Excessive testosterone raises mortality risk in older men

Older men whose testosterone levels were neither low nor high tended to live longer, according to new research accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Testosterone is a key male sex hormone involved in maintaining sex drive, sperm production and bone health. Physicians have long known that low testosterone levels can signal health problems, but the new study found men may not fare better when levels of the hormone rise too high.

"Older men who had testosterone in the middle range survived longer than their counterparts who had either low or high levels of the hormone," said the study's lead author, Bu Beng Yeap, MBBS, FRACP, PhD, of the University of Western Australia, based in Fremantle Hospital, Western Australia. "When the body metabolizes testosterone, it produces dihydrotestosterone (DHT), which is tied to a lower risk of dying from ischemic heart disease. Having the right amount of testosterone and higher levels of DHT might indicate these men are in better health overall, or it could help them maintain good health as they grow older."

The population-based cohort study analyzed the mortality rate in a group of 3,690 community-dwelling men between the ages of 70 to 89 in Perth, Western Australia. Participants' testosterone and DHT levels were measured between 2001 and 2004. Researchers analyzed the group's survival rate as of December 2010.

Researchers divided the men into four groups based on their testosterone levels. Men with the lowest testosterone levels had the highest cumulative mortality rate, followed by the men with the highest testosterone levels. Men with circulating testosterone levels in the 9.8 to 15.8 nmol/L range tended to live longer.

"Sex hormones are an important predictor of mortality in older men, but we haven't determined if treatments to change testosterone and DHT levels can alter these outcomes," Yeap said. "Additional research into these findings, including randomized clinical trials, could help identify ways to leverage this information to improve health in older men."

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Other authors of the study include: H. Alfonso, S.A.P. Chubb, G.J. Hankey, O.P. Almeida, P.E. Norman and L. Flicker of the University of Western Australia; D.J. Handelsman of the University of Sydney; and J. Golledge of James Cook University in Townsville, Queensland, Australia.

The study, "In Older Men an Optimal Plasma Testosterone is Associated with Reduced All-Cause Mortality, and Higher Dihydrotestosterone with Reduced Ischaemic Heart Disease Mortality, while Estradiol Levels Do Not Predict Mortality," was published online, ahead of print.

Founded in 1916, The Endocrine Society is the world's oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 16,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland.