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Type: Journal article
Title: Endogenous testosterone and mortality in men: A systematic review and meta-analysis
Author: Araujo, A.
Dixon, J.
Suarez, E.
Murad, M.
Guey, L.
Wittert, G.
Citation: Journal of Clinical Endocrinology and Metabolism, 2011; 96(10):3007-3019
Publisher: Endocrine Society
Issue Date: 2011
ISSN: 0021-972X
Statement of
Andre B. Araujo, Julia M. Dixon, Elizabeth A. Suarez, M. Hassan Murad, Lin T. Guey, and Gary A. Wittert
Abstract: <h4>Context</h4>Low testosterone levels have been associated with outcomes that reduce survival in men.<h4>Objective</h4>Our objective was to perform a systematic review and meta-analysis of published studies to evaluate the association between endogenous testosterone and mortality.<h4>Data sources</h4>Data sources included MEDLINE (1966 to December 2010), EMBASE (1988 to December 2010), and reference lists.<h4>Study selection</h4>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.<h4>Data extraction</h4>Reviewers working independently and in duplicate determined methodological quality of studies and extracted descriptive, quality, and outcome data.<h4>Data synthesis</h4>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).<h4>Conclusion</h4>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).
Keywords: Humans
Cardiovascular Diseases
Body Mass Index
Cause of Death
Risk Assessment
Age Factors
Middle Aged
United States
Meta-Analysis as Topic
Rights: Copyright © 2011 by The Endocrine Society
DOI: 10.1210/jc.2011-1137
Grant ID: ARC
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