Cited by 167Hormonal and reproductive studiesSperm and Testicular FunctionPhysical Activity and Health

The DOI matches its Crossref record; 42 of the 42 references it cites were found in a registry or an index; 5 of the 38 sources its claims cite were checked for support.

Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men

Open access

Abstract

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.

Overview

AI snapshot

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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Integrity signals

Registry

Crossref · 10.1007/s10552-009-9318-y

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

77 Own result · 9 Own method · 8 No full text of the sources · 5 Own interpretation · 2 Partly supported · 2 No basis given · 1 Supported · 1 Supported so far · 1 Not supported · accuracy not yet measured

  • It may state two separate claims as one. 10
  • Probably not a substantial claim. 16
23 of 23
  • 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.”
5 of 5

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Metadata

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.
Venue
Cancer Causes & Control
Published
2009-03-10
Volume
20
Issue
6
Pages
877-886
ISSN
  • 0957-5243 (ISSN-L)
  • 1573-7225
OpenAlex
W1965390566
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
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 › Public Health, Environmental and Occupational Health › 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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