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Endogenous Testosterone and Mortality in Men A Systematic Review and Meta-Analysis


, : Endogenous Testosterone and Mortality in Men A Systematic Review and Meta-Analysis. The Journal of Clinical Endocrinology & Metabolism 96(10): 3007-3019

Low testosterone levels have been associated with outcomes that reduce survival in men.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 21), EMBASE (1988 to December 21), 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 (1%) of abstracts. 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 82 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 < .1) and CVD mortality (P = .6), 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 = .2), reported lower testosterone levels (P = .18), followed subjects for a shorter time period (P = .1), and sampled blood throughout the day (P = .3).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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