Individual testosterone decline and future mortality risk in men

OBJECTIVE: Male aging is characterized by a decline in testosterone (T) levels with a substantial variability between subjects. However, it is unclear whether differences in age-related changes in T are associated with general health. We investigated associations between mortality and intra-individual changes in serum levels of total T, SHBG, free T, estradiol and LH during a ten year period with up to 18 years of registry follow-up.

DESIGN: 1,167 men aged 30 to 60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study and who had a follow-up examination ten years later (MONICA10) were included. From MONICA10 the men were followed up to 18 years (mean: 15.2 years) in national mortality registries via their unique personal ID number.

METHODS: Cox proportional hazard models were used to investigate the association between intra-individual hormone changes and all-cause-, CVD-, and cancer mortality.

RESULTS: A total of 421 men (36.1%) died during the follow-up period. Men with most pronounced decline in total T (<10th percentile) had a higher all-cause mortality risk compared to men within the 10th to 90th percentile (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.08-2.36). No consistent associations were seen in cause-specific mortality analyses.

CONCLUSION: Our study showed that higher mortality rates were seen among the men who had the most pronounced age-related decline in T, independent of their baseline T levels.