Endogenous testosterone and mortality in men

A systematic review and meta-analysis

Andre B. Araujo, Julia M. Dixon, Elizabeth A. Suarez, Mohammad H Murad, Lin T. Guey, Gary A. Wittert

Research output: Contribution to journalArticle

342 Citations (Scopus)

Abstract

Context: Low testosterone levels have been associated with outcomes that reduce survival in men. Objective: Our objective was to perform a systematic review and meta-analysis of published studies to evaluate the association between endogenous testosterone and mortality. Data Sources: Data sources included MEDLINE (1966 to December 2010), EMBASE (1988 to December 2010), and reference lists. Study Selection: Eligible studies were published English-language observational studies of men that reported the association between endogenous testosterone and all-cause or cardiovascular disease (CVD) mortality. A two-stage process was used for study selection. 1) Working independently and in duplicate, reviewers screened a subset (10%) of abstracts. Results indicated 96% agreement, and thereafter, abstract screening was conducted in singlicate. 2) All full-text publications were reviewed independently and in duplicate for eligibility. Data Extraction: Reviewers working independently and in duplicate determined methodological quality of studies and extracted descriptive, quality, and outcome data. Data Synthesis: Of 820 studies identified, 21 were included in the systematic review, and 12 were eligible for meta-analysis [n = 11 studies of all-cause mortality (16,184 subjects); n = 7 studies of CVD mortality (11,831 subjects)]. Subject mean age and testosterone level were 61 yr and 487 ng/dl, respectively, and mean follow-up time was 9.7 yr. Between-study heterogeneity was observed among studies of all-cause (P<.001) and CVD mortality (P=0.06), limiting the ability to provide validsummary estimates. Heterogeneity in all-cause mortality (higher relative risks) was observed in studies that included older subjects (P = 0.020), reported lower testosterone levels (P = 0.018), followed subjects for a shorter time period (P = 0.010), and sampled blood throughout the day (P = 0.030). Conclusion: Low endogenous testosterone levels are associated with increased risk of all-cause and CVD death in community-based studies of men, but considerable between-study heterogeneity, which was related to study and subject characteristics, suggests that effects are driven by differences between cohorts (e.g. in underlying health status).

Original languageEnglish (US)
Pages (from-to)3007-3019
Number of pages13
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number10
DOIs
StatePublished - Oct 2011

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Testosterone
Meta-Analysis
Mortality
Cardiovascular Diseases
Information Storage and Retrieval
Association reactions
Aptitude
MEDLINE
Health Status
Observational Studies
Publications
Screening
Blood
Language
Health
Survival

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Endogenous testosterone and mortality in men : A systematic review and meta-analysis. / Araujo, Andre B.; Dixon, Julia M.; Suarez, Elizabeth A.; Murad, Mohammad H; Guey, Lin T.; Wittert, Gary A.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 10, 10.2011, p. 3007-3019.

Research output: Contribution to journalArticle

Araujo, Andre B. ; Dixon, Julia M. ; Suarez, Elizabeth A. ; Murad, Mohammad H ; Guey, Lin T. ; Wittert, Gary A. / Endogenous testosterone and mortality in men : A systematic review and meta-analysis. In: Journal of Clinical Endocrinology and Metabolism. 2011 ; Vol. 96, No. 10. pp. 3007-3019.
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abstract = "Context: Low testosterone levels have been associated with outcomes that reduce survival in men. Objective: Our objective was to perform a systematic review and meta-analysis of published studies to evaluate the association between endogenous testosterone and mortality. Data Sources: Data sources included MEDLINE (1966 to December 2010), EMBASE (1988 to December 2010), and reference lists. Study Selection: Eligible studies were published English-language observational studies of men that reported the association between endogenous testosterone and all-cause or cardiovascular disease (CVD) mortality. A two-stage process was used for study selection. 1) Working independently and in duplicate, reviewers screened a subset (10{\%}) of abstracts. Results indicated 96{\%} agreement, and thereafter, abstract screening was conducted in singlicate. 2) All full-text publications were reviewed independently and in duplicate for eligibility. Data Extraction: Reviewers working independently and in duplicate determined methodological quality of studies and extracted descriptive, quality, and outcome data. Data Synthesis: Of 820 studies identified, 21 were included in the systematic review, and 12 were eligible for meta-analysis [n = 11 studies of all-cause mortality (16,184 subjects); n = 7 studies of CVD mortality (11,831 subjects)]. Subject mean age and testosterone level were 61 yr and 487 ng/dl, respectively, and mean follow-up time was 9.7 yr. Between-study heterogeneity was observed among studies of all-cause (P<.001) and CVD mortality (P=0.06), limiting the ability to provide validsummary estimates. Heterogeneity in all-cause mortality (higher relative risks) was observed in studies that included older subjects (P = 0.020), reported lower testosterone levels (P = 0.018), followed subjects for a shorter time period (P = 0.010), and sampled blood throughout the day (P = 0.030). Conclusion: Low endogenous testosterone levels are associated with increased risk of all-cause and CVD death in community-based studies of men, but considerable between-study heterogeneity, which was related to study and subject characteristics, suggests that effects are driven by differences between cohorts (e.g. in underlying health status).",
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