At natural levels, testosterone is only weakly associated with aggression, and giving it in experiments has no reliable overall effect. "Roid rage" is reported at abuse doses many times higher.
What Research Says About Testosterone and Aggression
The measured association is small. Geniole and colleagues' 2020 meta-analysis in Hormones and Behavior pooled studies of resting levels, changes in levels and testosterone given experimentally. Resting levels correlated with aggression at r = 0.054, where zero means no relationship and one a perfect one. That explains under 1% of differences in aggression. In experiments, the effect was r = 0.046, not statistically significant.
Experimental effects appear only in particular men. In a double-blind, placebo-controlled experiment, Carré and colleagues gave 121 men one dose of testosterone or placebo before a game designed to provoke them. Aggression did not rise overall, only in men high in dominance or low in self-control.
In adolescents the link is unconfirmed. Duke and colleagues' 2014 systematic review covered 27 studies of healthy boys aged nine to 18. Most cross-sectional studies, which measure hormone and behavior once, found an association, but the one longitudinal study found little.
The reviewers warned that blaming testosterone risks "apportioning blame inappropriately."
Abuse Doses vs TRT Doses ("Roid Rage")
Dose separates testosterone replacement therapy (TRT) from abuse, and the rest of this article concerns adults. The Depo-Testosterone label's replacement dose works out to at most 200 mg a week. Illicit users typically take at least 500 mg a week, often over 1,000 mg, according to the Endocrine Society's 2014 scientific statement.
Pope and colleagues ran a randomized, placebo-controlled crossover trial, in which each man received both treatments in turn. Its 56 men aged 20 to 50 spent six weeks on placebo and six on testosterone cypionate rising to 600 mg a week. That is three times the label maximum.
Mania scores and aggressive responses rose on average. Of 50 men at 600 mg, 84% showed minimal psychiatric effects. Another 12% developed mild hypomania, a lesser form of mania with elevated or irritable mood, and 4% marked hypomania.
The National Institute on Drug Abuse (NIDA) reports more anger and fights among misusers, "sometimes called 'roid rage.'" Personality and other drug use may confound the finding.
Testosterone labels warn that abuse can cause hostility and aggression, but state that dependence at approved doses "has not been documented." The aggression risk appears at doses above the replacement range.
Mood Changes on TRT
At prescribed doses, average mood changes are small and mostly favorable. Walther and colleagues' 2019 meta-analysis pooled 27 randomized placebo-controlled trials in 1,890 men. Testosterone reduced depressive symptoms slightly more than placebo.
TRAVERSE, analyzed for mood by Bhasin and colleagues, randomized men with low testosterone and high cardiovascular risk to gel or placebo. Gel brought modestly greater gains in mood and energy.
In the AndroGel 1.62% label's 182-day trial, six of 234 men on gel and none of 40 on placebo had "emotional lability," the label's term covering mood swings, impatience, anger, and aggression. Anger on TRT is the exception rather than the average response.
Mood Changes on Tirzepatide
Tirzepatide also acts on hormone receptors, though not those related to testosterone. The evidence so far shows no increase in depression or suicidal thinking on it. The weekly injection activates receptors for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), making it a GLP-1 receptor agonist.
The tirzepatide products available in the United States differ in their mood warnings. Mounjaro, approved for type 2 diabetes, never carried a suicidality warning. Zepbound, approved for weight management and obstructive sleep apnea, carried one until early 2026. The US Food and Drug Administration (FDA) has reviewed no mood information for compounded tirzepatide, since compounded drugs are not FDA-approved.
FDA reviewed GLP-1 receptor agonist medicines in a January 13, 2026, drug safety communication. Its meta-analysis of 91 placebo-controlled trials covered 107,910 patients, and its insurance-claims study about 2.2 million new users.
Neither showed increased suicidal ideation or behavior, so FDA asked for the warning's removal from Saxenda, Wegovy, and Zepbound. Whether tirzepatide data were included is not stated.
Wadden and colleagues' post hoc analysis, designed after data collection, pooled three SURMOUNT trials in 4,056 adults with obesity and no known major psychiatric illness. Four of its seven authors were Eli Lilly employees. By week 72, self-reported depression scores were low in both groups and slightly lower on tirzepatide. Suicidal ideation occurred in 0.6% of each group.
FDA still asks patients to keep taking the medicine and raise mood changes with a clinician. For the FDA-approved products, the 2026 evidence is reassuring within the population studied.
Warning Signs
Some mood changes need a clinician, whichever drug is involved.
- On tirzepatide, patients should report new or worsening depression, suicidal thoughts or unusual changes in mood or behavior.
- Irritability with sweating, shakiness or confusion can mean low blood sugar, mainly alongside insulin or a sulfonylurea, an older diabetes pill.
- During steroid misuse, irritability, aggressiveness, and reckless behavior can signal hypomania, and stopping can bring depressed mood and occasional suicidality.
In the United States, anyone with suicidal thoughts can call or text the 988 Suicide and Crisis Lifeline.
Who Should Not Take TRT
TRT treats confirmed testosterone deficiency, and some men should not take it. The testosterone labels list contraindications, conditions that rule a drug out, including breast cancer, known or suspected prostate cancer and pregnancy. The Endocrine Society's 2018 guideline adds high red blood cell concentration, recent heart attack or stroke, uncontrolled heart failure, and a clotting tendency.
The guideline counts reduced sexual desire as a suggestive sign of low testosterone, but low energy and motivation only as nonspecific ones. How far low testosterone explains poor motivation is a question the aggression research does not answer.
Sources
- Testosterone and aggression: Geniole et al., Horm Behav, 2020; Carré et al., Biol Psychiatry, 2017; Duke et al., J Adolesc Health, 2014
- Steroid doses: Depo-Testosterone label, 2025; Endocrine Society Scientific Statement on Performance-Enhancing Drugs, 2014; Pope et al., Arch Gen Psychiatry, 2000; NIDA Anabolic Steroids, 2024
- TRT and mood: Walther et al., JAMA Psychiatry, 2019; Bhasin et al., J Clin Endocrinol Metab (TRAVERSE), 2024; AndroGel 1.62% label, 2025
- Tirzepatide: Mounjaro label, 2026; Zepbound label, 2026; FDA Clarifies Policies for Compounders, 2026; FDA Drug Safety Communication on GLP-1 RA Suicidality Warning, 2026; Wadden et al., Obesity (SURMOUNT), 2026
- Warning signs: 988 Suicide and Crisis Lifeline, 2026
- TRT eligibility: Endocrine Society Testosterone Therapy Guideline, 2018