Lower circulating testosterone (T) is a consequence rather than a cause of poor health in older men: the Concord Health and Ageing in Men Project (CHAMP) — ASN Events
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  3. Lower circulating testosterone (T) is a consequence rather than a cause of poor health in older men: the Concord Health and Ageing in Men Project (CHAMP)

Lower circulating testosterone (T) is a consequence rather than a cause of poor health in older men: the Concord Health and Ageing in Men Project (CHAMP) (#43)

Benjumin Hsu 1 2 3 , Robert G Cumming 1 2 3 , Vasi Naganathan 3 , Fiona M Blyth 3 , David J Handelsman 2
  1. School of Public Health, University of Sydney, Sydney, NSW, Australia
  2. ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
  3. Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, NSW, Australia

Aims: Low circulating T in older men is associated with many health problems. We compared cross-sectional and longitudinal analyses of hormones and morbidity in the CHAMP cohort to deduce the direction of causality.

Methods: The population-based CHAMP cohort of men aged 70 years and older were assessed at baseline (n=1705), 2-year (n=1367) and 5-year (n=958) follow-up. At each visit, serum T, dihydrotestosterone (DHT), estradiol (E2) and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry and related cross-sectionally or longitudinally using general estimating equations to self-rated health, quality of life, functional disability, muscle mass and strength, metabolic syndrome, sexual function, bone mineral density, falls and fractures, and cognitive function.

Results: Cross-sectionally, low serum T, DHT, E2 and E1 were associated with most outcomes. Longitudinally, low baseline serum T and E2 predict increased functional disability but no other studied health outcomes whereas low baseline serum E1 predicted deterioration in self-rated health, functional abilities and bone loss. However, a decline in serum T (<10%) or E1 was significantly associated with declines in sexual and cognitive functions over time. As placebo-controlled trials show that (a) the decrease in serum T is too small to explain the decrease in sexual function1-2 and (b) testosterone treatment does not improve cognitive function3. The decrease in circulating T is more likely to result from, rather than cause, reduced sexual function or cognition.

Conclusions: These findings from a large representative group of older Australian men suggest that declines in serum T levels may be a consequence, rather than a cause, of poor health in older men. Further studies are warranted to investigate serum E1 in men as an important novel health biomarker. 

  1. Finkelstein JS, Yu EW, Burnett-Bowie SA 2013 Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med 369:2457
  2. Gray PB, Singh AB, Woodhouse LJ, Storer TW, Casaburi R, Dzekov J, Dzekov C, Sinha-Hikim I, Bhasin S 2005 Dose-dependent effects of testosterone on sexual function, mood, and visuospatial cognition in older men. J Clin Endocrinol Metab 90:3838-3846
  3. Cherrier MM, Anderson K, Shofer J, Millard S, Matsumoto AM 2015 Testosterone treatment of men with mild cognitive impairment and low testosterone levels. Am J Alzheimers Dis Other Demen 30:421-30
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