This paper recognizes the fact that there may be many reasons for the higher prevalence of major depressive disorder in women compared to men. Albert names socioeconomic factors, cultural factors, abuse, and education in particular. However, this paper seems to land on the fact of hormonal fluctuation as one of the main triggers for onset of major depressive disorder.

According to this study, there are a handful of times where those assigned female at birth are more likely to begin experiencing depressive symptoms, namely: when starting puberty, after giving birth, and during the transition into menopause. On average, the prevalence rates of women and men are generally similar after 65 years of age. All of these correlations lead to the conclusion that the female reproductive hormones contribute to mental disorders such as depression and anxiety. The hormone which fluctuates the most, and is also responsible for parts of positive affect, would be estrogen.

Although those assigned male at birth don't typically have naturally-high levels of estrogen, the male brain converts testosterone into estrogen, which can allow for the hormonal balance. Since cisgender males don't undergo much hormonal adjustment after puberty, there would be less opportunity for vulnerability to mental disorders such as major depression.