Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men
Open accessAbstract
BackgroundWe evaluated the associations of smoking, alcohol consumption, and physical activity with sex steroid hormone concentrations among 1,275 men ≥20 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III).MethodsSerum concentrations of testosterone, estradiol, and sex hormone-binding globulin (SHBG) were measured. We compared geometric mean concentrations across levels of smoking, alcohol, and physical activity using multiple linear regression.ResultsCurrent smokers had higher total testosterone (5.42, 5.10, and 5.26 ng/ml in current, former, and never smokers), free testosterone (0.110, 0.102, and 0.104 ng/ml), total estradiol (40.0, 34.5, and 33.5 pg/ml), and free estradiol (1.05, 0.88, and 0.84 pg/ml) compared with former and never smokers (all p ≤ 0.05). Men who consumed ≥1 drink/day had lower SHBG than men who drank less frequently (31.5 vs. 34.8 nmol/l, p = 0.01); total (p-trend = 0.08) and free testosterone (p-trend = 0.06) increased with number of drinks per day. Physical activity was positively associated with total (p-trend = 0.01) and free testosterone (p-trend = 0.05).ConclusionsIn this nationally representative sample of men, smoking, alcohol, and physical activity were associated with hormones and SHBG, thus these factors should be considered as possible confounders or upstream variables in studies of hormones and men’s health, including prostate cancer.
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Written from the paper’s full text.
TL;DR
In NHANES III, current smoking, alcohol intake, and physical activity were associated with sex steroid hormone and SHBG concentrations in 1,275 U.S. men. The authors conclude these modifiable factors should be considered as possible confounders or upstream variables in studies of hormones and men’s health.
Key findings
Current smokers had higher total testosterone (5.42, 5.10, and 5.26 ng/mL in current, former, and never smokers), free testosterone (0.110, 0.102, and 0.104 ng/mL), total estradiol (40.0, 34.5, and 33.5 pg/mL), and free estradiol (1.05, 0.88, and 0.84 pg/mL) than former and never smokers (all P≤0.05). Men who consumed ≥1 drink/day had lower SHBG than men who drank less frequently (31.5 vs. 34.8 nmol/L, P=0.01); total and free testosterone increased with number of drinks per day (P-trend=0.08 and P-trend=0.06). Men in the highest physical activity category had higher total testosterone (5.42 vs. 5.05 ng/mL, P=0.003) and free testosterone (0.109 vs. 0.098 ng/mL, P=0.005) and lower total estradiol (35.2 vs. 38.1 pg/mL, P=0.009) than those reporting no activity; the abstract reports positive trends for total and free testosterone (P-trend=0.01 and P-trend=0.05), while the results text states trends across activity levels were not statistically significant. Men passively exposed to cigarette smoke had greater total testosterone (5.21 vs. 4.90 ng/mL, P=0.03) and free testosterone (0.104 vs. 0.096 ng/mL, P=0.005) than those unexposed.
Methods
Cross-sectional analysis of 1,275 men aged 20–90 in NHANES III Phase I morning examination, after exclusions for prostate cancer, wheelchair/leg paralysis, missing or extreme hormone values, and missing exposure or percent body fat data. Serum testosterone, estradiol, and SHBG were measured by competitive electrochemiluminescence immunoassays; free testosterone and free estradiol were estimated from total hormones, SHBG, and albumin using mass action equations; androstanediol glucuronide was measured by enzyme immunoassay. Multivariable linear regression used Phase I morning sampling weights, natural-log-transformed hormones, and adjustment for age, race/ethnicity, percent body fat, mutual adjustment for smoking, alcohol, and physical activity, and mutual adjustment for other hormones; tests for trend and age interaction were performed.
Limitations
The authors state that the cross-sectional design precludes conclusions about temporality (e.g., higher testosterone could increase exercise capacity rather than physical activity influencing testosterone), that self-reported lifestyle factors may cause misclassification, and that residual confounding by unrecognized factors is possible. Evident from the text, though not framed by the authors as a limitation: the study was restricted to Phase I morning-session men with available stored serum and complete exposure/body-fat data, which may limit generalizability.
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Claims the paper makes
5 of 38 cited sources checked · 2 supported · 1 flagged · accuracy not yet measured
- Findingown data
Current drinkers possibly had higher total testosterone concentrations than non-drinkers.
“current drinkers had lower concentrations of SHBG and possibly higher testosterone and free testosterone levels compared with non-drinkers”
Quote in the paperSubstantial claim - Findingown data
Among older men, total testosterone did not increase with an increasing number of drinks consumed per day (P-trend=0.4).
“Both total (P-trend=0.06) and free (P-trend=0.05) testosterone increased with an increasing number of drinks consumed per day among younger,(<44 years), but not older men (P-trend=0.4 and P-trend=0.3, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Among younger men (<44 years), total estradiol concentrations decreased with increasing frequency of physical activity (P-trend=0.03).
“total and free estradiol concentrations decreased with increasing frequency of physical activity among younger men (<44 years; P-trend=0.03 and P-trend=0.03, respectively)”
Quote in the paperSubstantial claim - Findingown data
No consistent patterns were seen between the amount of alcohol consumed, as measured by the 24-hour dietary recall, or the frequency of heavy episodic drinking and any of the hormones or SHBG.
“No consistent patterns were seen between the amount of alcohol consumed, as measured by the 24-hour dietary recall, or the frequency of heavy episodic drinking and any of the hormones or SHBG.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Current smokers had higher free testosterone than former and never smokers (0.110, 0.102 and 0.104 ng/mL; P≤0.05).
“free testosterone (0.110, 0.102 and 0.104 ng/mL)”
- Also stated in: § RESULTS · plain
“free testosterone (0.110, 0.102 and 0.104 ng/mL)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Also stated in: § RESULTS · plain
- Findingown data
Men passively exposed to cigarette smoke had greater total testosterone than those unexposed (5.21 vs 4.90 ng/mL, P=0.03).
“Men passively exposed to cigarette smoke also had greater total testosterone (5.21 compared with 4.90 ng/mL, P=0.03)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Among current smokers, higher daily number of cigarettes smoked, pack-years smoked and serum cotinine were associated with greater free estradiol (all P-trend≤0.06).
“However, higher daily number of cigarettes smoked, pack-years smoked and serum cotinine were all associated with greater concentrations of total estradiol and free estradiol (all P-trend≤0.06; table 2).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
There was a significant interaction between age and smoking status and androstanediol glucuronide (P-interaction=0.01).
“However, a significant interaction was observed between age and smoking status and androstanediol glucuronide (P-interaction=0.01)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Current cigarette smokers had higher free testosterone concentrations than never smokers.
“current cigarette smokers had higher concentrations of total testosterone, total estradiol, free testosterone and free estradiol compared with never smokers”
Quote in the paperSubstantial claim - Findingown data
Current cigarette smokers had higher free estradiol concentrations than never smokers.
“current cigarette smokers had higher concentrations of total testosterone, total estradiol, free testosterone and free estradiol compared with never smokers”
- Also stated in: § Cigarette smoking · plain
“we observed that total and free estradiol concentrations were higher in current smokers than in never smokers, with a positive dose-response relationship seen with increasing number of cigarettes smoked per day and number of pack-years smoked”
Quote in the paperSubstantial claim - Also stated in: § Cigarette smoking · plain
- Findingown data
Men who consumed more than one alcoholic drink per day had lower SHBG levels than those who consumed no alcohol.
“Men who consumed more than one alcoholic drink per day had significantly lower levels of SHBG than those who consumed no alcohol”
Quote in the paperSubstantial claim - Findingown data
SHBG was inversely associated with increasing amount of alcohol consumed based on the food frequency questionnaire (p-trend=0.07).
“SHBG, which was inversely associated with increasing amount of alcohol consumed (p-trend=0.07) based on the food frequency questionnaire”
Quote in the paperNot a substantial claim - Findingown data
In multivariable models, men in the highest category of frequency of physical activity had higher free testosterone concentrations than men who reported no physical activity.
“men in the highest category of frequency of physical activity had higher concentrations of both total (5.42 vs. 5.05 ng/mL; P=0.003) and free testosterone (0.109 vs. 0.098 ng/mL; P=0.005)”
- Also stated in: § DISCUSSION · plain
“men who engaged frequently in physical activity had higher concentrations of total and free testosterone compared with sedentary men”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
No association was seen between total physical activity and SHBG.
“No associations were seen between total or vigorous physical activity and androstanediol glucuronide or SHBG.”
- Also stated in: § Physical activity · plain
“In contrast, after adjustment for testosterone and estradiol, no associations were seen between smoking status or physical activity and SHBG.”
Quote in the paperSubstantial claim - Also stated in: § Physical activity · plain
- Findingown data
Concentrations of SHBG did not differ by smoking status (P=0.7).
“Concentrations of androstanediol glucuronide (P=0.2) and SHBG (P=0.7) did not differ by smoking status.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men passively exposed to cigarette smoke had elevated mean free testosterone concentrations.
“Men passively exposed to cigarette smoke had elevated mean total and free testosterone concentrations, approaching levels observed among active smokers.”
Quote in the paperSubstantial claim - Findingown data
Among older men, free testosterone did not increase with an increasing number of drinks consumed per day (P-trend=0.3).
“Both total (P-trend=0.06) and free (P-trend=0.05) testosterone increased with an increasing number of drinks consumed per day among younger,(<44 years), but not older men (P-trend=0.4 and P-trend=0.3, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
After adjustment for testosterone and estradiol, no association was observed between current smoking and SHBG.
“Previous studies have reported higher SHBG concentrations among current smokers [16, 18, 19, 22], while we observed no association.”
- Also stated in: § Physical activity · plain
“In contrast, after adjustment for testosterone and estradiol, no associations were seen between smoking status or physical activity and SHBG.”
Quote in the paperSubstantial claim - Also stated in: § Physical activity · plain
- Findingown data
Among current smokers, no dose-response relationship was seen between cigarettes smoked per day, pack-years smoked or serum cotinine and concentrations of total testosterone, SHBG, androstanediol glucuronide or free testosterone (all P-trend>0.4).
“Among current smokers, no dose-response relationship was seen between cigarettes smoked per day, pack-years smoked or serum cotinine and concentrations of total testosterone, SHBG, androstanediol glucuronide or free testosterone (all P-trend>0.4).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
No dose-response relationship was observed between the number of cigarettes smoked and total testosterone concentrations.
“We did not observe a dose-response relationship between the number of cigarettes smoked and concentrations of total testosterone or free testosterone”
Quote in the paperSubstantial claim - Findingown data
No association was seen between vigorous physical activity and androstanediol glucuronide.
“No associations were seen between total or vigorous physical activity and androstanediol glucuronide or SHBG.”
Quote in the paperNot a substantial claim - Findingown data
In the absence of adjustment for testosterone and estradiol, there was a significant positive trend between frequency of physical activity and SHBG concentration.
“we found a significant positive trend between frequency of physical activity and SHBG concentration”
Quote in the paperSubstantial claim - Findingown data
In the sub-analysis, total estradiol was higher in current smokers than never smokers (40.0 vs 33.8 pg/mL; P<0.001).
“Using these definitions, total testosterone (5.42 vs. 4.95 ng/mL; P=0.04), free testosterone (0.110 vs. 0.096 ng/mL; P=0.009), total estradiol (40.0 vs. 33.8 pg/mL; P<0.001) and free estradiol (1.05 vs. 0.84 pg/mL; P=0.001) concentrations were higher in current smokers than in never smokers”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Concentrations of androstanediol glucuronide did not differ by smoking status (P=0.2).
“Concentrations of androstanediol glucuronide (P=0.2) and SHBG (P=0.7) did not differ by smoking status.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men currently actively exposed to tobacco smoke, as measured by cotinine, had higher free testosterone than men unexposed to tobacco smoke.
“Men currently actively exposed to tobacco smoke, as measured by cotinine, also had higher concentrations of testosterone, free testosterone, estradiol, and free estradiol compared with men unexposed (i.e., neither active, nor passive exposure) to tobacco smoke.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
In the sub-analysis, free estradiol was higher in current smokers than never smokers (1.05 vs 0.84 pg/mL; P=0.001).
“Using these definitions, total testosterone (5.42 vs. 4.95 ng/mL; P=0.04), free testosterone (0.110 vs. 0.096 ng/mL; P=0.009), total estradiol (40.0 vs. 33.8 pg/mL; P<0.001) and free estradiol (1.05 vs. 0.84 pg/mL; P=0.001) concentrations were higher in current smokers than in never smokers”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
In multivariable models, men in the highest category of frequency of physical activity had lower total estradiol concentrations than men who reported no physical activity.
“and lower concentrations of both total (35.2 vs. 38.1 pg/mL; P=0.009) and free estradiol (0.88 vs. 0.95 pg/mL; P=0.09) than those who reported no physical activity”
Quote in the paperSubstantial claim - Findingown data
In multivariable models, men in the highest category of frequency of physical activity had lower free estradiol concentrations than men who reported no physical activity.
“and lower concentrations of both total (35.2 vs. 38.1 pg/mL; P=0.009) and free estradiol (0.88 vs. 0.95 pg/mL; P=0.09) than those who reported no physical activity”
Quote in the paperNot a substantial claim - Findingown data
There was an interaction (P-interaction=0.06) between age and frequency of alcohol consumption with total and free testosterone.
“An interaction (P-interaction=0.06) was observed between age and the frequency of alcohol consumption with total and free testosterone.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingreasoning
Compared with never smokers, men unexposed to cigarette smoke based on cotinine concentration had lower free testosterone.
“Compared with never smokers, men unexposed to cigarette smoke based on cotinine concentration had lower concentrations of total and free testosterone.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Current smokers had higher free estradiol than former and never smokers (1.05, 0.878 and 0.844 pg/mL; P≤0.05).
“free estradiol (1.05, 0.88 pg/mL and 0.84 pg/mL)”
- Also stated in: § RESULTS · plain
“free estradiol (1.05, 0.878 and 0.844 pg/mL)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Also stated in: § RESULTS · plain
- Findingown data
Men passively exposed to cigarette smoke had greater free testosterone than those unexposed (0.104 vs 0.096 ng/mL, P=0.005).
“and free testosterone (0.104 compared with 0.096 ng/mL, P=0.005) concentrations than those unexposed to tobacco smoke.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Current cigarette smokers had higher total testosterone concentrations than never smokers.
“current cigarette smokers had higher concentrations of total testosterone, total estradiol, free testosterone and free estradiol compared with never smokers”
Quote in the paperSubstantial claim - Findingown data
Former smokers did not have higher total testosterone concentrations than never smokers.
“Former smokers did not have higher total and free testosterone levels than never smokers, suggesting that the association between cigarette smoke and hormones is reversible following smoking cessation.”
Quote in the paperSubstantial claim - Findingown data
Trends in hormone concentrations across physical activity levels were not statistically significant.
“although the trends in concentrations across activity levels were not statistically significant (table 4)”
Quote in the paperNot a substantial claim - Findingown data
Among older men (≥44 years), there was no trend in total estradiol concentrations with increasing frequency of physical activity (P-trend=0.7).
“but not older men (≥44 years; P-trend=0.7 and P-trend=0.5, respectively)”
Quote in the paperSubstantial claim - Findingown data
Current drinkers had lower SHBG concentrations than non-drinkers.
“current drinkers had lower concentrations of SHBG and possibly higher testosterone and free testosterone levels compared with non-drinkers”
Quote in the paperSubstantial claim - Findingown data
Among older men (≥44 years), there was no trend in free estradiol concentrations with increasing frequency of physical activity (P-trend=0.5).
“but not older men (≥44 years; P-trend=0.7 and P-trend=0.5, respectively)”
Quote in the paperNot a substantial claim - Findingown data
Current cigarette smokers had higher total estradiol concentrations than never smokers.
“current cigarette smokers had higher concentrations of total testosterone, total estradiol, free testosterone and free estradiol compared with never smokers”
- Also stated in: § Cigarette smoking · plain
“we observed that total and free estradiol concentrations were higher in current smokers than in never smokers, with a positive dose-response relationship seen with increasing number of cigarettes smoked per day and number of pack-years smoked”
Quote in the paperSubstantial claim - Also stated in: § Cigarette smoking · plain
- Findingown data
Among current smokers, higher daily number of cigarettes smoked, pack-years smoked and serum cotinine were associated with greater total estradiol (all P-trend≤0.06).
“However, higher daily number of cigarettes smoked, pack-years smoked and serum cotinine were all associated with greater concentrations of total estradiol and free estradiol (all P-trend≤0.06; table 2).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Among younger men (<44 years), free testosterone increased with an increasing number of drinks consumed per day (P-trend=0.05).
“Both total (P-trend=0.06) and free (P-trend=0.05) testosterone increased with an increasing number of drinks consumed per day among younger,(<44 years), but not older men (P-trend=0.4 and P-trend=0.3, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men who reported vigorous physical activity more than four times a week had higher total estradiol concentrations than those who reported less frequent vigorous physical activity.
“those who reported vigorous physical activity more than four times a week had higher total estradiol concentrations than those who reported less frequent vigorous physical activity”
Quote in the paperSubstantial claim - Findingown data
Younger men (<44 years) had androstanediol glucuronide concentrations of 12.7 ng/mL in never, 13.7 ng/mL in former, and 13.2 ng/mL in current smokers.
“(younger men <44 years: never: 12.7 ng/mL; former: 13.7 ng/mL; current: 13.2 ng/mL)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
The inverse trend between frequency of alcohol consumption and SHBG was statistically significant (P-trend=0.01).
“the inverse trend was statistically significant (P-trend=0.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Older men (≥44 years) who were current smokers had lower androstanediol glucuronide than never smokers (never: 11.6 ng/mL; former: 10.5 ng/mL; current: 9.1 ng/mL; P=0.06).
“older men (≥44 years) who were current smokers (never: 11.6 ng/mL; former: 10.5 ng/mL; current: 9.1 ng/mL) had lower androstanediol glucuronide than never smokers (P=0.06)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men currently actively exposed to tobacco smoke, as measured by cotinine, had higher total estradiol than men unexposed to tobacco smoke.
“Men currently actively exposed to tobacco smoke, as measured by cotinine, also had higher concentrations of testosterone, free testosterone, estradiol, and free estradiol compared with men unexposed (i.e., neither active, nor passive exposure) to tobacco smoke.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
No dose-response relationship was observed between the number of cigarettes smoked and free testosterone concentrations.
“We did not observe a dose-response relationship between the number of cigarettes smoked and concentrations of total testosterone or free testosterone”
Quote in the paperSubstantial claim - Findingown data
Among younger men (<44 years), total testosterone increased with an increasing number of drinks consumed per day (P-trend=0.06).
“Both total (P-trend=0.06) and free (P-trend=0.05) testosterone increased with an increasing number of drinks consumed per day among younger,(<44 years), but not older men (P-trend=0.4 and P-trend=0.3, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Age modified the association between physical activity and total estradiol (P-interaction=0.004).
“Age was found to modify the association between physical activity and both total and free estradiol (P-interaction=0.004)”
Quote in the paperNot a substantial claim - Findingown data
In multivariable models, men in the highest category of frequency of physical activity had higher total testosterone concentrations than men who reported no physical activity.
“men in the highest category of frequency of physical activity had higher concentrations of both total (5.42 vs. 5.05 ng/mL; P=0.003) and free testosterone (0.109 vs. 0.098 ng/mL; P=0.005)”
- Also stated in: § DISCUSSION · plain
“men who engaged frequently in physical activity had higher concentrations of total and free testosterone compared with sedentary men”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Results for alcohol grams per day were similar when calculated from the food frequency questionnaire compared with the 24-hour dietary recall, except for SHBG.
“Our results were similar when grams of alcohol per day were calculated from the food frequency questionnaire when compared with the 24-hour dietary recall, with the exception of SHBG”
Quote in the paperNot a substantial claim - Findingown data
Age modified the association between physical activity and free estradiol (P-interaction=0.004).
“Age was found to modify the association between physical activity and both total and free estradiol (P-interaction=0.004)”
Quote in the paperSubstantial claim - Findingown data
No associations were observed between specific types of alcohol (beer, wine and liquor) and serum hormone and SHBG concentrations.
“Additionally, no associations were observed between specific types of alcohol (beer, wine and liquor) and serum hormone and SHBG concentrations (data not shown).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Physical activity was positively associated with total testosterone (P-trend=0.01).
“Physical activity was positively associated with total (P-trend=0.01) and free testosterone (P-trend=0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported physical activity accurately reflects usual physical activity.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men currently actively exposed to tobacco smoke, as measured by cotinine, had higher free estradiol than men unexposed to tobacco smoke.
“Men currently actively exposed to tobacco smoke, as measured by cotinine, also had higher concentrations of testosterone, free testosterone, estradiol, and free estradiol compared with men unexposed (i.e., neither active, nor passive exposure) to tobacco smoke.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
In the sub-analysis, free testosterone was higher in current smokers than never smokers (0.110 vs 0.096 ng/mL; P=0.009).
“Using these definitions, total testosterone (5.42 vs. 4.95 ng/mL; P=0.04), free testosterone (0.110 vs. 0.096 ng/mL; P=0.009), total estradiol (40.0 vs. 33.8 pg/mL; P<0.001) and free estradiol (1.05 vs. 0.84 pg/mL; P=0.001) concentrations were higher in current smokers than in never smokers”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men currently actively exposed to tobacco smoke, as measured by cotinine, had higher total testosterone than men unexposed to tobacco smoke.
“Men currently actively exposed to tobacco smoke, as measured by cotinine, also had higher concentrations of testosterone, free testosterone, estradiol, and free estradiol compared with men unexposed (i.e., neither active, nor passive exposure) to tobacco smoke.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Physical activity was positively associated with free testosterone (P-trend=0.05).
“Physical activity was positively associated with total (P-trend=0.01) and free testosterone (P-trend=0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported physical activity accurately reflects usual physical activity.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingreasoning
Compared with never smokers, men unexposed to cigarette smoke based on cotinine concentration had lower total testosterone.
“Compared with never smokers, men unexposed to cigarette smoke based on cotinine concentration had lower concentrations of total and free testosterone.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Men who engaged in vigorous physical activity at least four times a week had higher total estradiol concentrations than men who engaged in no physical activity (37.3 vs. 35.5 pg/mL; P=0.09).
“men who engaged in vigorous physical activity at least four times a week had higher concentrations of total estradiol than men who engaged in no physical activity (37.3 vs. 35.5 pg/mL; P=0.09)”
- Also stated in: § DISCUSSION · plain
“men who engaged in vigorous physical activity had higher concentrations of total estradiol compared with sedentary men”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In the multivariable-adjusted model, current smokers had higher total testosterone than former and never smokers (geometric means 5.42, 5.10 and 5.26 ng/mL; P≤0.05).
“Current smokers had higher total testosterone (5.42, 5.10 and 5.26 ng/mL in current, former and never smokers)”
- Also stated in: § RESULTS · plain
“current smokers had higher concentrations of total testosterone (the geometric means were 5.42, 5.10 and 5.26 ng/mL in current, former and never smokers, respectively)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Also stated in: § RESULTS · plain
- Findingown data
Among younger men (<44 years), free estradiol concentrations decreased with increasing frequency of physical activity (P-trend=0.03).
“total and free estradiol concentrations decreased with increasing frequency of physical activity among younger men (<44 years; P-trend=0.03 and P-trend=0.03, respectively)”
Quote in the paperSubstantial claim - Findingown data
No association was observed between vigorous physical activity and free testosterone.
“In contrast, no association was observed between vigorous physical activity and total or free testosterone in our study.”
Quote in the paperSubstantial claim - Findingown data
No association was observed between vigorous physical activity and total testosterone.
“In contrast, no association was observed between vigorous physical activity and total or free testosterone in our study.”
Quote in the paperSubstantial claim - Findingown data
In a sub-analysis redefining current smokers as self-reported current smokers with active cotinine and never smokers as self-reported never smokers with cotinine in the no exposure range, total testosterone was higher in current smokers than never smokers (5.42 vs 4.95 ng/mL; P=0.04).
“Using these definitions, total testosterone (5.42 vs. 4.95 ng/mL; P=0.04), free testosterone (0.110 vs. 0.096 ng/mL; P=0.009), total estradiol (40.0 vs. 33.8 pg/mL; P<0.001) and free estradiol (1.05 vs. 0.84 pg/mL; P=0.001) concentrations were higher in current smokers than in never smokers”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
In analyses unadjusted for testosterone and estradiol, current smokers had greater SHBG concentrations than former and never smokers.
“in analyses unadjusted for testosterone and estradiol, current smokers were observed to have significantly greater concentrations of SHBG than former and never smokers (the geometric means of SHBG were 37.0, 33.5 and 33.1 nmol/L in current, former and never smokers, respectively; P≤0.005)”
- Also stated in: § Physical activity · plain
“In the absence of adjustment for testosterone and estradiol, current smokers had higher SHBG concentrations than never smokers”
Quote in the paperSubstantial claim - Also stated in: § Physical activity · plain
- Findingown data
No association was seen between vigorous physical activity and SHBG.
“No associations were seen between total or vigorous physical activity and androstanediol glucuronide or SHBG.”
Quote in the paperNot a substantial claim - Findingown data
Current smokers had higher total estradiol than former and never smokers (40.0, 34.5 and 33.5 pg/mL; P≤0.05).
“total estradiol (40.0, 34.5 and 33.5 pg/mL)”
- Also stated in: § RESULTS · plain
“total estradiol (40.0, 34.5 and 33.5 pg/mL)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Also stated in: § RESULTS · plain
- Findingown data
Men with usual intake of at least one drink per day had lower SHBG than men who consumed 0 to 6 drinks/week (31.5 vs 34.8 nmol/L, P=0.01).
“men with usual intake of at least one drink per day had lower concentrations of SHBG than men who consumed 0 to 6 drinks/week (31.5 vs. 34.8 nmol/L, P=0.01)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
No association was seen between total physical activity and androstanediol glucuronide.
“No associations were seen between total or vigorous physical activity and androstanediol glucuronide or SHBG.”
Quote in the paperNot a substantial claim - Findingown data
Frequency of alcohol consumption was positively associated with free testosterone (P-trend=0.06), although not statistically significant.
“The frequency of alcohol consumption was positively associated with total testosterone (P-trend= 0.08) and free testosterone (P-trend=0.06), although these associations were not statistically significant.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Findingown data
Current drinkers possibly had higher free testosterone concentrations than non-drinkers.
“current drinkers had lower concentrations of SHBG and possibly higher testosterone and free testosterone levels compared with non-drinkers”
Quote in the paperSubstantial claim - Findingown data
Men passively exposed to cigarette smoke had elevated mean total testosterone concentrations.
“Men passively exposed to cigarette smoke had elevated mean total and free testosterone concentrations, approaching levels observed among active smokers.”
Quote in the paperSubstantial claim - Findingown data
Former smokers did not have higher free testosterone concentrations than never smokers.
“Former smokers did not have higher total and free testosterone levels than never smokers, suggesting that the association between cigarette smoke and hormones is reversible following smoking cessation.”
Quote in the paperSubstantial claim - Findingown data
SHBG was not associated with alcohol based on the 24-hour dietary recall.
“but not associated based on the dietary recall”
Quote in the paperNot a substantial claim - Findingown data
Among current smokers, total and free estradiol concentrations showed a positive dose-response relationship with increasing number of cigarettes smoked per day and number of pack-years smoked.
“with a positive dose-response relationship seen with increasing number of cigarettes smoked per day and number of pack-years smoked”
Quote in the paperSubstantial claim - Interpretationown data
The sub-analysis findings were consistent with those seen when defining smoking status based on self-report only or based on cotinine only.
“findings that were consistent with those seen when defining smoking status based on self-report only or based on cotinine only.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Study design and conductnone given
The analysis was able to control for confounders that have not been previously measured or considered in other studies.
“From an epidemiologic perspective, we were able to control for confounders that have not been previously measured or considered in other studies.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The cross-sectional design of NHANES III precluded drawing conclusions regarding the temporality of the observed associations.
“The cross-sectional design of NHANES III precluded us from drawing conclusions regarding the temporality of the observed associations.”
Quote in the paperSubstantial claim - Interpretationreasoning
The difference in testosterone between never smokers and men unexposed by cotinine is likely due to the never smoker category consisting of men with both no exposure and passive exposure to tobacco smoke.
“This difference is likely due to the never smoker category consisting of men with both no exposure and passive exposure to tobacco smoke.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
- Interpretationown data
The association between cigarette smoke and sex steroid hormones is reversible following smoking cessation.
“Former smokers did not have higher total and free testosterone levels than never smokers, suggesting that the association between cigarette smoke and hormones is reversible following smoking cessation.”
Quote in the paperSubstantial claim - Interpretationown data
Modifiable behaviors such as cigarette smoking, alcohol consumption and physical activity may be associated with concentrations of sex steroid hormones among adult men.
“modifiable behaviors such as cigarette smoking, alcohol consumption and physical activity may be associated with concentrations of sex steroid hormones among adult men”
Quote in the paperSubstantial claim - Study design and conductown data
Mutual adjustment for other hormones was of particular importance.
“We found mutual adjustment for other hormones to be of particular importance.”
Quote in the paperSubstantial claim
- May combine two claims. 10
- Classified as probably not a substantial claim. 16
May combine two claims.
PremisecitationPrevious studies of cigarette smoking, alcohol consumption and physical activity with sex steroid hormones and SHBG levels in men were limited by small sample sizes, were restricted to older men, or both.
“Previous studies of cigarette smoking, alcohol consumption and physical activity with sex steroid hormones and SHBG levels in men were limited by small sample sizes [22], were restricted to older men [17], or both [20].”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [22] Barrett-Connor E, Khaw KT (1987) Cigarette smoking and increased endogenous estrogen levels in men. Am J Epidemiol 126:187–192 source
- cites [17] Muller M, den Tonkelaar I, Thijssen JH, Grobbee DE, van der Schouw YT (2003) Endogenous sex hormones in men aged 40–80 years. Eur J Endocrinol 149:583–589. doi: 10.1530/eje.0.1490583 source
- cites [20] Svartberg J, Jorde R (2007) Endogenous testosterone levels and smoking in men. The fifth Tromso study. Int J Androl 30:137–143. doi: 10.1111/j.1365-2605.2006.00720.x source
The citation is attached to “or both,” attributing to this paper a study that was both small and restricted to older men. Instead, the Introduction reports 3,427 men, and Subjects and methods says participants aged 30 and older were eligible. The paper’s discussion describes some *earlier* studies as small or involving older men; that does not describe this study. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAdiposity is a well-known modifiable predictor of sex steroid hormones in men.
“Adiposity is a well-known modifiable predictor of sex steroid hormones in men [14, 16–20]”
Quote in the paperNot a substantial claim1 of 6 sources checked- cites [14] Rohrmann S, Nelson WG, Rifai N, Brown TR, Dobs A, Kanarek N et al (2007) Serum estrogen, but not testosterone levels differ between black and white men in a nationally representative sample of Americans. J Clin Endocrinol Metab 92:2519–2525 source
- cites [16] Handa K, Ishii H, Kono S, Shinchi K, Imanishi K, Mihara H et al (1997) Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men. Atherosclerosis 130:37–44. doi: 10.1016/S0021-9150(96)06041-8 source
- cites [17] Muller M, den Tonkelaar I, Thijssen JH, Grobbee DE, van der Schouw YT (2003) Endogenous sex hormones in men aged 40–80 years. Eur J Endocrinol 149:583–589. doi: 10.1530/eje.0.1490583 source
- cites [18] Svartberg J, Midtby M, Bonaa KH, Sundsfjord J, Joakimsen RM, Jorde R (2003) The associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromso Study. Eur J Endocrinol 149:145–152. doi: 10.1530/eje.0.1490145 source
- cites [19] Tamimi R, Mucci LA, Spanos E, Lagiou A, Benetou V, Trichopoulos D (2001) Testosterone and oestradiol in relation to tobacco smoking, body mass index, energy consumption and nutrient intake among adult men. Eur J Cancer Prev 10:275–280. doi: 10.1097/00008469-200106000-00012 source
- cites [20] Svartberg J, Jorde R (2007) Endogenous testosterone levels and smoking in men. The fifth Tromso study. Int J Androl 30:137–143. doi: 10.1111/j.1365-2605.2006.00720.x source
The Subjects and methods section says waist circumference is associated with total and free testosterone, and the discussion calls anthropometric measurements strong predictors of testosterone levels. The paper supports adiposity-related measures as predictors of testosterone in men, but does not establish the broader claim about sex steroid hormones generally or test whether modifying adiposity changes hormone levels. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn previous NHANES III studies, low free and bioavailable testosterone were associated with type 2 diabetes.
“In previous studies published in NHANES III, low free and bioavailable testosterone were associated with type 2 diabetes [2]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [2] Selvin E, Feinleib M, Zhang L, Rohrmann S, Rifai N, Nelson WG et al (2007) Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care 30:234–238. doi: 10.2337/dc06-1579 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSex steroid hormone concentrations have been associated with health conditions in men, including prostate cancer, diabetes, low bone mineral density, lower urinary tract symptoms, impaired cognitive function, and cardiovascular disease.
“Sex steroid hormone concentrations have been previously shown to be associated with health conditions in men, including prostate cancer [1], diabetes [2, 3], low bone mineral density [4], lower urinary tract symptoms [5], impaired cognitive function [6, 7] and cardiovascular disease [8–10].”
Quote in the paperNot a substantial claim1 of 4 sources checked- cites [1] Platz EA, Giovannucci E (2004) The epidemiology of sex steroid hormones and their signaling and metabolic pathways in the etiology of prostate cancer. J Steroid Biochem Mol Biol 92:237–253. doi: 10.1016/j.jsbmb.2004.10.002 source
- cites [2] Selvin E, Feinleib M, Zhang L, Rohrmann S, Rifai N, Nelson WG et al (2007) Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care 30:234–238. doi: 10.2337/dc06-1579 source
- cites [3] Ding EL, Song Y, Malik VS, Liu S (2006) Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 295:1288–1299. doi: 10.1001/jama.295.11.1288 source
- cites [4] Paller CJ, Shiels MS, Rohrmann S, Basaria S, Rifai N, Nelson W et al (2009) Relationship of sex steroid hormones with bone mineral density in a nationally-representative sample of men. Clin Endocrinol (Oxf) 70:26–34. doi: 10.1111/j.1365-2265.2008.03300.x source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn some studies, current smokers had higher circulating concentrations of total testosterone, free testosterone, total estradiol and SHBG.
“In some studies, current smokers had higher circulating concentrations of total testosterone, free testosterone, total estradiol and sex hormone-binding globulin (SHBG) [16, 18–23]”
Quote in the paperNot a substantial claim1 of 7 sources checked- cites [16] Handa K, Ishii H, Kono S, Shinchi K, Imanishi K, Mihara H et al (1997) Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men. Atherosclerosis 130:37–44. doi: 10.1016/S0021-9150(96)06041-8 source
- cites [18] Svartberg J, Midtby M, Bonaa KH, Sundsfjord J, Joakimsen RM, Jorde R (2003) The associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromso Study. Eur J Endocrinol 149:145–152. doi: 10.1530/eje.0.1490145 source
- cites [19] Tamimi R, Mucci LA, Spanos E, Lagiou A, Benetou V, Trichopoulos D (2001) Testosterone and oestradiol in relation to tobacco smoking, body mass index, energy consumption and nutrient intake among adult men. Eur J Cancer Prev 10:275–280. doi: 10.1097/00008469-200106000-00012 source
- cites [20] Svartberg J, Jorde R (2007) Endogenous testosterone levels and smoking in men. The fifth Tromso study. Int J Androl 30:137–143. doi: 10.1111/j.1365-2605.2006.00720.x source
The Results (page unavailable) report higher total and free testosterone in current smokers than in never-smokers and a positive association between smoking and SHBG. The Subjects and methods section lists the hormones measured but not estradiol; our copy does not substantiate the claim about higher total estradiol. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [21] English KM, Pugh PJ, Parry H, Scutt NE, Channer KS, Jones TH (2001) Effect of cigarette smoking on levels of bioavailable testosterone in healthy men. Clin Sci 100:661–665. doi: 10.1042/CS20010011 source
- cites [22] Barrett-Connor E, Khaw KT (1987) Cigarette smoking and increased endogenous estrogen levels in men. Am J Epidemiol 126:187–192 source
- cites [23] Hackney AC, Fahrner CL, Gulledge TP (1998) Basal reproductive hormonal profiles are altered in endurance trained men. J Sports Med Phys Fitness 38:138–141
May combine two claims.
Findingown dataFormer smokers had lower total testosterone than never smokers, but the difference was not statistically significant (P=0.3).
“Former smokers appeared to have lower concentrations of both total and free testosterone than never smokers, although the differences were not statistically significant (P=0.3 and 0.6, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
May combine two claims.
Findingown dataFrequency of alcohol consumption was positively associated with total testosterone (P-trend=0.08), although not statistically significant.
“The frequency of alcohol consumption was positively associated with total testosterone (P-trend= 0.08) and free testosterone (P-trend=0.06), although these associations were not statistically significant.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
May combine two claims.
Findingown dataFormer smokers had lower free testosterone than never smokers, but the difference was not statistically significant (P=0.6).
“Former smokers appeared to have lower concentrations of both total and free testosterone than never smokers, although the differences were not statistically significant (P=0.3 and 0.6, respectively).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenLaboratory technicians were blinded to participant characteristics.
“Laboratory technicians were blinded to participant characteristics.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe association between alcohol consumption and sex steroid hormone concentrations has been inconsistent, with some evidence suggesting no association and other evidence supporting increased androstanediol glucuronide and estradiol and decreased SHBG with increased alcohol consumption.
“The association between alcohol consumption and sex steroid hormone concentrations has been inconsistent, with some evidence suggesting no association [16–19], and other evidence supporting increased levels of androstanediol glucuronide [16], and estradiol [17], and decreased levels of SHBG [18] with increased alcohol consumption.”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [16] Handa K, Ishii H, Kono S, Shinchi K, Imanishi K, Mihara H et al (1997) Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men. Atherosclerosis 130:37–44. doi: 10.1016/S0021-9150(96)06041-8 source
- cites [17] Muller M, den Tonkelaar I, Thijssen JH, Grobbee DE, van der Schouw YT (2003) Endogenous sex hormones in men aged 40–80 years. Eur J Endocrinol 149:583–589. doi: 10.1530/eje.0.1490583 source
- cites [18] Svartberg J, Midtby M, Bonaa KH, Sundsfjord J, Joakimsen RM, Jorde R (2003) The associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromso Study. Eur J Endocrinol 149:145–152. doi: 10.1530/eje.0.1490145 source
- cites [19] Tamimi R, Mucci LA, Spanos E, Lagiou A, Benetou V, Trichopoulos D (2001) Testosterone and oestradiol in relation to tobacco smoking, body mass index, energy consumption and nutrient intake among adult men. Eur J Cancer Prev 10:275–280. doi: 10.1097/00008469-200106000-00012 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe large sample size and the generalizability of these results to the adult United States male population are major strengths of this analysis.
“The large sample size and the generalizability of these results to the adult United States male population are major strengths of this analysis.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationMen with low free testosterone, low bioavailable testosterone, and low estradiol had a higher risk of mortality, while men with low SHBG had a lower risk of mortality.
“men with low free testosterone, low bioavailable testosterone, and low estradiol had a higher risk of mortality, while men with low SHBG had a lower risk of mortality [11]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Platz EA (2008) Low testosterone and risk of premature death in older men: analytical and preanalytical issues in measuring circulating testosterone. Clin Chem 54:1110–1112. doi: 10.1373/clinchem.2008.104901 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenReliance on self-report for many lifestyle factors may have led to misclassification.
“Reliance on self-report for many of the lifestyle factors may have led to misclassification.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenMorning sample participants were chosen for this hormone study to reduce variation due to diurnal production of sex hormones.
“Morning sample participants were chosen for this hormone study to reduce variation due to diurnal production of sex hormones.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEndurance athletes may have lower concentrations of free and total testosterone than non-athletes.
“Additionally, endurance athletes may have lower concentrations of free and total testosterone than non-athletes [24, 25].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [24] Maimoun L, Lumbroso S, Manetta J, Paris F, Leroux JL, Sultan C (2003) Testosterone is significantly reduced in endurance athletes without impact on bone mineral density. Horm Res 59:285–292. doi: 10.1159/000070627 source
- cites [25] Vermeulen A, Verdonck L, Kaufman JM (1999) A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666–3672. doi: 10.1210/jc.84.10.3666 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn previous NHANES III studies, increased androstanediol glucuronide and total estradiol were associated with lower urinary tract symptoms.
“increased androstanediol glucuronide and total estradiol were associated with lower urinary tract symptoms [5]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Rohrmann S, Nelson WG, Rifai N, Kanarek N, Basaria S, Tsilidis KK et al (2007) Serum sex steroid hormones and lower urinary tract symptoms in Third National Health and Nutrition Examination Survey (NHANES III). Urology 69:708–713. doi: 10.1016/j.urology.2007.01.011 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn previous NHANES III studies, low free estradiol and low free testosterone were associated with osteopenia.
“low free estradiol and low free testosterone were associated with osteopenia [4]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] Paller CJ, Shiels MS, Rohrmann S, Basaria S, Rifai N, Nelson W et al (2009) Relationship of sex steroid hormones with bone mineral density in a nationally-representative sample of men. Clin Endocrinol (Oxf) 70:26–34. doi: 10.1111/j.1365-2265.2008.03300.x source
Classified as probably not a substantial claim.
Study design and conductcitationThe study applied Phase I morning sampling weights to account for the complex NHANES sampling design, including unequal probabilities of selection, over-sampling, and non-response.
“In all analyses, we applied the Phase I morning sampling weights to account for the complex NHANES sampling design, including unequal probabilities of selection, over-sampling, and non-response [34].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ (1996) Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 88:1118–1126. doi: 10.1093/jnci/88.16.1118 source
Classified as probably not a substantial claim. May combine two claims.
Study design and conductown dataAll models included adjustment for age, race/ethnicity, percent body fat, mutual adjustment for other exposures of interest, and mutual adjustment for other hormones in quartiles.
“All models included terms for adjustment for age (continuous), race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican-American, other race/ethnicity), percent body fat (continuous), mutual adjustment for other exposures of interest”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThere may have been confounding by unrecognized factors associated with smoking, alcohol, physical activity and hormone concentrations.
“Additionally, there may have been confounding by unrecognized factors associated with smoking, alcohol, and physical activity and with hormone concentrations.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataIn this nationally-representative sample of men, smoking, alcohol and physical activity were associated with hormones and SHBG.
“In this nationally-representative sample of men, smoking, alcohol and physical activity were associated with hormones and SHBG”
Quote in the paperSubstantial claim- Rests on an assumption: The observed cross-sectional associations reflect effects of smoking, alcohol consumption, and physical activity on sex steroid hormone levels rather than reverse causation or residual confounding.
- Rests on an assumption: Self-reported smoking status accurately classifies lifetime and current smoking exposure.
- Rests on an assumption: Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
- Rests on an assumption: Self-reported physical activity accurately reflects usual physical activity.
- Rests on an assumption: Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAge and race are well-established, non-modifiable predictors of sex steroid hormone concentrations in men.
“Age [13, 14] and race [13–15] are well-established, but non-modifiable, predictors of sex steroid hormone concentrations in men.”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [13] Ukkola O, Gagnon J, Rankinen T, Thompson PA, Hong Y, Leon AS et al (2001) Age, body mass index, race and other determinants of steroid hormone variability: the HERITAGE Family Study. Eur J Endocrinol 145:1–9. doi: 10.1530/eje.0.1450001 source
- cites [14] Rohrmann S, Nelson WG, Rifai N, Brown TR, Dobs A, Kanarek N et al (2007) Serum estrogen, but not testosterone levels differ between black and white men in a nationally representative sample of Americans. J Clin Endocrinol Metab 92:2519–2525 source
- cites [15] Allen NE, Appleby PN, Davey GK, Key TJ (2002) Lifestyle and nutritional determinants of bioavailable androgens and related hormones in British men. Cancer Causes Control 13:353–363. doi: 10.1023/A:1015238102830 source
May combine two claims.
PremisecitationFew studies have addressed the association between physical activity and hormone levels, with inconsistent findings.
“Few studies have addressed the association between physical activity and hormone levels, with inconsistent findings [16–19].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [16] Handa K, Ishii H, Kono S, Shinchi K, Imanishi K, Mihara H et al (1997) Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men. Atherosclerosis 130:37–44. doi: 10.1016/S0021-9150(96)06041-8 source
- cites [17] Muller M, den Tonkelaar I, Thijssen JH, Grobbee DE, van der Schouw YT (2003) Endogenous sex hormones in men aged 40–80 years. Eur J Endocrinol 149:583–589. doi: 10.1530/eje.0.1490583 source
- cites [18] Svartberg J, Midtby M, Bonaa KH, Sundsfjord J, Joakimsen RM, Jorde R (2003) The associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromso Study. Eur J Endocrinol 149:145–152. doi: 10.1530/eje.0.1490145 source
- cites [19] Tamimi R, Mucci LA, Spanos E, Lagiou A, Benetou V, Trichopoulos D (2001) Testosterone and oestradiol in relation to tobacco smoking, body mass index, energy consumption and nutrient intake among adult men. Eur J Cancer Prev 10:275–280. doi: 10.1097/00008469-200106000-00012 source
The paper relies on this without support.
The observed cross-sectional associations reflect effects of smoking, alcohol consumption, and physical activity on sex steroid hormone levels rather than reverse causation or residual confounding.
“If these lifestyle factors are shown to be associated with sex steroid hormone concentrations among men, they should be considered as possible confounders or upstream variables (variables that are related to the outcome only via their influence on sex steroid hormones) in future studies of hormones and men’s health.”
The paper relies on this without support.
Self-reported smoking status accurately classifies lifetime and current smoking exposure.
“Participants were classified as never, former and current smokers based on self-reported smoking habits”
The paper relies on this without support.
Self-reported alcohol consumption frequency from the food frequency questionnaire accurately reflects usual alcohol intake.
“Frequency of alcohol consumption was measured by a food frequency questionnaire.”
The paper relies on this without support.
Self-reported physical activity accurately reflects usual physical activity.
“A standardized scheme [30] was utilized to code and classify each reported physical activity by rate of energy expenditure.”
The paper relies on this without support.
Stored serum samples assayed in 2005 provide valid measurements of hormone concentrations at the time of the survey.
“Stored serum samples, which had been aliquotted and stored at −70°C since the time of the survey, were assayed for sex steroid hormones at the Children’s Hospital Boston, MA.”
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?
Age, cigarette smoking, BMI, alcohol consumption and physical activity have been reported to be probably or possibly associated with hormone levels.
“Probable and possible associations of several factors, including age, cigarette smoking, body mass index (BMI), alcohol consumption and physical activity with hormone levels have been reported. 11-17”
From Cigarette smoking has a positive and independent effect on testosterone levels (2013) · cites this paper as [13]
The reported effects of smoking on testosterone levels in men are controversial, with some evidence suggesting no association and others reporting higher or lower total testosterone levels among smokers compared to nonsmokers.
“However, the reported effects of smoking on testosterone levels in men are controversial, with some evidence even suggesting no association 15,19-24 and others reporting higher 13,14,25-32 or lower 33,34 levels of TT among smokers compared to nonsmokers.”
From Cigarette smoking has a positive and independent effect on testosterone levels (2013) · cites this paper as [13]
Male cigarette smokers have higher testosterone levels compared to non-smokers.
“It is well known that male cigarette smokers have higher testosterone levels compared to non-smokers, however, the mechanism behind this is debated (Shiels et al., 2009;Holmboe et al., 2015).”
From Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population (2020) · cites this paper as Shiels et al., 2009
It has previously been shown that testosterone levels were different for smokers and non-smokers but within the group of smokers, testosterone levels did not differ according to number of cigarettes smoked per day.
“However, it has previously been shown that testosterone levels were different for smokers and non-smokers but within the group of smokers, testosterone levels did not differ according to number of cigarettes smoked per day (Shiels et al., 2009)”
From Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population (2020) · cites this paper as Shiels et al., 2009
Previous studies have shown that smokers have significantly higher levels of TST and EST than non-smokers.
“previous studies have shown that smokers have significantly higher levels of TST and EST than non-smokers [16–19]”
From Associations between smoking, sex steroid hormones, trouble sleeping, and depression among U.S. adults: a cross-sectional study from NHANES (2013–2016) (2024) · cites this paper as [19]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Physical-activity trend described as both significant and nonsignificant
MajorThe abstract reports a significant trend for total testosterone across physical-activity levels (P-trend=0.01), while the Results state that the trends across activity levels were not statistically significant.
“Physical activity was positively associated with total (P-trend=0.01) and free testosterone (P-trend=0.05).”
“although the trends in concentrations across activity levels were not statistically significant (table 4).”
Alcohol-associated SHBG change reverses direction in Discussion
MinorThe Results report lower SHBG among men drinking at least once a day, but the Discussion calls the change an increase in SHBG in this study.
“However, the increase in SHBG seen in our study occurred at a low level of alcohol consumption, thus it is unlikely that it is due to liver damage.”
“men with usual intake of at least one drink per day had lower concentrations of SHBG than men who consumed 0 to 6 drinks/week (31.5 vs. 34.8 nmol/L, P=0.01)”
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- Authors
- Shiels, M. S., Rohrmann, S., Menke, A., Selvin, E., Crespo, C. J., Rifai, N., Dobs, A., Feinleib, M., Guallar, E., & Platz, E. A.
- Affiliations
- Johns Hopkins University (US)
- German Cancer Research Center (DE)
- Portland State University (US)
- Boston Children's Hospital (US)
- Corresponding author
- Platz, Elizabeth A.
- ORCID
- Venue
- Cancer Causes & Control
- Published
- 2009-03-10
- Volume
- 20
- Issue
- 6
- Pages
- 877-886
- ISSN
- 0957-5243 (ISSN-L)
- 1573-7225
- PMC
- PMC3004151
- OpenAlex
- W1965390566
- Semantic Scholar
- df854099339168b23f3ce761777bc99cac2f2644
- Cited by
- 166
- References
- 42
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 7 · 2023: 18 · 2022: 6 · 2021: 20 · 2020: 14 · 2019: 7 · 2018: 7 · 2017: 4 · 2016: 9 · 2015: 14 · 2014: 12 · 2013: 16 · 2012: 11
- FWCI
- 6.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Cancer Causes & Control (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Johns Hopkins University
- National Institute for Health and Care Research
- National Institutes of Health
- National Cancer Institute (T32CA009314)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK076595)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- cigarette smoking, alcohol consumption, physical activity, sex hormones, testosterone, estradiol, sex hormone-binding globulin, free testosterone, free estradiol, men's health, prostate cancer, NHANES III
- MeSH terms
- Adult, Alcohol Drinking, Estradiol, Humans, Male, Motor Activity, Nutrition Surveys, Sex Hormone-Binding Globulin, Smoking, Testosterone, United States, Linear Models, Age Distribution
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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.
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