A new study published in the Journal of Affective Disorders reports a sex-divergent relationship between testosterone and suicide risk in late-life depression, with higher testosterone appearing to shield older men from suicidality, while being linked to greater risk among older women. Researchers from Beijing Anding Hospital and Capital Medical University in China led the investigation.
Depression in later life is a pressing global public health concern. Among those aged 60 to 89 experiencing major depressive episodes, suicidal thoughts tend to persist and the risk of suicide is higher than in younger groups. Social isolation, chronic illnesses and declining cognitive function are among factors contributing to this vulnerability.
Biological markers, such as circulating hormone levels, can offer objective clues about a patient’s internal state. Testosterone helps regulate mood, energy and behaviour. While both men and women produce the hormone, men naturally have higher levels, and ageing alters production in different ways across sexes.
The Beijing team studied 805 inpatients treated for severe depression between 2013 and 2020. Of these, 382 had documented suicidal ideation or behaviours at admission, while 423 had no such history.
Researchers collected data on age, medical history, alcohol use and recent stressful life events, and drew early-morning blood samples within days of hospital admission to account for daily hormonal variation.
Because men typically have ten to twenty times more circulating testosterone than women, the researchers standardised hormone levels within each sex to compare relative changes on an even scale.
Results showed a clear divergence by 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 risk, equating to about a 7.6 per cent absolute risk reduction for an average older man without major co‑factors.
By contrast, for older women, every standard increase in testosterone was associated with a higher likelihood of suicidality, with the absolute risk rising by roughly 4.5 per cent per unit increase in the hormone.
The study also identified factors that appeared to influence risk differently by sex. Alcohol use was strongly linked to increased suicide risk in men, while bodily illnesses such as diabetes or heart disease were more strongly associated with female suicidality. Recent stressful life events increased risk for both sexes.
Researchers caution that the study’s design limits its conclusions. It relied on hospital records from a single time point and cannot establish causation; the participants were all inpatients with severe depression, so findings may not apply to those with milder symptoms or outpatient treatment.
Hormone levels naturally fluctuate during the day and in response to stress, and the study used a single blood test taken near admission, which may not reflect longer-term baselines. The researchers also noted missing information on variables such as body mass index and specific medications.
The authors advocate for longitudinal studies that track hormone levels and depressive symptoms over months or years to determine whether testosterone changes reliably predict suicide risk. They also emphasise that altering testosterone levels without a full endocrine assessment can provoke unwanted effects, and that clinical trials are needed to assess whether monitoring these markers could safely enhance suicide prevention 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.
