CME 
JOBS 
OUTBREAKS 
PEER-TO-PEER 
QUIZZES & QUESTIONS 
MEDTECH Low testosterone and hormonal imbalances linked to increased mortality and cardiovascular disease risk in men, suggesting critical implications for endocrine and cardiovascular health management.
This meta-analysis of prospective cohort studies investigates the associations between sex hormone levels and all-cause and cardiovascular mortality in aging men. Utilizing individual participant data from nine studies and summary estimates from eleven studies, the research shows variations in testosterone, SHBG, LH, DHT, and estradiol concentrations impact mortality and cardiovascular disease risk over a substantial follow-up period.
Study Design:
- Participants:
- Nine studies provided individual participant data (IPD) encompassing 255,830 participant-years.
- Eleven studies provided summary estimates including 24,109 participants.
- Measurements:
- Sex steroids measured using mass spectrometry.
- Hormones analyzed included testosterone, SHBG, LH, DHT, and estradiol.
- Follow-up: Minimum of 5 years.
- Covariates: Age, BMI, marital status, alcohol consumption, smoking, physical activity, hypertension, diabetes, creatinine concentration, cholesterol ratio, and lipid medication use.
Key Findings:
- Testosterone:
- Baseline concentrations below 7.4 nmol/L (<213 ng/dL) associated with higher all-cause mortality.
- Concentrations below 5.3 nmol/L (<153 ng/dL) linked to increased CVD mortality.
- Luteinizing Hormone (LH):
- Concentrations above 10 IU/L associated with higher all-cause mortality.
- Estradiol:
- Concentrations below 5.1 pmol/L linked to increased all-cause mortality.
- Sex Hormone–Binding Globulin (SHBG):
- Lower concentrations associated with lower all-cause mortality and CVD mortality.
- Dihydrotestosterone (DHT):
- Lower baseline concentrations (median for Q1 vs. Q5, 0.69 vs. 2.45 nmol/L) linked to higher all-cause mortality (adjusted HR, 1.19) and CVD mortality (adjusted HR, 1.29).
- Increased risk for incident CVD events at concentrations below 0.59 nmol/L.
HCN Medical Memo
This study highlights the critical role of sex hormone levels in predicting mortality and cardiovascular disease risk in men. Clinicians should consider regular hormonal assessments in older male patients as part of comprehensive cardiovascular risk management.
More on Testosterone
