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Epidemiology: testosterone and the metabolic syndrome

Abstract

Low levels of testosterone, hypogonadism, have several common features with the metabolic syndrome. In the Tromsø Study, a population-based health survey, testosterone levels were inversely associated with anthropometrical measurements, and the lowest levels of total and free testosterone were found in men with the most pronounced central obesity. Total testosterone was inversely associated with systolic blood pressure, and men with hypertension had lower levels of both total and free testosterone. Furthermore, men with diabetes had lower testosterone levels compared to men without a history of diabetes, and an inverse association between testosterone levels and glycosylated hemoglobin was found. Thus, there are strong associations between low levels of testosterone and the different components of the metabolic syndrome. In addition, an independent association between low testosterone levels and the metabolic syndrome itself has recently been presented in both cross-sectional and prospective population-based studies. Thus, testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men. However, clinical trials are needed to confirm this assumption.

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References

  1. Svartberg J, Midtby M, Bønaa KH, Sundsfjord J, Joakimsen RM, Jorde R . Associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromsø Study. Eur J Endocrinol 2003; 149: 145–152.

    Article  CAS  PubMed  Google Scholar 

  2. Svartberg J, von Mühlen D, Sundsfjord J, Jorde J . Waist circumference and testosterone levels in community dwelling men. The Tromsø Study. Eur J Epidemiol 2004; 19: 657–663.

    Article  CAS  PubMed  Google Scholar 

  3. Svartberg J, Jorde R, Sundsfjord J, Bønaa KH, Barrett-Connor E . Seasonal variation of testosterone and waist to hip ratio in men: The Tromsø Study. J Clin Endocrinol Metab 2003; 88: 3099–3104.

    Article  CAS  PubMed  Google Scholar 

  4. Svartberg J, von Mühlen D, Schirmer H, Barrett-Connor E, Sundsfjord J, Jorde R . Association of endogenous testosterone with blood pressure and left ventricular mass in men. The Tromsø Study. Eur J Endocrinol 2004; 150: 65–71.

    Article  CAS  PubMed  Google Scholar 

  5. Svartberg J, Jenssen T, Sundsfjord J, Jorde R . The associations of endogenous testosterone and sex hormone-binding globulin with glycosylated hemoglobin levels, in community dwelling men. The Tromsø Study. Diabetes Metab 2004; 30: 29–34.

    Article  CAS  PubMed  Google Scholar 

  6. Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and clssification of diabetes mellitus. Provisional report of a WHO consultation. Diabetes Med 1998; 15: 539–553.

    Article  CAS  Google Scholar 

  7. Adult Treatment Panel III. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Circulation 2002; 106: 3143–3421.

  8. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003; 9: 237–252.

    PubMed  Google Scholar 

  9. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Available at: www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf. (accessed 23 April 2006).

  10. Ford ES, Giles WH . A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care 2003; 26: 575–581.

    Article  PubMed  Google Scholar 

  11. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709–2716.

    Article  PubMed  Google Scholar 

  12. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA . Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156: 1070–1077.

    Article  PubMed  Google Scholar 

  13. Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, Skinner JS et al. Contribution of body fatness and adipose tissue distribution to the age variation in plasma hormone concentration in men: The HERITAGE Family Study. J Clin Endocrinol Metab 2000; 85: 1026–1031.

    CAS  PubMed  Google Scholar 

  14. Haffner SM, Valdez RA, Stern MP, Katz MS . Obesity, body fat distribution and sex hormones in men. Int J Obes Relat Metab Disord 1993; 17: 643–649.

    CAS  PubMed  Google Scholar 

  15. Khaw KT, Barrett-Connor E . Lower endogenous androgens predict central adiposity in men. Ann Epidemiol 1992; 2: 675–682.

    Article  CAS  PubMed  Google Scholar 

  16. Khaw KT, Barrett-Connor E . Endogenous sex hormones, high density lipoprotein cholesterol, and other lipoprotein fractions in men. Arterioscler Thromb 1991; 11: 489–494.

    Article  CAS  PubMed  Google Scholar 

  17. Handa K, Ishii H, Kono S, Shinchi K, Imanishi K, Mihara H et al. Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men. Atherosclerosis 1997; 130: 37–44.

    Article  CAS  PubMed  Google Scholar 

  18. Stefanick ML, Williams PT, Krauss RM, Terry RB, Vranizan KM, Wood PD . Relationships of plasma estradiol, testosterone, and sex hormone-binding globulin with lipoproteins, apolipoproteins, and high-density lipoprotein subfraction in men. J Clin Endocrinol Metab 1987; 64: 723–729.

    Article  CAS  PubMed  Google Scholar 

  19. Zmuda JM, Cauley JA, Kriska A, Glynn NW, Gutai JP, Kuller LH . Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-age men. A 13-year follow-up of former multiple risk factor intervention trial participants. Am J Epidemiol 1997; 146: 609–617.

    Article  CAS  PubMed  Google Scholar 

  20. Khaw KT, Barrett-Connor E . Blood pressure and endogenous testosterone in men: an inverse relationship. J Hypertens 1988; 6: 329–332.

    Article  CAS  PubMed  Google Scholar 

  21. Lindholm J, Winkel P, Brodthagen U, Gyntelberg F . Coronary risk factors and plasma sex hormones. Am J Med 1982; 73: 648–651.

    Article  CAS  PubMed  Google Scholar 

  22. Bonithon-Kopp C, Scarabin PY, Bara L, Castanier M, Jacqueson A, Roger M . Relationship between sex hormones and haemostatic factors in healthy middle-aged men. Atherosclerosis 1988; 71: 71–76.

    Article  CAS  PubMed  Google Scholar 

  23. Dai WS, Gutai JP, Kuller LH, Laporte RE, Falvo-Gerard L, Caggiula A . Relation between plasma high-density lipoprotein cholesterol and sex hormone concentration in men. Am J Cardiol 1984; 53: 1259–1263.

    Article  CAS  PubMed  Google Scholar 

  24. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ 2001; 322: 15–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Goodman-Gruen D, Barrett-Connor E . Sex differences in the association of endogenous sex hormone levels and glucose tolerance status in older men and women. Diabetes Care 2000; 23: 912–918.

    Article  CAS  PubMed  Google Scholar 

  26. Seidell JC, Björntorp P, Sjöström L, Kvist H, Sannerstedt R . Visceral fat accumulation in men is positively associated with insulin, glucose and c-peptide levels, but negatively with testosterone levels. Metabolism 1990; 39: 897–901.

    Article  CAS  PubMed  Google Scholar 

  27. Pasquali R, Casimirri F, Cantebelli S, Melchionda N, Labate AMM, Fabbri R et al. Effect of obesity and body fat distribution on sex hormones and insulin in men. Metabolism 1991; 40: 101–104.

    Article  CAS  PubMed  Google Scholar 

  28. Simon D, Preziosi P, Barrett-Connor E, Roger M, Saint-Paul M, Nahoul K et al. Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study. Diabetologia 1992; 35: 173–177.

    Article  CAS  PubMed  Google Scholar 

  29. Haffner S, Valdez RA, Mykkänen L, Stern MP, Katz MS . Decreased testosterone and dehydroepiandrosterone sulfate concentrations are associated with increased insulin and glucose concentrations in non-diabetic men. Metabolism 1994; 43: 599–603.

    Article  CAS  PubMed  Google Scholar 

  30. Haffner SM, Shaten J, Stern MP, Smith GD, Kuller L . Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. multiple risk factor intervention trial. Am J Epidemiol 1996; 143: 889–897.

    Article  CAS  PubMed  Google Scholar 

  31. Oh JY, Barrett-Connor E, Wedick NM, Wingard DL . Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study. Diabetes Care 2002; 25: 55–60.

    Article  CAS  PubMed  Google Scholar 

  32. Muller M, Grobbee DE, den Tonkelaar I, Lamberts WJ, van der Schouw YT . Endogenous sex hormones and metabolic syndrome in aging men. J Clin Endocrinol Metab 2005; 90: 2618–2623.

    Article  CAS  PubMed  Google Scholar 

  33. Laaksonen DE, Niskanen L, Punnonen K, Nyyssönen K, Tuomainen T-P, Valkonen V-P et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care 2004; 27: 1036–1041.

    Article  CAS  PubMed  Google Scholar 

  34. Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB . Low sex hormone-binding globulin, total testosterone and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab 2006; 91: 843–850.

    Article  CAS  PubMed  Google Scholar 

  35. Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP et al. The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. J Clin Endocrinol Metab 2005; 90: 712–719.

    Article  CAS  PubMed  Google Scholar 

  36. Barrett-Connor E, Khaw KT . Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study. Circulation 1988; 78: 539–545.

    Article  CAS  PubMed  Google Scholar 

  37. Yarnell JW, Beswick AD, Sweetnam PM, Riad-Fahmy D . Endogenous sex hormones and ischemic heart disease in men. The Caerphilly prospective study. Arterioscler Thromb 1993; 13: 517–520.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to J Svartberg.

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Svartberg, J. Epidemiology: testosterone and the metabolic syndrome. Int J Impot Res 19, 124–128 (2007). https://doi.org/10.1038/sj.ijir.3901499

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