Age-specific population centiles for androgen status in men

Handelsman, David J.; Yeap, Bu B.; Flicker, Leon; Martin, Sean; Wittert, Gary; Ly, Linda

doi:10.1530/eje-15-0380

Cited by 92 publications

(53 citation statements)

References 63 publications

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“…Exclusions included men more than 70 years of age due to the acknowledged age-related decline in testosterone after this point, (12) significant noncirrhosis lifelimiting illnesses including active cancer, estimated glomerular filtration rate of <30 mL/minute/1.73 m 2 , or severe cardiac failure (New York Heart Association class III or IV). Patients with hepatocellular carcinoma were excluded due to the different natural history and transplant requirements for these patients as compared to cirrhosis alone.…”

Section: Exclusionsmentioning

confidence: 99%

“…Total testosterone and free testosterone were significantly lower in men who required hospitalization for major infection during the study period compared with those who did not (total testosterone, 3.60 [IQR, 1.80-12.9] versus 18.8 [IQR, 12.0-26.2] nmol/L; P < 0.001; free testosterone, 71 [IQR, versus 222 [IQR, 141-264] pmol/L; P < 0.001). MELD score and Child-Pugh score were significantly higher in men who suffered major infection (MELD score, 16 [IQR,.5] versus 9 [IQR, [7][8][9][10][11][12]; P < 0.001; Child-Pugh score, 10 [IQR, [8][9][10][11] versus 6 [IQR, [5][6][7][8]; P < 0.001). Hemoglobin, sodium, SHBG, and LH were also lower in those suffering significant infection compared with those who did not (Table 3).…”

Section: Major Infectionmentioning

confidence: 99%

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Low serum testosterone is associated with adverse outcome in men with cirrhosis independent of the model for end‐stage liver disease score

et al. 2016

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Low serum testosterone has been retrospectively associated with mortality in men on the liver transplant waiting list. The impact of testosterone deficiency on other outcomes has not previously been assessed. We conducted a single center prospective observational study of all men with cirrhosis seen between 2013 and 2014. Baseline data included sex hormone profile, Model for End-Stage Liver Disease (MELD) score, and standard biochemistry. Outcomes were recorded over 12 months including major infection, liver transplantation, and death. Of 268 cirrhotic men, the median MELD score was 10 (interquartile range [IQR], 8-15) and median serum testosterone was 17.4 nmol/L (IQR, 8.9-25.0 nmol/L). During the study period, 32 (12%) men died, 18 (7%) received a liver transplant, and 51 (19%) suffered a major infection. Mortality markedly increased when total testosterone fell below a threshold value of 8.3 nmol/L, and this cutoff was used for further analysis. Testosterone below 8.3 nmol/L was associated with the combined outcome of death or transplantation independently of the MELD score (hazard ratio [HR], 2.36; IQR, 1.16-4.81; P = 0.02) for testosterone (and HR, 1.22; IQR, 1.18-1.27; P < 0.001 for MELD). Low total testosterone was also an independent risk factor for major infection (HR, 3.61; IQR, 1.61-8.06; P < 0.001) and nearly significant for mortality alone (HR, 2.39; IQR, 0.97-5.88; P = 0.057). Low free testosterone (<139 pmol/L) was similarly independently associated with death or transplantation (HR, 2.43; IQR, 1.12-5.29; P = 0.03) and infection (HR, 3.3; IQR, 1.46-7.46; P = 0.004). In conclusion, low testosterone is a novel prognostic marker in men with cirrhosis that is numerically associated with increased mortality or need for transplantation, as well as risk for major infection. Interventional studies of testosterone therapy are required to investigate whether correcting low testosterone can reduce mortality and improve other clinical outcomes. Liver Transplantation 22 1482-1490 2016 AASLD.

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Section: Exclusionsmentioning

confidence: 99%

Section: Major Infectionmentioning

confidence: 99%

Low serum testosterone is associated with adverse outcome in men with cirrhosis independent of the model for end‐stage liver disease score

et al. 2016

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“…Sex hormone concentrations decline as men age [1]. Epidemiological studies in middle-aged and older men have predominantly focused on cardiovascular and mortality endpoints.…”

Section: Introductionmentioning

confidence: 99%

Higher Dihydrotestosterone Is Associated with the Incidence of Lung Cancer in Older Men

et al. 2017

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Advancing age is associated with increased cancer incidence, but the role of sex hormones as risk predictors for common cancers in older men remains uncertain. This study was performed to assess associations of testosterone (T), dihydrotestosterone (DHT) and estradiol (E2), with incident prostate, lung and colorectal cancer in community-dwelling older men. Plasma T, DHT and E2 were assayed using liquid chromatography-mass spectrometry between 2001 and 2004 in 3690 men. Cancer outcomes until 20 June 2013 were ascertained using data linkage. Analyses were performed using proportional hazards competing-risks models, and adjustments were made for potential confounding factors including smoking status. Results are expressed as subhazard ratios (SHR). There were 348, 107 and 137 cases of prostate, lung and colorectal cancers respectively during a median of 9.1-year follow-up. Mean T was comparable in current and non-smokers, whilst mean DHT was lower in ex- and current smokers compared to non-smokers. After adjusting for confounders including smoking, higher T or DHT was associated with an increased incidence of lung cancer (SHR = 1.30, 95% CI 1.06-1.60; p = 0.012 per 1 SD increase in T and SHR = 1.29, 95% CI 1.08-1.54; p = 0.004 for DHT). Sex hormones were not associated with prostate or colorectal cancer. In older men, higher T or DHT predict increased incidence of lung cancer over the next decade. Sex hormones are not associated with incident prostate or colorectal cancer. Further studies are warranted to determine if similar associations of sex hormones with lung cancer are present in other populations and to investigate potential underlying mechanisms.

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“…Male ageing is accompanied by a decline in circulating testosterone (T) . Even very healthy older men have lower T concentrations compared to healthy younger men .…”

Section: Introductionmentioning

confidence: 99%

Progressive impairment of testicular endocrine function in ageing men: Testosterone and dihydrotestosterone decrease, and luteinizing hormone increases, in men transitioning from the 8th to 9th decades of life

Yeap

Manning

Chubb

et al. 2017

Clinical Endocrinology

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SummaryContext: Sex hormone trajectories in ageing men and their health implications remain unclear. We examined longitudinal trajectories and associations of testosterone (T), dihydrotestosterone (DHT), oestradiol (E2), luteinizing hormone (LH) and sex hormonebinding globulin (SHBG) in oldest old men.Design: Prospective cohort study. Participants:We studied 1025 community-dwelling men median age 75.1 years at baseline with 8.6 years of follow-up. Measurements:Baseline and follow-up T, DHT and E2 were assayed using mass spectrometry. Physical performance was assessed at follow-up. Correlations and covariateadjusted P-values were determined.Results: Longitudinal change in T was −2.0%/year, DHT −7.2%/year, LH +7.5%/year, SHBG +5.6%/year while E2 remained stable. Annualized increases in LH correlated with decreases in T and DHT (r = −.20, P < .0001 and r = −.12, P = .0035, respectively).Higher baseline T correlated with better physical performance at follow-up (eg, Step test r = .07, P = .03), as did higher baseline DHT (eg, time to sit-stand [TSS] r = −.07, P = .01). Larger annualized increases in LH predicted poorer physical performance at follow-up (eg, TSS r = .14, P = .001). Higher T at follow-up was associated with better physical performance (eg, TSS r = −.07, P = .04), as were higher DHT and lower LH. At baseline, 24 men (2.4%) had abnormally high LH (>16 IU/L); at follow-up, 175 (17.4%) had high LH of whom 70 had low T (<6.4 nmol/L). Conclusions:Annualized increases in LH are associated with declines in T and DHT, and predict poorer subsequent physical performance in oldest old men. Men transitioning from 8th to 9th decades exhibit biochemical evidence of progressively impaired testicular endocrine function, warranting further evaluation. K E Y W O R D Sageing, dihydrotestosterone, luteinizing hormone, oestradiol, physical performance, sex hormone-binding globulin, testosterone

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Age-specific population centiles for androgen status in men

Cited by 92 publications

References 63 publications

Low serum testosterone is associated with adverse outcome in men with cirrhosis independent of the model for end‐stage liver disease score

Low serum testosterone is associated with adverse outcome in men with cirrhosis independent of the model for end‐stage liver disease score

Higher Dihydrotestosterone Is Associated with the Incidence of Lung Cancer in Older Men

Progressive impairment of testicular endocrine function in ageing men: Testosterone and dihydrotestosterone decrease, and luteinizing hormone increases, in men transitioning from the 8th to 9th decades of life

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