The Relative Contributions of Aging, Health, and Lifestyle Factors to Serum Testosterone Decline in Men
Abstract
Context: Although it is known that serum testosterone (T) concentrations decline with age, the relative contributions of changes in health and lifestyle to that decline have not been adequately assessed. Objective: The objective of this study was to establish the relative importance of aging, health, and lifestyle in contributing to male T decline. Design: A prospective cohort study of health and endocrine functioning in randomly selected men with a baseline visit (T1, 1987–1989) and two follow-up visits (T2, 1995–1997; T3, 2002–2004) was conducted. Setting: An observational study of men residing in greater Boston, Massachusetts, was conducted. Participants: Participants included 1667 men aged 40 to 70 at baseline; follow-up was conducted on 947 (57%) and 584 (35%) at T2 and T3, respectively. Main Outcome Measures: Main outcome measures included total serum T, calculated free T (FT), and SHBG. Results: There were substantial declines in total serum T and FT levels associated with aging alone. However, many health and lifestyle changes were associated with accelerated decline. A 4- to 5-kg/m2 increase in body mass index or loss of spouse was associated with declines in total serum T comparable to that associated with approximately 10 yr of aging. Results were similar for FT, but fewer factors were associated with SHBG after age was taken into account. Conclusions: Both chronological aging and changes in health and lifestyle factors are associated with declines in serum T. Comorbidities and lifestyle influences may be as strongly associated with declining T levels as is aging itself over the short- to midterm. These results suggest the possibility that age-related hormone decline may be decelerated through the management of health and lifestyle factors.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
The Massachusetts Male Aging Study reported that an increase in body mass index of 4 to 5 kg/m2 was associated with a comparable decline in total serum testosterone levels as 10 years of ageing.
“The Massachusetts Male Aging Study reported that an increase in body mass index of 4 to 5 kg/m2 was associated with a comparable decline in total serum testosterone levels as 10 years of ageing [18].”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [18]
Obese men are prone to lower total T as well as lower SHBG concentrations, implying a substantial risk for misclassification when using 'normal' reference ranges.
“Imposed by their obese status, these men are prone to lower total T as well as lower SHBG concentrations, implying a substantial risk for misclassification when using ‘normal’ reference ranges [180, 181].”
From Role of sex hormone-binding globulin in the free hormone hypothesis and the relevance of free testosterone in androgen physiology (2022) · cites this paper as [181]
Numerous studies have consistently found age-dependent decreases in testosterone.
“Numerous studies have consistently identified age-dependent decreases in T.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [36]
In a cohort of 456 men aged 19-40 from the Framingham Heart Study Generation 3, mean total testosterone was 724 ng/dl, with upper and lower intervals of 1197 and 348 ng/dl.
“Mean TT was 724 ng/dl (25.1 nmol/L), with upper (97.5%) and lower (2.5%) intervals noted to be 1197 and 348 ng/dl (41.5 and 12.1 nmol/L), respectively.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [36]
A study of non-obese healthy men aged 19-40 from the Framingham Heart Study reported calculated free testosterone levels of 70 pg/ml.
“A second study of non-obese healthy men aged 19–40 years from the Framingham Heart Study reported calculated fT levels of 70 pg/ml (242.7 pmol/L).”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [36]
In men, total testosterone declines at about 1% per year and free testosterone at about 2% per year.
“The decline in total and free T levels in men occurs at a rate of approximately 1% and 2% per year, respectively (Figure 1A).33, 34”
From Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications (2021) · cites this paper as [34]
In large prospective observational studies, weight gain and development of comorbidities were consistently associated with an acceleration of the age-related decline in testosterone levels.
“In large prospective observational studies, weight gain and development of comorbidities were consistently associated with an acceleration of the age-related decline in testosterone levels (17, 18).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [17]
A 4 to 5 kg/m2 increase in BMI or an incident chronic disease such as type 2 diabetes is associated with declines in testosterone levels equivalent to 10 years of aging.
“A 4 to 5 kg⁄m2 increase in body mass index (BMI) or an incident chronic disease such as type 2 diabetes is associated with declines in testosterone levels equivalent to 10 years of aging (17).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [17]
Cites
A Critical Evaluation of Simple Methods for the Estimation of Free Testosterone in Serum
Vermeulen, A., Verdonck, L., & Kaufman, J. M. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.10.6079 · Cited by 3,824 · see citing works
Feldman, H. A., Longcope, C., Derby, C. A., Johannes, C. B., Araujo, A. B., Coviello, A. D., Bremner, W. J., & McKinlay, J. B. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.2.8201 · Cited by 1,861 · see citing works
Self-citationStellato, R. K., Feldman, H. A., Hamdy, O., Horton, E. S., & McKinlay, J. B. (2000) · Diabetes Care · doi:10.2337/diacare.23.4.490 · Cited by 618 · see citing works
Self-citationAraujo, A. B., O’Donnell, A. B., Brambilla, D. J., Simpson, W. B., Longcope, C., Matsumoto, A. M., & McKinlay, J. B. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031719 · Cited by 591 · see citing works
Self-citationKupelian, V., Page, S. T., Araujo, A. B., Travison, T. G., Bremner, W. J., & McKinlay, J. B. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1326 · Cited by 561 · see citing works
Self-citationModifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?
Derby, C. A., Mohr, B. A., Goldstein, I., Feldman, H. A., Johannes, C. B., & McKinlay, J. B. (2000) · Urology · doi:10.1016/s0090-4295(00)00614-2 · Cited by 552 · see citing works
Self-citationFerrini, R. L., & Barrett-Connor, E. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009519 · Cited by 473 · see citing works
Vermeulen, A. (1996) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.81.5.1821 · Cited by 455 · see citing works
Field, A. E., Colditz, G. A., Willett, W. C., Longcope, C., & McKinlay, J. B. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.79.5.7962322 · Cited by 421 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., & Montori, V. M. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2354 · Cited by 1,954 · see citing works
Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-00229 · Cited by 1,736 · see citing works
Identification of late-onset hypogonadism in middle-aged and elderly men
Wu, F. C. W., Tajar, A., Beynon, J. M., Pye, S. R., Silman, A. J., Finn, J. D., O'Neill, T. W., Bartfai, G., Casanueva, F. F., Forti, G., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0911101 · Cited by 1,544 · see citing works
Wu, F. C. W., Tajar, A., Pye, S. R., Silman, A. J., Finn, J. D., O'Neill, T. W., Bartfai, G., Casanueva, F., Forti, G., Giwercman, A., et al. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1972 · Cited by 939 · see citing works
Tajar, A., Forti, G., O'Neill, T. W., Lee, D. M., Silman, A. J., Finn, J. D., Bartfai, G., Boonen, S., Casanueva, F. F., Giwercman, A., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1796 · Cited by 604 · see citing works
Testosterone treatment and mortality in men with low testosterone levels
Shores, M. M., Smith, N. L., Forsberg, C. W., Anawalt, B. D., & Matsumoto, A. M. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2591 · Cited by 460 · see citing works
Camacho, E. M., Huhtaniemi, I. T., O'Neill, T. W., Finn, J. D., Pye, S. R., Lee, D. M., Tajar, A., Bartfai, G., Boonen, S., Casanueva, F. F., et al. (2013) · European Journal of Endocrinology · doi:10.1530/eje-12-0890 · Cited by 392 · see citing works
Low Testosterone in Men with Type 2 Diabetes: Significance and Treatment
Grossmann, M. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0118 · Cited by 350 · see citing works
Travison, T. G., Vesper, H. W., Orwoll, E., Wu, F., Kaufman, J. M., Wang, Y., Lapauw, B., Fiers, T., Matsumoto, A. M., & Bhasin, S. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2935 · Cited by 326 · see citing works
Self-citationBasaria, S. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61126-5 · Cited by 328 · see citing works
Lowered testosterone in male obesity: Mechanisms, morbidity and management
Grossmann, M., Tang Fui, M., & Dupuis, P. (2014) · Asian Journal of Andrology · doi:10.4103/1008-682x.122365 · Cited by 293 · see citing works
Allan, C. A., Strauss, B. J. G., Burger, H. G., Forbes, E. A., & McLachlan, R. I. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1291 · Cited by 298 · see citing works
Grossmann, M., & Matsumoto, A. M. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-3580 · Cited by 246 · see citing works
Genetic determinants of serum testosterone concentrations in men
Ohlsson, C., Wallaschofski, H., Lunetta, K. L., Stolk, L., Perry, J. R. B., Koster, A., Petersen, A.-K., Eriksson, J., Lehtimäki, T., Huhtaniemi, I. T., et al. (2011) · PLoS Genetics · doi:10.1371/journal.pgen.1002313 · Cited by 224 · see citing works
Endocrine Aspects of Male Sexual Dysfunctions
Buvat, J., Maggi, M., Gooren, L., Guay, A. T., Kaufman, J., Morgentaler, A., Schulman, C., Tan, H. M., Torres, L. O., Yassin, A., et al. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01780.x · Cited by 221 · see citing works
Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications
Pataky, M. W., Young, W. F., & Nair, K. S. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.07.033 · Cited by 207 · see citing works
Antonio, L., Wu, F. C. W., O'Neill, T. W., Pye, S. R., Ahern, T. B., Laurent, M. R., Huhtaniemi, I. T., Lean, M. E. J., Keevil, B. G., Rastrelli, G., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4106 · Cited by 174 · see citing works
Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample
Hall, S. A., Esche, G. R., Araujo, A. B., Travison, T. G., Clark, R. V., Williams, R. E., & McKinlay, J. B. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0021 · Cited by 167 · see citing works
Self-citationLongitudinal changes in testosterone over five years in community-dwelling men
Shi, Z., Araujo, A. B., Martin, S., O'Loughlin, P., & Wittert, G. A. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-3842 · Cited by 165 · see citing works
Allan, C. A., & McLachlan, R. I. (2010) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0b013e3283398ee2 · Cited by 168 · see citing works
Hypogonadism and male obesity: Focus on unresolved questions
Grossmann, M. (2018) · Clinical Endocrinology · doi:10.1111/cen.13723 · Cited by 164 · see citing works
Saad, F., Aversa, A., M. Isidori, A., & J. Gooren, L. (2012) · Current Diabetes Reviews · doi:10.2174/157339912799424573 · Cited by 148 · see citing works
Hormone Replacement Therapy and Physical Function in Healthy Older Men. Time to Talk Hormones?
Giannoulis, M. G., Martin, F. C., Nair, K. S., Umpleby, A. M., & Sonksen, P. (2012) · Endocrine Reviews · doi:10.1210/er.2012-1002 · Cited by 132 · see citing works
Narinx, N., David, K., Walravens, J., Vermeersch, P., Claessens, F., Fiers, T., Lapauw, B., Antonio, L., & Vanderschueren, D. (2022) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-022-04562-1 · Cited by 96 · see citing works
Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy
Ide, V., Vanderschueren, D., & Antonio, L. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms22010021 · Cited by 101 · see citing works
Eriksson, J., Haring, R., Grarup, N., Vandenput, L., Wallaschofski, H., Lorentzen, E., Hansen, T., Mellström, D., Pedersen, O., Nauck, M., et al. (2017) · PLOS ONE · doi:10.1371/journal.pone.0176277 · Cited by 101 · see citing works
Trost, L. W., & Mulhall, J. P. (2016) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2016.04.068 · Cited by 98 · see citing works
Hypogonadism in the HIV-infected man
Rochira, V., & Guaraldi, G. (2014) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2014.06.005 · Cited by 95 · see citing works
Travison, T. G., Shackelton, R., Araujo, A. B., Hall, S. A., Williams, R. E., Clark, R. V., O'Donnell, A. B., & McKinlay, J. B. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01679.x · Cited by 89 · see citing works
Self-citationThe prevalence of and risk factors for androgen deficiency in aging Taiwanese men
Liu, C.-C., Wu, W.-J., Lee, Y.-C., Wang, C.-J., Ke, H.-L., Li, W.-M., Hsiao, H.-L., Yeh, H.-C., Li, C.-C., Chou, Y.-H., et al. (2009) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2008.01171.x · Cited by 82 · see citing works
Koncarevic, A., Cornwall-Brady, M., Pullen, A., Davies, M., Sako, D., Liu, J., Kumar, R., Tomkinson, K., Baker, T., Umiker, B., et al. (2010) · Endocrinology · doi:10.1210/en.2010-0134 · Cited by 71 · see citing works
Body composition, metabolic syndrome and testosterone in ageing men
Allan, C. A., Strauss, B. J. G., & McLachlan, R. I. (2007) · International Journal of Impotence Research · doi:10.1038/sj.ijir.3901552 · Cited by 67 · see citing works
The Emerging Link Between Hypogonadism and Metabolic Syndrome
Guay, A. T. (2009) · Journal of Andrology · doi:10.2164/jandrol.108.006015 · Cited by 50 · see citing works
Travison, T. G., Zhuang, W. V., Lunetta, K. L., Karasik, D., Bhasin, S., Kiel, D. P., Coviello, A. D., & Murabito, J. M. (2014) · Clinical Endocrinology · doi:10.1111/cen.12260 · Cited by 41 · see citing works
Damgaard–Olesen, A., Johannsen, T. H., Holmboe, S. A., Søeborg, T., Petersen, J. H., Andersson, A., Aadahl, M., Linneberg, A., & Juul, A. (2016) · Clinica Chimica Acta · doi:10.1016/j.cca.2015.12.042 · Cited by 39 · see citing works
Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery
Sultan, S., Patel, A. G., El-Hassani, S., Whitelaw, B., Leca, B. M., Vincent, R. P., le Roux, C. W., Rubino, F., Aywlin, S. J. B., & Dimitriadis, G. K. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.00408 · Cited by 39 · see citing works
Testosterone administration in older men
Matsumoto, A. M. (2013) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2013.02.011 · Cited by 32 · see citing works
Haring, R., Xanthakis, V., Coviello, A., Sullivan, L., Bhasin, S., Wallaschofski, H., Murabito, J. M., & Vasan, R. S. (2012) · International Journal of Andrology · doi:10.1111/j.1365-2605.2012.01285.x · Cited by 22 · see citing works
Testosterone therapy in older men with late-onset hypogonadism: a counter-rationale
Basaria, S. (2013) · Endocrine Practice · doi:10.4158/ep13318.ra · Cited by 18 · see citing works
Certainly More Guidelines than Rules
McLachlan, R. I. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0838 · Cited by 18 · see citing works
- Authors
- Travison, T. G., Araujo, A. B., Kupelian, V., O’Donnell, A. B., & McKinlay, J. B.
- Affiliations
- New England Research Institutes (US)
- New England Research Institutes, Watertown, Massachusetts 02472
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-12-05
- Volume
- 92
- Issue
- 2
- Pages
- 549-555
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2079711628
- Cited by
- 410
- References
- 10
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 19 · 2023: 18 · 2022: 17 · 2021: 19 · 2020: 18 · 2019: 14 · 2018: 22 · 2017: 22 · 2016: 22 · 2015: 23 · 2014: 35 · 2013: 26 · 2012: 30
- FWCI
- 11.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (7p01ag004673-05)
- National Institute on Aging (AG 04673)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 51345, R01DK044995, DK44995, R01DK051345)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- male hypogonadism, aging, body mass index, obesity, death of a spouse, comorbidities, lifestyle factors, free testosterone, sex hormone-binding globulin
- MeSH terms
- Adult, Aged, Aging, Boston, Endocrine System, Health Status, Humans, Hypogonadism, Life Style, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Sex Hormone-Binding Globulin, Testosterone, Cohort Studies
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
