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Sex-Associated Differences in Age-Related Sensorineural Hearing Loss: Why Are Men More Vulnerable?
Seokhwan Lee1, Sung-Won Choi1,2
1Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
The World Journal of Men'S Health
|July 31, 2026
Summary
Men experience earlier and more severe age-related hearing loss than women, influenced by genetics, lifestyle, and hormones. Understanding these sex differences is key for targeted hearing health strategies in aging populations.
Area of Science:
- Otolaryngology
- Endocrinology
- Gerontology
Background:
- Age-related hearing loss (ARHL) is a significant health issue, causing communication difficulties and social isolation.
- Men typically exhibit earlier and more severe high-frequency hearing loss compared to age-matched women.
- This disparity is linked to gender-specific exposures and biological sex factors, including hormonal influences.
Purpose of the Study:
- To synthesize current evidence on sex differences in auditory aging.
- To explore the interplay of endocrine factors, ototoxic exposures, and comorbidities in shaping hearing loss.
- To identify knowledge gaps and propose future research directions for sex-stratified auditory health.
Main Methods:
- Review of existing epidemiological and mechanistic studies on sex differences in ARHL.
- Analysis of the role of steroid signaling (estrogen and androgen pathways) in cochlear function.
- Application of a life-course, "multi-hit" framework to understand auditory dimorphisms.
Main Results:
- Sex differences in hearing thresholds are evident early in life and persist through aging.
- While estrogen may offer some otoprotection, hormone replacement therapy's effects on hearing are complex and not uniformly beneficial.
- Emerging evidence suggests testosterone may be associated with better high-frequency hearing in older men.
- Interactions between genetic predispositions, hormonal changes, environmental exposures, and cardiometabolic health contribute to sex-specific ARHL patterns.
Conclusions:
- Auditory aging is shaped by a complex interplay of factors, not a single cause.
- Sex-stratified research is crucial for understanding and addressing hearing loss disparities.
- Risk-stratified screening and proactive hearing assessments, especially for aging men with potential hormonal imbalances, are recommended for early detection and intervention.
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