Low Free Testosterone Predicts Mortality from Cardiovascular Disease But Not Other Causes: The Health in Men Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 97; no. 1; pp. 179 - 189
• Main Authors: Hyde, Zoë, Norman, Paul E, Flicker, Leon, Hankey, Graeme J, Almeida, Osvaldo P, McCaul, Kieran A, Chubb, S. A. Paul, Yeap, Bu B
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-01-2012; Copyright by The Endocrine Society
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; Down-Regulation; Endocrinopathies; Feeding. Feeding behavior; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Health; Humans; Male; Medical sciences; Osmolar Concentration; Prognosis; Residence Characteristics - statistics & numerical data; Risk Factors; Survival Analysis; Testosterone - blood; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Human; Obesity; Androgen; Nutrition; Mortality; Nutrition disorder; Prediction; Metabolic diseases; Male; Cardiovascular disease; Epidemiology; Testosterone; Cause; Testicular hormone; Sex steroid hormone; Endocrinology; Nutritional status; Public health
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2011-1617

Context:
Low testosterone is associated with all-cause mortality, but the relationship with cause-specific mortality is uncertain.
Objective:
Our objective was to explore associations between testosterone and its related hormones and cause-specific mortality.
Design:
This was a population-based cohort study.
Setting and Participants:
Demographic and clinical predictors of mortality, and testosterone, SHBG, and LH were measured from 2001–2004 in 3637 community-dwelling men aged 70–88 yr (mean, 77 yr).
Main Outcome Measure:
Cause of death was obtained via electronic record linkage until December 31, 2008.
Results:
During a mean follow-up period of 5.1 yr, there were 605 deaths. Of these, 207 [34.2%; 95% confidence interval (CI) = 30.4–38.1%] were due to cardiovascular disease (CVD), 231 to cancer (38.2%; 95% CI = 34.3–42.1%), 130 to respiratory diseases (21.5%; 95% CI = 18.2–24.8%), and 76 to other causes (12.6%; 95% CI = 9.9–15.2%). There were 39 deaths attributable to both cancer and respiratory diseases. Lower free testosterone (hazard ratio = 1.62; 95% CI = 1.20–2.19, for 100 vs. 280 pmol/liter), and higher SHBG and LH levels were associated with all-cause mortality. In cause-specific analyses, lower free testosterone (sub-hazard ratio = 1.71; 95% CI = 1.12–2.62, for 100 vs. 280 pmol/liter) and higher LH predicted CVD mortality, while higher SHBG predicted non-CVD mortality. Higher total testosterone and free testosterone levels (sub-hazard ratio = 1.96; 95% CI = 1.14–3.36, for 400 vs. 280 pmol/liter) were associated with mortality from lung cancer.
Conclusions:
Low testosterone predicts mortality from CVD but is not associated with death from other causes. Prevention of androgen deficiency might improve cardiovascular outcomes but is unlikely to affect longevity otherwise.