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Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making
Published on: March 2, 2011
Endogenous testosterone and mortality risk
Emily J Meyer1,2, Gary Wittert1,2,3
1Endocrine, Diabetes and Metabolic Unit, Royal Adelaide Hospital, Port Road, SA 5000, Australia.
Abstract:
In men, obesity and metabolic complications are associated with lower serum testosterone (T) and dihydrotestosterone (DHT) and an increased risk of, and mortality from, multiple chronic diseases in addition to cardiovascular disease (CVD). The causal interrelationships between these factors remain a matter of debate. In men with untreated congenital and lifelong forms of hypogonadotropic hypogonadism, there appears to be no increased risk. Men with Klinefelter's syndrome have an increased risk of various types of cancers, as well as CVD, which persist despite T therapy. In the absence of pathology of the hypothalamic-pituitary-gonadal axis, the effect of modest reductions in serum T in aging men is unclear. The prevalence of low serum T concentrations is high in men with cancer, renal disease, and respiratory disease and is likely to be an indicator of severity of systemic disease, not hypogonadism. Some population-based studies have found low serum T to be associated with a higher risk of deaths attributed to cancer, renal disease, and respiratory disease, while others have not. Although a meta-analysis of longitudinal studies has shown an association between low serum T and all-cause mortality, marked heterogeneity between studies limited a firm conclusion. Therefore, while a decrease in T particularly occurring later in life may be associated with an increase in all-cause and specific types of mortality in men, the differential effects, if any, of T and other sex steroids as compared to health and lifestyle factors are unknown at the current time.
Insights
Low testosterone (T) in aging men may link to increased mortality, but its causal role versus other health factors remains unclear. Further research is needed to understand these complex relationships.
Area of Science:
- Endocrinology
- Men's Health
- Chronic Disease Epidemiology
Background:
- Obesity and metabolic issues in men correlate with reduced testosterone (T) and dihydrotestosterone (DHT), alongside higher risks for chronic diseases and cardiovascular disease (CVD).
- The precise causal links between these hormonal changes, obesity, and disease outcomes are not fully established.
- While certain conditions like Klinefelter's syndrome show increased disease risk, the impact of mild testosterone decline in aging men without specific pathologies is debated.
Purpose of the Study:
- To investigate the association between serum testosterone levels and the risk of chronic diseases and mortality in men.
- To clarify the role of testosterone in relation to obesity, metabolic complications, and specific health conditions.
- To examine whether low testosterone is an indicator of systemic disease severity or a direct cause of increased mortality.
Main Methods:
- Review of existing literature, including population-based studies and meta-analyses of longitudinal data.
- Analysis of associations between serum testosterone concentrations and risks of cardiovascular disease, cancer, renal disease, and respiratory disease.
- Consideration of specific male populations, such as those with hypogonadotropic hypogonadism and Klinefelter's syndrome.
Main Results:
- Low serum T is prevalent in men with severe systemic diseases (cancer, renal, respiratory) and may indicate disease severity rather than primary hypogonadism.
- Some studies link low T to increased mortality from cancer, renal, and respiratory diseases, but findings are inconsistent.
- A meta-analysis indicated a link between low T and all-cause mortality, yet significant heterogeneity limited definitive conclusions.
Conclusions:
- A decline in testosterone later in life might be associated with increased all-cause and specific mortality in men.
- The independent effects of testosterone versus other health and lifestyle factors on mortality risk are currently unknown.
- Further research is required to disentangle the complex interplay between sex hormones, metabolic health, and long-term health outcomes in men.
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