Endogenous Testosterone and Mortality in Men: A Systematic Review and Meta-Analysis
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CONTEXT: Low testosterone levels have been associated with outcomes that reduce survival in men. OBJECTIVE: Our objective was to perform a systematic review and meta-analysis of published studies to evaluate the association between endogenous testosterone and mortality. DATA SOURCES: Data sources included MEDLINE (1966 to December 2010), EMBASE (1988 to December 2010), and reference lists. STUDY SELECTION: Eligible studies were published English-language observational studies of men that reported the association between endogenous testosterone and all-cause or cardiovascular disease (CVD) mortality. A two-stage process was used for study selection. 1) Working independently and in duplicate, reviewers screened a subset (10%) of abstracts. Results indicated 96% agreement, and thereafter, abstract screening was conducted in singlicate. 2) All full-text publications were reviewed independently and in duplicate for eligibility. DATA EXTRACTION: Reviewers working independently and in duplicate determined methodological quality of studies and extracted descriptive, quality, and outcome data. DATA SYNTHESIS: Of 820 studies identified, 21 were included in the systematic review, and 12 were eligible for meta-analysis [n = 11 studies of all-cause mortality (16,184 subjects); n = 7 studies of CVD mortality (11,831 subjects)]. Subject mean age and testosterone level were 61 yr and 487 ng/dl, respectively, and mean follow-up time was 9.7 yr. Between-study heterogeneity was observed among studies of all-cause (P < .001) and CVD mortality (P = 0.06), limiting the ability to provide valid summary estimates. Heterogeneity in all-cause mortality (higher relative risks) was observed in studies that included older subjects (P = 0.020), reported lower testosterone levels (P = 0.018), followed subjects for a shorter time period (P = 0.010), and sampled blood throughout the day (P = 0.030). CONCLUSION: Low endogenous testosterone levels are associated with increased risk of all-cause and CVD death in community-based studies of men, but considerable between-study heterogeneity, which was related to study and subject characteristics, suggests that effects are driven by differences between cohorts (e.g. in underlying health status).
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- Authors
- Araujo, A. B., Dixon, J. M., Suarez, E. A., Murad, M. H., Guey, L. T., & Wittert, G. A.
- Affiliations
- New England Research Institutes (US)
- Mayo Clinic (US)
- The University of Adelaide (AU)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-10
- Volume
- 96
- Issue
- 10
- Pages
- 3007-3019
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3200249
- OpenAlex
- W1987977957
- Cited by
- 671
- References
- 65
- Citations by year
- 2026: 16 · 2025: 31 · 2024: 31 · 2023: 44 · 2022: 52 · 2021: 42 · 2020: 43 · 2019: 40 · 2018: 43 · 2017: 57 · 2016: 47 · 2015: 55 · 2014: 64 · 2013: 61 · 2012: 43
- FWCI
- 7.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Eli Lilly and Company
- New England Research Institutes
- National Institutes of Health
- Medical Research Council
- Australian Research Council
- National Health and Medical Research Council
- National Institute on Aging (R01AG020727)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- endogenous testosterone, androgen deficiency, all-cause mortality, cardiovascular mortality, men, study heterogeneity, community-based cohort
- MeSH terms
- Adult, Age Factors, Aged, Cardiovascular Diseases, Cause of Death, Humans, Male, Middle Aged, Mortality, Smoking, Survival, Testosterone, United States, Meta-Analysis as Topic, Body Mass Index, Risk Assessment
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