Low Testosterone Associated with Increased Mortality

by Jeffrey Dach MD

Forty Per Cent More Likely to Die

Two reports published in the recent medical literature showed that low testosterone is associated with increased mortality.(1)(2)(3)  Upper Left Image: Chemical structure of human, bio-identiical testosterone courtesy of wikimedia commons.

In the first study from 2006, low testosterone was found to be associated with increased mortality among veterans. (1) . A low testosterone level was a total testosterone level of less than 250 ng/dL and 858 men were followed for 8 years. Those with low testosterone levels had an increased mortality rate (hazard ratio, 1.88). (1)

Left chart from Arch Int Med 2006 Molly Shores (1) Low Testosterone group (Green Line) had highest mortality rate.

In the second study published in 2008 tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years. Low testosterone symptoms reported by these men included decreased libido, erectile dysfunction, fatigue, loss of strength, decrease in bone density and decreased muscle mass. Also, these men tended to be overweight or obese, and at higher risk for cardiovascular disease and diabetes. Men with the lowest testosterone, below 241 total serum level, were 40% more likely to die.(2)

A third study published by Dr Malkin in Heart 2010 showed that men with known  coronary artery disease commonly had low testosterone levels which was associated with double the mortality rate compared with men with normal levels. (6)  Dr Malkin says: “Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%)”

Conclusion:

Low testosterone in males is associated with increased mortality from coronary artery disease.  Androgen deficiency is also associated with increased rate of depression. metabolic syndrome and low libido.(4,5)  Testosterone supplementation in androgen deficient males is therefore beneficial.

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Jeffrey Dach MD
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Links and References

(1) http://www.ncbi.nlm.nih.gov/pubmed/16908801
Low Serum Testosterone and Mortality in Male Veterans Arch Intern Med. 2006;166:1660-1665 Molly M. Shores, MD; Alvin M. Matsumoto, MD; Kevin L. Sloan, MD; Daniel R. Kivlahan, PhD .Conclusions Low testosterone levels were associated with increased mortality in male veterans.

(2) http://jcem.endojournals.org/cgi/content/full/93/1/68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190742/
The Journal of Clinical Endocrinology & Metabolism 2008 Jan;93(1):68-75.
Low Serum Testosterone and Mortality in Older Men. Gail A. Laughlin, Eliza beth Barrett-Connor and Jaclyn Bergstrom. Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093

Results: During an average 11.8-yr follow-up, 538 deaths occurred. Men whose total testosterone levels were in the lowest quartile (<241 ng/dl) were 40% [hazards ratio (HR) 1.40; 95% confidence interval (CI) 1.14–1.71] more likely to die than those with higher levels, independent of age, adiposity, and lifestyle. Additional adjustment for health status markers, lipids, lipoproteins, blood pressure, glycemia, adipocytokines, and estradiol levels had minimal effect on results. The low testosterone-mortality association was also independent of the metabolic syndrome, diabetes, and prevalent cardiovascular disease but was attenuated by adjustment for IL-6 and C-reactive protein. In cause-specific analyses, low testosterone predicted increased risk of cardiovascular (HR 1.38; 95% CI 1.02–1.85) and respiratory disease (HR 2.29; 95% CI 1.25–4.20) mortality but was not significantly related to cancer death (HR 1.34; 95% CI 0.89–2.00). Results were similar for bioavailable testosterone.

Conclusions: Testosterone insufficiency in older men is associated with increased risk of death over the following 20 yr, independent of multiple risk factors and several preexisting health conditions.

(3)http://abcnews.go.com/Health/ActiveAging/story?id=3247773&page=1&page=1
Low Testosterone Could Kill You. Low Levels of Male Hormone May be More Dangerous Than Previously Thought By SUPINDA BUNYAVANICH, M.D. ABC News Medical Unit June 6, 2007

Low testosterone may lead to a greater risk of death, according to a study presented Tuesday at the annual meeting of the Endocrine Society in Toronto.
Men with low testosterone had a 33 percent greater death risk over their next 18 years of life compared with men who had higher testosterone, according to the study conducted by Dr. Elizabeth Barrett-Connor and colleagues at the University of California at San Diego. “It’s very exciting and potentially a groundbreaking study,” said Barrett-Connor. “But it needs to be confirmed.” The study tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years.

4) http://www.medicalnewstoday.com/articles/153822.php
Testosterone Replacement For Men With Low Testosterone Improves Liver Function, Metabolic Syndrome. Testosterone deficiency, which becomes more common with age, is linked not only to decreased libido but also to a number of medical problems. These include the metabolic syndrome a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke and type 2 diabetes.

5) http://www.news-medical.net/news/2008/03/04/35897.aspx
Low testosterone levels linked to depression in older men March 2008
Older men with lower free testosterone levels in their blood appear to have higher prevalence of depression, according to a report in the March issue of Archives of General Psychiatry.

6) Malkin, Chris J., et al. “Low serum testosterone and increased mortality in men with coronary heart disease.” Heart 96.22 (2010): 1821-1825. low-serum-testosterone-and-increased-mortality-in-men-with-coronary-heart-disease-malkin-chris-heart-2010  Background To examine the effect of serum testosterone levels on survival in a consecutive series of men with confirmed coronary disease and calculate the prevalence of testosterone deficiency.

Design Longitudinal follow-up study.  Setting Tertiary referral cardiothoracic centre. Patients 930 consecutive men with coronary disease referred for diagnostic angiography recruited between June 2000 and June 2002 and followed up for a mean of 6.9±2.1 years.

Outcome All-cause mortality and vascular mortality. Prevalence of testosterone deficiency.

Results The overall prevalence of biochemical testosterone deficiency in the coronary disease cohort using bio-available testosterone (bio-T) <2.6 nmol/l was 20.9%, using total testosterone <8.1 nmol/l was 16.9% and using either was 24%. Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%), p=0.002). The only parameters found to influence time to all-cause and vascular mortality (HR ± 95% CI) in multivariate analyses were the presence of left ventricular dysfunction (3.85; 1.72 to 8.33), aspirin therapy (0.63; 0.38 to 1.0), β-blocker therapy (0.45; 0.31 to 0.67) and low serum bio-T (2.27; 1.45 to 3.6).

Conclusions In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival.

Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida 33314
954-792-4663
http://www.drdach.com/
http://www.naturalmedicine101.com/
http://www.truemedmd.com/
http://www.bioidenticalhormones101.com/

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