All-cause death is elevated among men with low testosterone, high luteinizing hormone (LH), or very low oestradiol concentrations, reveals a study.
In addition, sex hormone–binding globulin (SHBG) shows a positive association and dihydrotestosterone (DHT) a nonlinear association with all-cause and cardiovascular disease (CVD) deaths.
A team of investigators performed this systematic review and meta-analysis to explore the relationships of sex hormones with all-cause and CVD mortality. Using databases, they searched for prospective cohort studies of community-dwelling men with sex steroids measured using mass spectrometry and at least 5 years of follow-up.
Nine studies provided individual participant data (IPD; 255,830 participant-years), while 11 studies had summary estimates (n=24,109).
Based on two-stage random-effects IPD meta-analyses, men with baseline testosterone concentrations <7.4 nmol/L (<213 ng/dL), LH concentrations >10 IU/L, oestradiol concentrations <5.1 pmol/L were at an increased risk for all-cause mortality, and those with testosterone concentrations <5.3 nmol/L (<153 ng/dL) were at greater CVD mortality risk.
On the other hand, men with lower SBHG concentration had lower all-cause mortality (median for quintile [Q] 1 vs Q5, 20.6 vs 68.3 nmol/L; adjusted hazard ratio [aHR], 0.85, 95 percent confidence interval [CI], 0.77‒0.95) and lower CVD mortality (aHR, 0.81, 95 percent CI, 0.65‒1.00).
Additionally, men with lower concentrations of DHT at baseline were at greater risk for all-cause (median for Q1 vs Q5, 0.69 vs 2.45 nmol/L; aHR, 1.19, 95 percent CI, 1.08‒1.30) and CVD mortality (aHR, 1.29, 95 percent CI, 1.03‒1.61). An elevated risk was also observed in those with DHT concentrations >2.45 nmol/L. Moreover, incident CVD events were increased in men with DHT concentrations <0.59 nmol/L.