High Levels of Androgens in Men Associated With Increased Risk for Anxiety Disorders

The results of a study published in the Journal of Affective Disorders suggest that higher serum total testosterone in men and androstenedione in young men may increase the risk for anxiety disorders. However, in women, androgens and sex hormone-binding globulin were not associated with anxiety and depressive disorders.

The evidence to date on the role of androgens in anxiety and depressive disorders has been equivocal. Both extremely high and extremely low serum concentrations of androgens have been implicated in increasing the risk for anxiety and depressive disorders in both men and women. However, the studies involved were limited by their design and resulted in inconsistent findings.

Eva Asselmann, PhD, from the Department of Psychology, Humboldt-Universität zu Berlin, and the Department of Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany, and colleagues analyzed data from the Study of Health in Pomerania, a prospective, longitudinal general population study of men and women from northeastern Germany. The data included baseline serum concentrations of total testosterone, androstenedione, and sex hormone-binding globulin for 993 men and 980 women. Participants were between the ages of 20 and 80 years at baseline, and 29 and 89 years at the 10-year follow-up. The investigators determined the 12-month, lifetime, and incident anxiety and depressive disorder occurrence, using the Munich-Composite International Diagnostic Interview at the 10-year follow-up.

The investigators found no significant association with anxiety or depressive disorders for androgens or sex hormone-binding globulin in either men or women. However, higher total testosterone in men was associated with a higher 12-month (odds ratio [OR], 1.46) and lifetime (OR = 1.34) risk for any anxiety disorder, and a higher lifetime risk for social phobia (OR, 2.15). The investigators also found an association with 12-month (OR, 1.48) and lifetime (OR, 1.39) specific phobia, but no association with either 12-month or lifetime depression. In younger men, higher levels of androstenedione increased the lifetime risk for anxiety more than in older men.

The authors note that although higher serum concentrations of total testosterone in men and androstenedione in younger men seem to predict an increased risk for anxiety disorders, these associations did not appear significant after correction for multiple testing.

Investigators list several limitations, including the relatively long follow-up period and the collection of blood samples at various times during the day, which can affect hormone levels. Furthermore, information on incident mental disorders was assessed retrospectively and, given the long follow-up period, could have been subject to recall memory biases.

The authors call for more investigation to clarify the role of androgens in both anxiety and depressive disorders.

Reference

Asselmann E, Kische H, Haring R, et al. Prospective associations of androgens and sex hormone-binding globulin with 12-month, lifetime and incident anxiety and depressive disorders in men and women from the general population. J Affect Disord. 2019;245:905-911.