Gonadal axis hormones in psychiatric male patients after a suicide attempt

  • John Tripodianakis
  • Manolis MarkianosEmail author
  • Olga Rouvali
  • Christos Istikoglou


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.


attempted suicide psychiatric diagnosis testosterone LH FSH 


  1. 1.
    Litman R (1967) Sigmund Freud on suicide. In: Shneidman E (ed) Essays in self-destruction. Science House, New York, pp 324–344Google Scholar
  2. 2.
    Lester D (1968) Suicide as an aggressive act. J Gen Psychol 79:83–86PubMedCrossRefGoogle Scholar
  3. 3.
    Miotto P, De Coppi M, Frezza M, Petretto D, Masala C, Petri A (2003) Suicidal ideation and aggressiveness in school-aged youths. Psychiatry Res 120:247–255PubMedCrossRefGoogle Scholar
  4. 4.
    Horesh N, Gothelf D, Ofek H, Weizman T, Apter A (1999) Impulsivity as a correlate of suicidal behavior in adolescent psychiatric inpatients. Crisis 20:8–14PubMedGoogle Scholar
  5. 5.
    Schneider B, Wetterling T, Sargk D, Schneider F, Schnabel A, Maurer K, Fritze J (2006) Axis I disorders and personality disorders as risk factors for suicide. Eur Arch Psychiatry Clin Neurosci 256:17–27PubMedCrossRefGoogle Scholar
  6. 6.
    Engstrom G, Persson B, Levander S (1999) Temperament traits in male suicide attempters and violent offenders. Eur Psychiatry 14:278–283PubMedCrossRefGoogle Scholar
  7. 7.
    Kalin NH (1999) Primate models to understand human aggression. J Clin Psychiatry 60(Suppl 15):S29–S32Google Scholar
  8. 8.
    Virkkunen M, Rawlings R, Tokola R, Poland RE, Guidotti A, Nemeroff C, et al. (1994) CSF biochemistries, glucose metabolism and diurnal activity rhythms in alcoholic violent offenders, fire setters and healthy volunteers. Arch Gen Psychiatry 51:20–27PubMedGoogle Scholar
  9. 9.
    Brooks JH, Reddon JR (1996) Serum testosterone in violent and nonviolent young offenders. J Clin Psychol 52:475–483PubMedCrossRefGoogle Scholar
  10. 10.
    Banks T, Dabbs JM (1996) Salivary testosterone and cortisol in a delinquent and violent urban subculture. J Soc Psychol 136:49–56PubMedCrossRefGoogle Scholar
  11. 11.
    Higley JD, Mehlman PT, Poland RE, Taub DM, Vickers J, Suomi SJ, et al. (1996) CSF testosterone and 5-HIAA correlate with different types of aggressive behaviors. Biol Psychiatry 40:1067–1082PubMedCrossRefGoogle Scholar
  12. 12.
    Simon NG, Cologer-Clifford A, Lu SF, McKenna SE, Hu S (1998) Testosterone and its metabolites modulate 5HT1A and 5HT1B agonist effects on intermale aggression. Neurosci Behav Rev 23:325–336Google Scholar
  13. 13.
    Stefulj J, Buttner A, Kubat M, Zill P, Balija M, Eisenmenger W, Bondy B, Jernej B (2004) 5HT-2C receptor polymorphism in suicide victims. Association studies in German and Slavic populations. Eur Arch Psychiatry Clin Neurosci 254:224–227PubMedGoogle Scholar
  14. 14.
    Evans J, Reeves B, Platt H, Leibenau A, Goldman D, Jefferson K, Nutt D (2000) Impulsiveness, serotonin genes and repetition of deliberate self-harm (DSH). Psychol Med 30:1327–1334PubMedCrossRefGoogle Scholar
  15. 15.
    Butterfield MI, Stechuchac KM, Connor KM, Davidson JRT, Wang C, Mackuen CL, et al. (2005) Neuroactive steroids and suicidality in posttraumatic stress disorder. Am J Psychiatry 162:380–382PubMedCrossRefGoogle Scholar
  16. 16.
    Thiblin I, Runeson B, Rajs J (1999) Anabolic androgenic steroids and suicide. Ann Clin Psychiatry 11:223–231PubMedCrossRefGoogle Scholar
  17. 17.
    Gustavsson G, Traskman-Benz L, Higley JD, Westrin A (2003) CSF testosterone in 43 male suicide attempters. Eur Neuropsychopharmacol 13:105–109PubMedCrossRefGoogle Scholar
  18. 18.
    Beck AT, Beck R, Kovacks M (1975) Classification of suicidal behaviors. I Quantifying intent and lethality. Am J Psychiatry 132:182–187Google Scholar
  19. 19.
    Markianos M, Hatzimanolis J, Lykouras L (1999) Switch from neuroleptics to clozapine does not influence pituitary-gonadal axis hormone levels in male schizophrenic patients. Eur Neuropsychopharmacol 9:533–536PubMedCrossRefGoogle Scholar
  20. 20.
    Zitzmann M, Nieschlag E (2001) Testosterone levels in healthy men and the relation to behavioral and physical characteristics: facts and constructs. Eur J Endocrinol 144:183–197PubMedCrossRefGoogle Scholar
  21. 21.
    Elman I, Breier A (1997) Effects of acute metabolic stress on plasma progesterone and testosterone in male subjects: relationship to pituitary-adrenocortical axis activation. Life Sci 61:1705–1712PubMedCrossRefGoogle Scholar
  22. 22.
    Spratt DJ, Cox P, Orav J, Moloney J, Bigos T (1993) Reproductive axis suppression in acute illness is related to disease severity. J Clin Endocrinol Metab 76:1548–1554PubMedCrossRefGoogle Scholar
  23. 23.
    Brown AS, Hembree WC, Friedman JH, Kaufmann CA, Gorman JM (1995) The gonadal axis in men with schizophrenia. Psychiatry Res 28:231–239CrossRefGoogle Scholar
  24. 24.
    Kaneda Y, Kavamura I, Fugii A, Ohmori T (2004) Impact of switch from typical to atypical antipsychotic drugs on quality of life and gonadal hormones in male patients with schizophrenia. Neuroendocrinol Lett 25:135–140PubMedGoogle Scholar
  25. 25.
    Mann JJ, Currier D, Stanley B, Oquendo MA, Amsel LV, Ellis SP (2006) Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol 9:465–474PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • John Tripodianakis
    • 1
  • Manolis Markianos
    • 2
    Email author
  • Olga Rouvali
    • 1
  • Christos Istikoglou
    • 3
  1. 1.Dept. of PsychiatryEvangelismos General HospitalAthensGreece
  2. 2.Laboratory of Clinical Neurochemistry, Eginition HospitalAthens University Medical SchoolAthensGreece
  3. 3.Dept. of PsychiatryAsclepeion HospitalVoula-AthensGreece

Personalised recommendations