All-cause mortality risk up for men with low testosterone

The risk for all-cause mortality is increased for men with low testosterone, high luteinizing hormone, or very low estradiol, according to a review published online May 14 in the Annals of Internal Medicine.

Bu B. Yeap, M.B.B.S., Ph.D., from the University of Western Australia in Perth, and colleagues conducted a systematic review to clarify associations of sex hormones with mortality and cardiovascular disease (CVD). Nine studies provided individual participant data (IPD; 255,830 participant-years), and summary estimates were provided by 11 studies (24,109 participants).

The researchers found that two-stage random-effects IPD meta-analyses indicated higher all-cause mortality for men with baseline testosterone concentrations below 7.4 nmol/L, luteinizing hormone concentrations above 10 IU/L, or estradiol concentrations below 5.1 pmol/L; higher CVD mortality risk was seen for those with testosterone concentrations below 5.3 nmol/L.

Lower sex hormone-binding globulin concentration was associated with lower all-cause and CVD mortality (adjusted hazard ratios, 0.85 and 0.81, respectively, for quintile 1 versus 5). Higher risk for all-cause and CVD mortality was seen for men with lower baseline dihydrotestosterone concentrations (adjusted hazard ratios, 1.19 and 1.29, respectively, for quintile 1 versus 5); risk increased with concentrations above 2.45 nmol/L. An increased risk for incident CVD events was seen for men with dihydrotestosterone concentrations below 0.59 nmol/L.

“We found that the testosterone concentration below which men had higher risk for all-cause mortality was 7.4 nmol/L (213 ng/dL),” the authors write. “This adds to information on reference ranges based on distributions of testosterone in selected samples of healthy men.”

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