An exploration of testosterone levels in patients with bipolar disorder

Bipolar disorder is burdensome for the individual and for society; it is associated with significant functional impairment, high comorbidity, lower quality of life and higher rates of suicide. 1 Pharmacotherapy with mood stabilisers and antipsychotics may not lead to sustained remission and more than two-thirds of those treated experience a recurrence within 5 years. 2 Given such poor treatment outcomes, novel approaches to improve therapeutic interventions are an important objective of bipolar disorder research. Mounting, albeit inconsistent, evidence suggests that testosterone may play a role in the pathophysiology of mood disorders. 3 However, the effects of testosterone are complex: the hormonal disorder polycystic ovarian syndrome is characterised by chronically increased testosterone levels and is associated with significantly increased depression, 4 but paradoxically, amelioration of depression has been found following testosterone administration in males 5 and females; 6–8 low testosterone levels have been reported in certain subgroups of men with depression; 9 androgen-induced hypomania has been reported; 10 and high testosterone levels may predict suicidal behaviour in women with bipolar disorder. 3 Further evidence clarifying the relationship between testosterone and bipolar disorder might pave the way for exploring the use of pharmacological strategies that optimise testosterone levels in patients with bipolar disorder. We therefore assessed testosterone levels in bipolar disorder and healthy controls and sought to explore whether this was different between males and females and whether there was a relationship between testosterone, mood and cognition.