High testosterone levels in male teenagers suffering from depression are associated with an increased risk of suicidal thoughts and behavior, according to a recent study. The findings suggest that blood tests that assess hormone levels could one day help doctors identify teenage boys who are most at risk of self-harm. The study was published in the journal BMC Psychiatry.
Depression and suicide rates among teenagers have steadily increased over the past decade. This issue poses a major public health challenge because doctors currently lack objective biological markers to predict which young people are most likely to consider or attempt suicide. Health professionals typically assess safety based on interviews, questionnaires, and self-reported symptoms. These subjective methods can miss hidden warning signs if patients are reluctant to share their true feelings.
Researchers have long debated whether sex hormones play a role in the biology of depression and suicide. Assessing testosterone levels has been the result of many years of scientific research with mixed results. Many past studies grouped adults and teens together or did not account for the dramatic differences in male and female biology. Hormone levels naturally change throughout a person’s life, so a single average measurement across all ages can obscure important details.
Adolescence is an sensitive period characterized by rapid physical development and the emergence of secondary sexual characteristics. During this period, the production of testosterone increases significantly in the body of a teenage boy. Such sudden changes can have a major impact on emotional regulation. The developing teenage brain often experiences a maturation mismatch between the prefrontal cortex, which controls logic and planning, and the limbic system, which processes emotions.
Poor emotional control can lead to impulsivity and aggression. Researchers believe that high testosterone levels may interact with the developing adolescent brain in a way that increases impulsive behavior through increased activity in the brain’s emotional centers. Han Wang and a team of colleagues at Beijing’s Capital Medical University set out to investigate this dynamic. They designed a study to see if testosterone levels were associated with suicidality, specifically in teens diagnosed with major depressive disorder.
The research team created a project that uses electronic medical records from Beijing Stable Hospital. Researchers collected data on 1,227 teens between the ages of 10 and 19 who were hospitalized for major depressive disorder from 2013 to 2020. Researchers excluded patients with other medical conditions, such as schizophrenia, autism, severe physical illness, or substance abuse. They divided the remaining teens into two categories based on whether they expressed suicidal ideation or engaged in suicidal behavior at the time of hospitalization.
Researchers collected demographic information, medical history, and results of blood tests taken immediately after patients arrived at the hospital. These blood tests provided measurements of each teen’s serum testosterone levels. Scientists analyzed data from male and female patients separately to account for natural differences in hormonal profiles. They adjusted the mathematical model to balance the effects of other variables such as age, smoking, alcohol intake, and patient disease duration.
Health records revealed a clear pattern among male patients. Teenage boys who exhibited suicidal thoughts and behaviors had higher testosterone levels than those who did not. This correlation persisted even after the researchers took into account other variables that could change the results. The presence of higher testosterone consistently showed an increased risk of self-harm in the male demographic.
The results for female patients were quite different. Researchers found no statistical difference in testosterone levels between girls who experienced suicidal thoughts and those who did not. Female patients in the study were more likely to report suicidal ideation overall than male patients, but testosterone levels were not associated with this risk. Researchers say other hormones, such as estrogen and progesterone, may be more associated with depression and emotional regulation in teenage girls.
Researchers note that suicide in men is often associated with extreme inward aggression and impulsivity. Medications that reduce impulsivity and aggression have been shown in the past to reduce suicide risk. Elevated testosterone may facilitate this impulsive pathway in young men. The researchers also noted that genetic variations that affect how testosterone enters the brain have been linked to suicide in previous scientific literature.
To confirm the robustness of their initial observations, the research team conducted a second analysis using a different set of hospital records. The validation dataset included 579 different teens who were hospitalized with major depressive disorder between 2022 and 2023. The researchers applied the exact same criteria and statistical model to this new group of patients. They also incorporated BMI data into a second analysis to assess whether patient weight influenced outcomes.
The second analysis fully corroborated the results of the primary dataset. Once again, male teens with suicidal thoughts and behaviors had higher testosterone levels than their peers without suicidal tendencies. The correlation remained strong even after adjusting for a new set of demographic variables. As before, female patients in the validation group showed no relationship between testosterone levels and suicidal behavior.
Although the study provides a detailed look at the biology of mental health, the authors acknowledge some limitations. Because the study relied entirely on searching past medical records, scientists could only observe correlations. They cannot prove that high testosterone causes suicidal behavior. It’s entirely possible that the severe stress of a suicidal crisis activates the body’s hormonal response, causing a sudden surge in testosterone production after the fact.
The scientists specified that their study only included teens with depression severe enough to require hospitalization. This result may not apply to youth with mild depression who are treated in outpatient clinics or at home. The study also did not take into account lifestyle variables such as sleep disorders and daily physical activity levels, which are known to alter a person’s natural hormonal balance. Additionally, the data could not distinguish between teens who merely considered suicide and those who actually attempted suicide.
Future studies will need to follow groups of teens over longer periods of time to see if elevated testosterone levels indeed precede suicidal thoughts. The researchers also hope to measure hormone levels at multiple points during patients’ recovery and monitor how these chemicals fluctuate as their mental health stabilizes. For female patients, future studies could track menstrual cycles and measure a broader range of hormones to map biological risk factors specific to female patients. On the other hand, this study serves as a reminder that depression in men and women may operate through very different biological pathways.
The study, “High Testosterone Levels Are Associated with Increased Suicide Risk in Male Adolescents with Depression,” was authored by Han Wang, Nan Lyu, Juan Huang, Bingbing Fu, Lili Shang, Fan Yang, Ling Zhang, and Qian Zhao.
