CoChat
Sign Up
Cited by 239Hormonal and reproductive studiesErythropoietin and Anemia TreatmentIron Metabolism and Disorders

Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial

Open access
Roy, Cindy N., Snyder, Peter J., Stephens-Shields, Alisa J., Artz, Andrew S., Bhasin, Shalender, Cohen, Harvey J., Farrar, John T., Gill, Thomas M. +22 more·2017·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2016.9540PMC PMC5433757
Open this paper in CoChat — free account

Abstract

Importance: In one-third of older men with anemia, no recognized cause can be found. Objective: To determine if testosterone treatment of men 65 years or older with unequivocally low testosterone levels and unexplained anemia would increase their hemoglobin concentration. Design, Setting, and Participants: A double-blinded, placebo-controlled trial with treatment allocation by minimization using 788 men 65 years or older who have average testosterone levels of less than 275 ng/dL. Of 788 participants, 126 were anemic (hemoglobin ≤12.7 g/dL), 62 of whom had no known cause. The trial was conducted in 12 academic medical centers in the United States from June 2010 to June 2014. Interventions: Testosterone gel, the dose adjusted to maintain the testosterone levels normal for young men, or placebo gel for 12 months. Main Outcomes and Measures: The percent of men with unexplained anemia whose hemoglobin levels increased by 1.0 g/dL or more in response to testosterone compared with placebo. The statistical analysis was intent-to-treat by a logistic mixed effects model adjusted for balancing factors. Results: The men had a mean age of 74.8 years and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30.7; 84.9% were white. Testosterone treatment resulted in a greater percentage of men with unexplained anemia whose month 12 hemoglobin levels had increased by 1.0 g/dL or more over baseline (54%) than did placebo (15%) (adjusted OR, 31.5; 95% CI, 3.7-277.8; P = .002) and a greater percentage of men who at month 12 were no longer anemic (58.3%) compared with placebo (22.2%) (adjusted OR, 17.0; 95% CI, 2.8-104.0; P = .002). Testosterone treatment also resulted in a greater percentage of men with anemia of known cause whose month 12 hemoglobin levels had increased by 1.0 g/dL or more (52%) than did placebo (19%) (adjusted OR, 8.2; 95% CI, 2.1-31.9; P = .003). Testosterone treatment resulted in a hemoglobin concentration of more than 17.5 g/dL in 6 men who had not been anemic at baseline. Conclusions and Relevance: Among older men with low testosterone levels, testosterone treatment significantly increased the hemoglobin levels of those with unexplained anemia as well as those with anemia from known causes. These increases may be of clinical value, as suggested by the magnitude of the changes and the correction of anemia in most men, but the overall health benefits remain to be established. Measurement of testosterone levels might be considered in men 65 years or older who have unexplained anemia and symptoms of low testosterone levels. Trial Registration: clinicaltrials.gov Identifier: NCT00799617.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamainternmed.2016.9540

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Men with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, direct or scatter radiation therapy to the testes, HIV, chronic narcotic use, infertility, pituitary disorders, or chronic corticosteroid use are at risk for low testosterone.

    “A meta-analysis of the literature suggests that men who have a history of unexplained anemia, 7 bone density loss, 8 diabetes, 9 exposure to chemotherapy, 10 direct or scatter radiation therapy to the testes, 11 HIV, 12 a history of chronic narcotic use, 13 infertility, 14 pituitary disorders, 15 and chronic corticosteroid use 16 are at risk for low testosterone.”

    From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [7]

    The Discussion supports considering testosterone testing in men aged 65 or older with unexplained anemia and symptoms of hypogonadism. It also says the proportion of older men with unexplained anemia who have low testosterone, compared with older men generally, is unknown. Thus it does not establish that men with unexplained anemia generally are at increased risk; the other listed conditions are not attributed to this citation. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Ten per cent lifestyle modification-induced weight loss was associated with a 2.9 nmol/L increase in total testosterone.

    “10% of LSM induced weight loss with 2.9 nmol/L increase of total testosterone”

    From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [21]

  • Five per cent of weight loss with lifestyle modification was associated with a 2 nmol/L increase in total testosterone and no increase in free testosterone.

    “Five per cent of weight loss with LSM was associated with the 2 mmol/L increase of total testosterone and no increase of free testosterone (21)”

    From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [21]

  • Weight loss of more than 15% was associated with a 5.7 nmol/L increase in total testosterone.

    “weight loss of more than 15% with increase by 5.7 mmol/L (21)”

    From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [21]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

5 of the 44 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Roy, C. N., Snyder, P. J., Stephens-Shields, A. J., Artz, A. S., Bhasin, S., Cohen, H. J., Farrar, J. T., Gill, T. M., Zeldow, B., Cella, D., Barrett-Connor, E., Cauley, J. A., Crandall, J. P., Cunningham, G. R., Ensrud, K. E., Lewis, C. E., Matsumoto, A. M., Molitch, M. E., Pahor, M., Swerdloff, R. S., Cifelli, D., Hou, X., Resnick, S. M., Walston, J. D., Anton, S., Basaria, S., Diem, S. J., Wang, C., Schrier, S. L., & Ellenberg, S. S.
Affiliations
  • Johns Hopkins University (US)
  • University of Pennsylvania (US)
  • Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • University of Chicago (US)
  • Brigham and Women's Hospital (US)
  • Duke Medical Center (US)
  • Yale University (US)
  • Northwestern University (US)
  • University of California San Diego (US)
  • University of Pittsburgh (US)
  • Albert Einstein College of Medicine (US)
  • Baylor College of Medicine (US)
  • University of Minnesota (US)
  • University of Alabama at Birmingham (US)
  • University of Washington (US)
  • University of Florida (US)
  • University of California, Los Angeles (US)
  • National Institutes of Health (US)
  • Stanford Medicine (US)
Corresponding author
Snyder, Peter J.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2017-04-01
Volume
177
Issue
4
Pages
480
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2016.9540
PMC
PMC5433757
OpenAlex
W2593639365
Cited by
239
References
44
Citations by year
2026: 8 · 2025: 24 · 2024: 24 · 2023: 17 · 2022: 31 · 2021: 25 · 2020: 22 · 2019: 33 · 2018: 34 · 2017: 21
FWCI
23.76
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5p30ag031679-15, UL1TR001863)
  • National Institute on Aging (U01AG030644, K07AG043587, P30-AG031679, U01AG034661, P30AG028740, P30AG021342)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32DK060455, P30DK020541)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Keywords
testosterone replacement therapy, testosterone gel, anemia, older men, androgen deficiency, hemoglobin, anemia of chronic disease, cancer-related anemia
MeSH terms
Aged, Androgens, Anemia, Double-Blind Method, Drug Administration Routes, Hemoglobins, Humans, Male, Testosterone, Treatment Outcome, Drug Monitoring, Hormone Replacement Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review