Low Serum Testosterone and Mortality in Male Veterans

Background Low serum testosterone is a common condition in aging. Moreover, it is associated with lower muscle mass and insulin resistance. This study evaluated whether low testosterone levels are a risk factor for mortality in male veterans.

Methods: Selection and Categorization of Participants

Firstly, we used a clinical database to identify men older than 40 years who underwent repeated testosterone level measurements from October 1, 1994, to December 31, 1999.

Importantly, none of these men had a prostate cancer diagnosis. We classified men based on testosterone levels. A low level was <250 ng/dL (<8.7 nmol/L) total and <0.75 ng/dL (<0.03 nmol/L) free. Men fell into three categories: low (166 men, 19.3%), equivocal (240 men, 28.0%), and normal (452 men,[52.7%]).

Methods: Analysis

Next, we estimated the risk for all-cause mortality. In addition, we employed Cox proportional hazards regression models and adjusted for demographic and clinical covariates during a follow-up period of up to 8 years.

Results: Mortality Rates

For the results, we found the mortality rate in men with normal testosterone levels was 20.1% (95% confidence interval [CI], 16.2%-24.1%). In contrast, men with equivocal testosterone levels had a mortality rate of 24.6% (95% CI, 19.2%-30.0%), and men with low testosterone levels experienced a mortality rate of 34.9% (95% CI, 28.5%-41.4%).

Results: Impact of Testosterone Levels on Mortality

When we adjusted for age, medical morbidity, and other clinical covariates, we still found an association between low testosterone levels and higher levels of mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P<.001). Meanwhile, equivocal testosterone levels were not significantly different from normal testosterone levels (hazard ratio, 1.38; 95% CI, 0.99%-1.92%; P=.06).

Results: Sensitivity Analysis

Hence, we conducted a sensitivity analysis. Moreover, we excluded men who died within the first year (50 men [5.8%]) to minimize the effect of acute illness. After this adjustment, we still found an association between low testosterone levels and elevated mortality.

Conclusion:

1) Testosterone Levels and Mortality Rates in Male Veterans

First, it is crucial to note that Specialists associated Low testosterone levels with higher levels of mortality in male veterans. Additionally, further prospective studies are necessary to examine the association between low testosterone levels and mortality.

2) The Decline of Testosterone with Aging

Moving on, testosterone levels decline with aging. Moreover, with an average decrease in total serum testosterone levels. Moreover, it is approximately 1.5% per year. 1 Additionally, the prevalence of low serum total testosterone levels. It is approximately 20% by the age of 50 years and 50% by the age of 80 years.

3) Effects and Variability of Low Testosterone Levels

Furthermore, manifestations of low testosterone include lower levels of muscle mass and bone mineral density, higher levels of fat mass, central obesity, insulin resistance, lower libido and energy, irritability, and dysphoria. 2 In contrast to menopause, in which all women undergo a nearly complete cessation of gonadal estrogen secretion, in men, gonadal androgen secretion decreases gradually and progressively after the age of 30 years, but does not generally cease, and androgen levels remain highly variable in older men. Additionally, they recently reported that the prevalence of clinical androgen deficiency (symptoms plus low testosterone levels) is about 6% to 12% in middle-aged and elderly men. 3 Moreover, testosterone levels also decrease with acute and chronic illnesses and with medications such as glucocorticoids and opiates. 2

4) Prevalence and Risks of Low Testosterone in Aging Men

Moreover, because of the aging of our society, we realized that low testosterone levels affect many older men. 2 In addition, the use of testosterone increased significantly, with a tripling in prescriptions for testosterone over a 3-year period. 4 However, despite the prominent increase in testosterone use, the overall risks and benefits remain unclear. 4 , 5

5) Initial Findings on Testosterone Levels and Mortality Rates

In a recent small study 6 in a geriatric rehabilitation unit, we found that men with a low testosterone level had a higher 6-month mortality level if we compare with men with a normal testosterone level who were of a comparable age and had comparable medical morbidity.

6) The Present Study on Testosterone and Mortality Rates

Lastly, considering these preliminary findings, we conducted the present retrospective cohort study to examine if repeatedly low serum testosterone levels were associated with higher level of mortality in a larger sample of middle-aged and elderly men with a longer follow-up, of up to 8 years.

Article Source: http://archinte.jamanetwork.com/article.aspx?articleid=410768

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