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Low Testosterone: A Risk Marker Rather Than a Risk Factor for Type 2 Diabetes
Stine A Holmboe1, Tina K Jensen1, Allan Linneberg1
1Department of Growth and Reproduction (S.A.H., T.K.J., N.E.S., A.J., A.-M.A.) and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (S.A.H., T.K.J., N.E.S., A.J., A.-M.A.), Rigshospitalet, University of Copenhagen, Department of Clinical Experimental Research (A.L.), Rigshospitalet, and Department of Clinical Medicine (A.L., A.J.), Faculty of Health and Medical Sciences, and Department of Biostatistics (T.S.), University of Copenhagen, DK-2100 Copenhagen, Denmark; and Research Centre for Prevention and Health (A.L., B.H.T.), The Capital Region, DK-2600 Glostrup, Denmark.
Low testosterone (T) and SHBG levels are associated with a reduced risk of type 2 diabetes (T2D) in men. This suggests low T is a marker, not a cause, of T2D.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Cardiovascular Health
Background:
- Low serum testosterone (T) is linked to type 2 diabetes (T2D) and cardiovascular disease (CVD).
- The causal relationship between low T and these conditions remains unclear, with T potentially being a risk factor or a marker.
Purpose of the Study:
- To investigate the association between serum levels of total T, sex hormone-binding globulin (SHBG), free T, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH).
- To determine the subsequent risk of developing T2D and/or cardiovascular disease in men.
Main Methods:
- A prospective cohort study of 5350 men aged 30-70 years was conducted.
- Participants were followed for up to 29 years, with T2D and cardiovascular outcomes (ischemic heart disease, stroke) meticulously recorded.
- Cox proportional hazards models were employed to analyze hormone levels and disease risk.
Main Results:
- Higher quartiles of total T and SHBG were significantly associated with a decreased risk of T2D, particularly in nonsmokers.
- Free T showed similar trends but lacked statistical significance in fully adjusted models.
- Hormonal associations with cardiovascular disease outcomes were inconsistent, with some positive associations observed in smokers.
Conclusions:
- The study indicates that low T and SHBG levels are markers, not causal factors, for T2D in men.
- The findings suggest that primary hypogonadism is unlikely to be a direct cause of T2D.
- Further research is needed to clarify the complex hormonal interplay in cardiovascular disease risk.
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