Leo Sher, M.D.

Our research article, “The effect of oral dexamethasone administration on testosterone levels in combat veterans with or without a history of suicide attempt” has been published in the Journal of Psychiatric Research online ahead of print (1).

Combat exposure has been linked to increased risk of suicidal ideation, suicide attempts, and death by suicide. Suicidality has been linked with altered testosterone levels. In this study, we examined morning baseline free and total testosterone levels and the effect of dexamethasone administration on testosterone levels in male combat veterans with or without a history of suicide attempt.

Only suicide attempters who made an attempt within 5 years preceding the day of initial assessment were enrolled. Non-attempters were recruited from the same population of psychiatric patients. Demographic and clinical parameters of the study participants were assessed and recorded. Blood samples were collected between 8:00 and 8:30 a.m. on the day prior to and following dexamethasone (0.5 mg) ingestion.

Suicide attempters had higher schedule for suicidal ideation (SSI) scores in comparison to non-attempters. Baseline free and total testosterone levels were lower in suicide attempters compared to non-attempters. In the whole sample, both baseline free and total testosterone levels negatively correlated with SSI scores.

Free testosterone levels decreased after dexamethasone administration among non-attempters but not among attempters. Free testosterone post-dexamethasone levels positively correlated with aggression scores among non-attempters but not among suicide attempters.

Our findings indicate that there are substantial differences in the testosterone regulation between combat veterans with or without a history of suicide attempt. Studies of the relation between the testosterone function and suicidal behavior among combat veterans may lead to improvement in detection of suicidality and finding new pharmacological targets for prevention of suicide among veterans. Future studies will determine whether therapeutic targeting of testosterone dysregulation attenuates severity of suicidal ideation and, thereby, reduces suicide risk.

Reference

1. Sher L, Bierer LM, Makotkine I, Yehuda R. The effect of oral dexamethasone administration on testosterone levels in combat veterans with or without a history of suicide attempt. J Psychiatr Res. 2020 Nov 20:S0022-3956(20)31093-1. doi: 10.1016/j.jpsychires.2020.11.034. Epub ahead of print.