Relationship Between Plasma Testosterone and Suicidal Behavior in Patients with Antisocial Personality Disorder

Abstract

Objective: Antisocial personality disorder (ASPD) is associated with a heightened risk of suicide, particularly
among male patients, where chosen suicide methods tend to be more lethal. The link between suicidal
behavior and plasma testosterone levels remains a key area of investigation. This study investigates
whether plasma testosterone levels differ between ASPD patients with a history of suicide attempts,
aiming to explore the hormone’s potential role as a biomarker for suicide risk. This study aimed to explore
the association between plasma testosterone levels and suicidal behavior in individuals with ASPD who
attempted suicide.

Methods: A total of 44 patients with ASPD and 24 healthy controls were enrolled, matched by age,
education, and gender. Biochemical evaluations included total and free testosterone, thyroid function
tests, blood lipids, folate, ferritin, and vitamin B12 levels. Psychopathological assessments were conducted
using the Hamilton Depression (HAM-D) and Anxiety (HAM-A) Scales.

Results: The mean ages of the patient and control groups were 22.26 (±3.04) and 24.36 (±2.5) years,
respectively. Free testosterone levels were significantly elevated in the patient group compared to controls
(P=.02). Hamilton Anxiety (HAM-A) and HAM-D scores were also notably higher in the patient group. A
positive correlation was identified between free testosterone levels and high-density lipoprotein in
patients with ASPD (R=0.520; P < .05).

Conclusion: These preliminary findings suggest that elevated free testosterone may contribute to
increased suicide risk in men with ASPD, potentially through its impact on impulsivity and aggression.
While the effect size was modest, identifying hormonal patterns associated with suicidal behavior may
help guide future risk assessment strategies. Further research with larger and more diverse samples is warranted.

Cite this article as: Garip B, İnanç Ö. Relationship between plasma testosterone and suicidal behavior in patients with
antisocial personality disorder. Neuropsychiatr Invest. 2025, 63, 0017, doi:10.5152/NeuropsychiatricInvest.2025.25017.