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Abstract

Volume 20, Issue 2 (March 2018) 20, 115–119; 10.4103/aja.aja_70_17

Endogenous testosterone and mortality risk

Emily J Meyer1,2, Gary Wittert1,2,3

1 Endocrine, Diabetes and Metabolic Unit, Royal Adelaide Hospital, Port Road, SA 5000, Australia
2 Discipline of Medicine, University of Adelaide, Adelaide, SA 5000 Australia
3 Discipline of Medicine and Freemasons Foundation Centre for Men’s Health, University of Adelaide, SA 5000, Australia

Correspondence: Dr. EJ Meyer (emily.meyer@sa.gov.au)

Date of Submission 09-Jan-2017 Date of Acceptance 29-Sep-2017 Date of Web Publication 30-Jan-2018

Abstract

In men, obesity and metabolic complications are associated with lower serum testosterone (T) and dihydrotestosterone (DHT) and an increased risk of, and mortality from, multiple chronic diseases in addition to cardiovascular disease (CVD). The causal interrelationships between these factors remain a matter of debate. In men with untreated congenital and lifelong forms of hypogonadotropic hypogonadism, there appears to be no increased risk. Men with Klinefelter's syndrome have an increased risk of various types of cancers, as well as CVD, which persist despite T therapy. In the absence of pathology of the hypothalamic–pituitary–gonadal axis, the effect of modest reductions in serum T in aging men is unclear. The prevalence of low serum T concentrations is high in men with cancer, renal disease, and respiratory disease and is likely to be an indicator of severity of systemic disease, not hypogonadism. Some population-based studies have found low serum T to be associated with a higher risk of deaths attributed to cancer, renal disease, and respiratory disease, while others have not. Although a meta-analysis of longitudinal studies has shown an association between low serum T and all-cause mortality, marked heterogeneity between studies limited a firm conclusion. Therefore, while a decrease in T particularly occurring later in life may be associated with an increase in all-cause and specific types of mortality in men, the differential effects, if any, of T and other sex steroids as compared to health and lifestyle factors are unknown at the current time.

Keywords: hypogonadism; mortality; testosterone

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.