🎗️Testosterone May Be Linked To Suicide Risk in Adolescence

Could a puberty-related hormone hold a clue regarding suicide risk? A study involving over 1,200 adolescents with depression found an association between higher testosterone levels and suicidal ideation or behavior in boys, but not in girls. While the findings do not prove that the hormone causes the behavior, they raise an intriguing possibility: during a stage when the brain is still maturing, hormonal changes may be part of a biological network far more complex than previously imagined.

Adolescence is a period of profound transformation for both the brain and the body. During puberty, levels of sex hormones, including testosterone, rise rapidly, driving physical, emotional, and behavioral changes. At the same time, depression is becoming increasingly common among adolescents and can heighten the risk of suicidal thoughts and behaviors.

Given this context, researchers investigated whether testosterone levels might be linked to suicide risk in adolescents already diagnosed with depression.

To do this, the researchers analyzed data from 1,227 adolescents aged 10 to 19 with major depressive disorder who were admitted to a psychiatric hospital in Beijing between 2013 and 2020.

Upon admission, information regarding the patients' age, clinical characteristics, and other data was collected, alongside a blood sample used to measure circulating testosterone levels. The adolescents were then compared based on the presence or absence of suicidal ideation or behavior.

To verify whether the results could be replicated, the researchers subsequently analyzed a second group of 579 adolescents treated between 2022 and 2023.

The most significant finding emerged among male adolescents. Those exhibiting suicidal thoughts or behaviors had significantly higher testosterone levels than those without such manifestations. The association persisted even after the researchers accounted for other factors that could influence the outcome.

The same pattern was observed in the second group of adolescents used for validation. In other words, within this specific population of male adolescents with depression, higher testosterone levels were associated with a greater likelihood of suicidal ideation or behavior.

However, there is a crucial detail: this does not mean that testosterone causes suicidal thoughts. The study found an association, not a cause-and-effect relationship. Other factors may be involved in this relationship.

Furthermore, the researchers measured testosterone at a single point in time, during hospitalization, rather than tracking the adolescents over years to see if hormonal changes preceded the onset of suicidal thoughts. Therefore, it remains unknown whether testosterone plays a direct role in this process, whether it serves as a marker for another biological change, or whether a combination of factors underlies the association.

One possible explanation relates to the way the adolescent brain is still maturing. The prefrontal cortex, located at the front of the brain, plays a role in planning, evaluating consequences, impulse control, and emotional regulation. Meanwhile, structures within the limbic system are heavily involved in emotions and responses to threats and rewards.

During adolescence, these systems are still undergoing changes and must work in tandem. Researchers are discussing the possibility that elevated testosterone levels might influence this balance by altering communication between regions responsible for control and those more closely linked to emotional responses. However, this is a biological hypothesis, and the study did not directly demonstrate that such brain changes actually occurred in the participants.

Another important finding was that this association did not appear in female adolescents. Testosterone levels did not differ significantly between girls with and without suicidal ideation or behavior.

This is particularly interesting because males and females have very different concentrations of this hormone and may also exhibit differences in how hormones influence the brain during development.

The result reinforces the possibility that sex-related biological factors may modify the relationship between hormones, depression, and suicidal behavior. Nevertheless, the researchers emphasize that larger studies conducted across different populations are needed to confirm this finding.

The most important thing, therefore, is not to view testosterone as a “suicide hormone,” but rather as a potential biological marker that warrants investigation in male adolescents presenting with depression and signs of suicide risk.

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High testosterone levels associated with elevated suicidal risk in male adolescents with depression. 

Han Wang, Nan Lyu, Juan Huang, Bingbing Fu, Lili Shang, Fan Yang, Ling Zhang, and Qian Zhao

BMC Psychiatry 25, 643 (2025). 

https://doi.org/10.1186/s12888-025-07098-3

Abstract: 

Adolescent suicide, as a public health issue, is becoming increasingly urgent, yet there remains a lack of effective objective biomarkers for identifying high-risk adolescents. While testosterone has been linked to suicide, no definitive conclusions have been reached. Studies in specific populations defined by significant changes in age or hormone levels and by gender have shown greater reproducibility. This study aims to investigate the association between testosterone levels and suicidal ideation or behavior in male and female adolescents with major depressive disorder (MDD). This retrospective, cross-sectional study included 1227 adolescents with MDD, aged 10–19 years, hospitalized at the Beijing Anding Hospital, Capital Medical University, from January 2013 to December 2020. Patients were categorized into two groups: those with suicidal ideation or behavior (MDS) and those without (MDNS). Demographic data, clinical characteristics, and serum testosterone levels at admission were extracted and compared. An additional 579 adolescents meeting the same inclusion criteria were included for validation, with data collected from January 2022 to December 2023. In male adolescents, testosterone levels were significantly higher in the MDS group compared to the MDNS group(Z = -4.340, P < 0.001). After adjusting for confounding factors, testosterone levels remained significantly associated with suicidal ideation or behavior (OR = 1.220, 95% CI: 1.098–1.356). This finding was confirmed in the validation data set (OR = 1.444, 95% CI: 1.139–1.832). No significant difference in testosterone levels was observed in females (Z = 1.643, P = 0.100). Elevated serum testosterone levels were independently associated with increased risk of suicidal ideation or behavior in male adolescents with MDD, but not in females. These findings highlight the necessity for sex-specific biomarkers, however, due to the intrinsic limitations of the current study, they necessitate further validation.