andropause syndrome.” Changgeng Yi Xue Za Zhi. 23(6):348-353, 2000.

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