A recent study reveals that testosterone levels may play opposite roles in how older men and women experience suicide risk during severe depression. While higher levels of the hormone appear to protect older men from suicidal thoughts and behaviors, elevated testosterone is associated with an increased risk for older women. The findings, published in the Journal of Affective Disorders, highlight the need for personalized approaches to psychiatric care based on biological sex.
Depression in older adults presents a major public health challenge worldwide. People over the age of 60 who experience major depressive episodes often have more persistent suicidal thoughts and higher rates of dying by suicide compared to younger populations. Social isolation, physical ailments, and declining cognitive function are all known to contribute to this vulnerability. However, medical professionals lack reliable biological markers to help identify which older patients are at the highest risk of self-harm.
Biological markers, such as hormone levels in the blood, can offer objective clues about a patient’s internal state. Testosterone is a steroid hormone that helps regulate mood, energy, and behavior. Both men and women produce testosterone, though men naturally produce much higher quantities. As people age, their natural hormone production changes. Older men experience a gradual decline in testosterone, which can sometimes lead to a clinical deficiency. Older women experience changes during and after menopause, sometimes resulting in relatively higher testosterone levels compared to their other hormones.
Prior research hints that unusual variations in testosterone might influence mood disorders and impulse control across a person’s lifespan. Han Wang and Qian Zhao, researchers at Beijing Anding Hospital and Capital Medical University in China, led a team to investigate whether these hormonal variations might explain differing suicide risks among older adults experiencing depression.
The research team analyzed medical records from 805 inpatients treated for severe depression between 2013 and 2020. The patients ranged in age from 60 to 89, and 382 of these individuals had documented suicidal ideation or behaviors when they were admitted to the psychiatric hospital. Suicidal ideation refers to thoughts of ending one’s life or passive wishes for death, while suicidal behaviors include intentional self-injury with lethal intent. The remaining 423 patients also suffered from severe depression but had no documented history of suicidal thoughts or actions.
The researchers collected data on each patient’s age, medical history, alcohol use, and recent stressful life events. They also recorded the results of blood tests taken early in the morning within a few days of the patients being admitted to the hospital. Drawing blood in the early morning helps account for the body’s natural daily rhythms.
Because men naturally have ten to twenty times more circulating testosterone than women, the researchers used a statistical technique to standardize the hormone levels within each sex group. This involved comparing each patient’s testosterone level to the average level for their own sex. This standardization allowed the researchers to evaluate how relative changes in the hormone affected men and women on an equal scale.
The results revealed a stark divergence based on biological sex. For older men, higher relative testosterone levels were associated with protection against suicidality. Every standard increase in testosterone corresponded to a measurable reduction in the likelihood of suicidal thoughts or behaviors. The researchers calculated that this equated to an absolute risk reduction of about 7.6 percent for an average older man without other major risk factors like alcohol use or physical disease.
The opposite pattern emerged for older women. For female patients, every standard increase in testosterone was associated with a higher likelihood of suicidality. The absolute risk for women was roughly 4.5 percent higher with each unit increase in the hormone.
The team also identified specific lifestyle and health factors that were linked to higher risks differently for men and women. Alcohol consumption was strongly associated with an increased suicide risk in men. The researchers suggest that alcohol might interact with hormone imbalances to exacerbate impulsivity and aggression in older men.
Physical illness and bodily ailments had a much stronger association with suicide risk in women. The presence of conditions like diabetes or heart disease was heavily linked to female suicidality. Recent stressful life events, such as family conflicts or the loss of a loved one, were associated with an elevated risk of suicidal thoughts and behaviors for both sexes equally.
The study relies on hospital records from a single point in time. This type of observational research can identify patterns and associations, but it cannot prove that changes in testosterone directly cause suicidal thoughts. The participants were also restricted to inpatients with severe depression, meaning the results might not apply to older adults with milder depressive symptoms or those receiving outpatient care.
Hormone levels naturally fluctuate throughout the day and can change in response to immediate stress. The researchers relied on a single blood test taken shortly after hospital admission, which might not capture an individual’s typical hormonal baseline over a longer period. The data also lacked information on certain variables that can influence hormones, such as body mass index and specific medications.
Future studies will need to track hormone levels and depressive symptoms over months or years to see if long-term testosterone changes reliably predict suicide risk. Medical professionals caution against attempting to alter hormone levels to treat depression based on observational findings. Adjusting testosterone without a complete endocrine evaluation can provoke unwanted side effects, including increased aggression or anxiety. Clinical trials are necessary to determine if monitoring these biological markers can safely improve suicide prevention strategies for older adults.
The study, “Sex-divergent association of testosterone with suicidal risk in late-life depression”, was authored by Han Wang, Nan Lyu, Juan Huang, Bingbing Fu, and Qian Zhao.