Gonadal axis hormones in psychiatric male patients after a suicide attempt

Abstract

Epidemiological and clinical studies support the view that aggressive acts like suicidal and violent behaviors share a common substrate. Certain aspects of violence in males have been related to high testosterone levels, but the relation of testosterone to attempted suicide has not been studied until now. We estimated plasma levels of testosterone (T), LH, and FSH in 80 male subjects after a suicide attempt and in whom a psychiatric assessment was done during their hospitalization. Suicide intent was evaluated in 72 subjects. A group of 56 healthy males in the same age range served as control. As a group, attempters showed significantly lower T levels, marginally higher LH, and normal FSH compared to controls. The attempters who used violent methods (26 subjects) had T levels even lower than the non-violent (drug overdose) subgroup. Comparisons of T levels of subgroups according to the (main) drug ingested (analgesics, benzodiazepines, antidepressants, neuroleptics, or other drugs) did not reveal any significant drug effect. In relation to diagnosis, the lowest T levels were found in the subgroup with schizophrenia (29 subjects). The T levels of this subgroup were also significantly lower compared to those of a group of 31 male schizophrenic patients, hospitalized and treated with neuroleptics. If the influence of post-attempt stress and medical condition on plasma T could be ruled out, low plasma T may prove to be a biological predictor of attempt, at least in male schizophrenic patients. Nevertheless, the findings differentiate suicidal behavior from other aggressive/violent behaviors and do not support the notion that suicidal and aggressive behaviors are manifestations of the same impulse.

Lack of Association between Testosterone and Suicide Attempts

“…This result does not support the putative role of testosterone as a biological marker for suicidal behavior, as has been proposed by Tripodianakis et al [17] . The association of high testosterone levels with specific axis I diagnoses [20] was also contradicted by our results, which show no differences between broad axis I categories.…”

“…In male suicide attempters, aggressiveness has been associated with low testosterone levels [17] , but this finding has not been replicated [18,19] . Gustavsson et al [20] did not find any significant association between testosterone levels and suicidal behaviors or aggressive-impulsive temperament.…”

“…Suicide has been the object of research looking for an association with testosterone levels, and previous studies reported low plasma T levels after suicide attempts [17,20] . This could reflect a downpeak reaction due to previous selfdirected aggression.…”

Gender-Specific Effects of Depression and Suicidal Ideation in Prosocial Behaviors

“…Regardless of these differentiations, the reversal of the gender-specific pattern of prosocial behavior in depressed suicidal patients seems to be related to a disruption of HPG axis. For instance, low testosterone levels have been reported in cerebrospinal fluid and serum in suicide attempters [62], [63]. Furthermore, suicide attempters that jumped off heights showed a trend toward lower testosterone levels without increases in luteinizing hormone, suggestive of dysfunction at the hypothalamus-pituitary level [64].…”

Association of testosterone levels and future suicide attempts in females with bipolar disorder

“…Tripodianakis et al (2007) compared testosterone levels in males admitted to hospital wards after a suicide attempt with testosterone levels in healthy males in the same age range and found that attempters had significantly lower testosterone levels compared to controls, and that the attempters who used violent methods had lower testosterone levels compared to the non-violent attempter subgroup Markianos et al (2009). examined testosterone levels in a group of male psychiatric patients who had attempted suicide by jumping, compared with a group of male subjects who were hospitalized after accidentally falling from a high height, and in healthy controls.…”