Bu B Yeap1,2, Ross J Marriott3, Leen Antonio4, Shalender Bhasin5, Adrian S Dobs6, Girish Dwivedi1,7, Leon Flicker1,8, Alvin M Matsumoto9, Claes Ohlsson10, Eric S Orwoll11, Suchitra Raj2, Christopher M Reid12, Dirk Vanderschueren4, Gary A Wittert13, Frederick C W Wu14, Kevin Murray3. 1. Medical School, University of Western Australia, Perth, WA, Australia. 2. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia. 3. School of Population and Global Health, University of Western Australia, Perth, WA, Australia. 4. Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium. 5. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Harry Perkins Institute of Medical Research, Perth, WA, Australia. 8. Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia. 9. Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA. 10. Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. 11. Oregon Health and Science University, Portland, OR, United States. 12. School of Public Health, Curtin University, Perth, WA, Australia. 13. Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia. 14. Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK.
Abstract
OBJECTIVE: Serum testosterone concentrations are affected by factors unrelated to hypothalamo-pituitary-testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone-binding globulin (SHBG) in men aged 40-69 years. DESIGN: Cross-sectional analysis of 208,677 community-dwelling men from the UK Biobank. MEASUREMENTS: We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models and effect size estimates. RESULTS: Median (interquartile range) for serum testosterone was 11.6 (9.4-14.1) nmol/L, SHBG 36.9 (27.9-48.1) nmol/L and cFT 213 (178-255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age and inversely with BMI (all P < .001). Living with a partner, (South) Asian ethnicity, never or previous smoker and some medical conditions were associated with lower testosterone. Poultry or fish eater, and higher physical activity were associated with higher testosterone (all P < .001). Testosterone was lowered by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2 , ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity and 0.3-1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L and cFT by ~60 pmol/L. CONCLUSIONS: The identified modifiable risk factors support lifestyle-based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalized interpretation of testosterone testing results with respect to existing reference ranges.
OBJECTIVE: Serum testosterone concentrations are affected by factors unrelated to hypothalamo-pituitary-testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone-binding globulin (SHBG) in men aged 40-69 years. DESIGN: Cross-sectional analysis of 208,677 community-dwelling men from the UK Biobank. MEASUREMENTS: We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models and effect size estimates. RESULTS: Median (interquartile range) for serum testosterone was 11.6 (9.4-14.1) nmol/L, SHBG 36.9 (27.9-48.1) nmol/L and cFT 213 (178-255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age and inversely with BMI (all P < .001). Living with a partner, (South) Asian ethnicity, never or previous smoker and some medical conditions were associated with lower testosterone. Poultry or fish eater, and higher physical activity were associated with higher testosterone (all P < .001). Testosterone was lowered by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2 , ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity and 0.3-1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L and cFT by ~60 pmol/L. CONCLUSIONS: The identified modifiable risk factors support lifestyle-based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalized interpretation of testosterone testing results with respect to existing reference ranges.
Authors: Bu B Yeap; Ross J Marriott; Laurens Manning; Girish Dwivedi; Graeme J Hankey; Frederick C W Wu; Jeremy K Nicholson; Kevin Murray Journal: Eur J Endocrinol Date: 2022-06-01 Impact factor: 6.558
Authors: Henrik Ryberg; Per Johansson; Anders Wallin; Johan F Emilsson; Elias Eriksson; Johan Svensson; Claes Ohlsson Journal: J Intern Med Date: 2022-05-31 Impact factor: 13.068