Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men

Abstract

Background-The relation between endogenous testosterone concentrations and health in men is controversial. Methods and Results-We examined the prospective relationship between endogenous testosterone concentrations and mortality due to all causes, cardiovascular disease, and cancer in a nested case-control study based on 11 606 men aged 40 to 79 years surveyed in 1993 to 1997 and followed up to 2003. Among those without prevalent cancer or cardiovascular disease, 825 men who subsequently died were compared with a control group of 1489 men still alive, matched for age and date of baseline visit. Endogenous testosterone concentrations at baseline were inversely related to mortality due to all causes (825 deaths), cardiovascular disease (369 deaths), and cancer (304 deaths). Odds ratios (95% confidence intervals) for mortality for increasing quartiles of endogenous testosterone compared with the lowest quartile were 0.75 (0.55 to 1.00), 0.62 (0.45 to 0.84), and 0.59 (0.42 to 0.85), respectively (PϽ0.001 for trend after adjustment for age, date of visit, body mass index, systolic blood pressure, blood cholesterol, cigarette smoking, diabetes mellitus, alcohol intake, physical activity, social class, education, dehydroepiandrosterone sulfate, androstanediol glucuronide, and sex hormone binding globulin). An increase of 6 nmol/L serum testosterone (Ϸ1 SD) was associated with a 0.81 (95% confidence interval 0.71 to 0.92, PϽ0.01) multivariable-adjusted odds ratio for mortality. Inverse relationships were also observed for deaths due to cardiovascular causes and cancer and after the exclusion of deaths that occurred in the first 2 years. Conclusions-In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease.

Are declining testosterone levels a major risk factor for ill-health in aging men?

“…Lower testosterone levels have been associated with increased overall and cardiovascular-related mortality in middle-aged and older men. [121][122][123] However, other studies have not shown a clear relationship between lower testosterone and higher mortality. 124,125 In the Caerphilly study, a higher ratio of cortisol to testosterone was associated with ischemic heart disease but this was attenuated after adjustment for components of the insulin-resistance syndrome.…”

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…[51][52][53][54][55][56][57][58][59] However, a 2010 meta-analysis limited to longitudinal (cohort) studies in middle-aged men found no association between endogenous TT levels and risk of CVD in middle-aged men. 60 A more recent study by Corona et al 61 found significant associations between low TT levels and high estradiol levels and CVD in a meta-analysis of 49 cross-sectional studies.…”

Hormonal effects on blood vessels

“…60 Recently, epidemiological studies have found that low testosterone levels are a predictor of all-cause and cardiovascular mortality in elderly men. 61,62 These findings were followed by studies investigating the incidence of CVD and testosterone levels. 63,64 According to these observations, endogenous testosterone appears to exert beneficial effects on the cardiovascular system.…”