Differential Testosterone Levels in Men, Women With Schizophrenia

Investigators conducted a systemic review and met-analysis to evaluate testosterone, DHEA, and DHEA-S levels in individuals with schizophrenia.

According to the results of a systematic review published in Psychoneuroendocrinology, testosterone levels were increased in women with stable multi-episode schizophrenia and decreased in men with stable multi-episode schizophrenia. Testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels were elevated in patients with first-episode psychosis.

In this systematic review, 34 studies (including 1742 individuals with schizophrenia and 1604 controls) that evaluated the levels of testosterone, DHEA, and DHEA-S were included. Effect size (ES) was estimated with Hedges’ g, and random-effects models were used for data analysis.

Among all patients with schizophrenia, DHEA-S levels were elevated relative to controls (ES 0.75; P =.005). Among patients with first-episode psychosis, free testosterone levels (ES 1.21; P =.009) and DHEA-S levels (P <.001) were increased. Similarly, acute relapse of schizophrenia was associated with higher levels of testosterone (ES 0.50; P <.001).

Among patients with stable multi-episode schizophrenia, a gender difference was reported for free testosterone levels. Total testosterone was elevated in women with stable multi-episode schizophrenia (ES 0.56; P <.001) and reduced in men with stable multi-episode schizophrenia (ES -0.62; P =.006). In an interview with Psychiatry Advisor, Błażej Misiak, MD, PhD, of the Department of Genetics at Wroclaw Medical University, Poland, explained that the gender difference might be caused by “some antipsychotic drugs increasing the levels of prolactin, which can exert opposite effects on testosterone production in males and females.”

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Dr Misiak concluded that the results “seem to be important in light of certain physical health impairments that are frequent in patients with schizophrenia, including sexual dysfunction or low bone mineral density. Therefore, the measurement of testosterone levels in patients with schizophrenia, undergoing long-term antipsychotic treatment, may have important clinical implications.”


Misiak B, Frydecka D, Loska O, et al. Testosterone, DHEA and DHEA-S in patients with schizophrenia: a systematic review and meta-analysis. Psychoneuroendocrinology. 2018;89:92-102.