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    In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality

    Access Status
    Open access via publisher
    Authors
    Yeap, B.
    Alfonso, Helman
    Paul Chubb, S.
    Handelsman, D.
    Hankey, G.
    Almeida, O.
    Golledge, J.
    Norman, P.
    Flicker, L.
    Date
    2014
    Type
    Journal Article
    
    Metadata
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    Citation
    Yeap, B. and Alfonso, H. and Paul Chubb, S. and Handelsman, D. and Hankey, G. and Almeida, O. and Golledge, J. et al. 2014. In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. Journal of Clinical Endocrinology and Metabolism. 99 (1).
    Source Title
    Journal of Clinical Endocrinology and Metabolism
    DOI
    10.1210/jc.2013-3272
    ISSN
    0021-972X
    School
    Epidemiology and Biostatistics
    URI
    http://hdl.handle.net/20.500.11937/29256
    Collection
    • Curtin Research Publications
    Abstract

    Context: Testosterone (T) levels decline with age and lower T has been associated with increased mortality in aging men. However, the associations of its metabolites, dihydrotestosterone (DHT) and estradiol (E2), with mortality are poorly defined. Objective: We assessed associations of T, DHT, and E2 with all-cause and ischemic heart disease (IHD) mortality in older men. Participants: Participants were community-dwelling men aged 70 to 89 years who were residing in Perth, Western Australia. Main Outcome Measures: Plasma total T, DHT, and E2 were assayed using liquid chromatographytandem mass spectrometry in early morning samples collected in 2001 to 2004 from 3690 men. Deaths to December 2010 were ascertained by data linkage. Results: There were 974 deaths (26.4%), including 325 of IHD. Men who died had lower baseline T (12.8 ± 5.1 vs 13.2 ± 4.8 nmol/L [mean ± SD], P = .013), DHT (1.4 ± 0.7 vs 1.5 ± 0.7 nmol/L, P = .002), and E2 (71.6 ± 29.3 vs 74.0 ± 29.0 pmol/L, P = .022). After allowance for other risk factors, T and DHT were associated with all-cause mortality (T: quartile [Q] Q2:Q1, adjusted hazard ratio [HR] = 0.82, P = .033; Q3:Q1, HR = 0.78, P = .010; Q4:Q1, HR = 0.86, P > .05; DHT: Q3:Q1, HR = 0.76, P = .003; Q4:Q1, HR=0.84, P > .05). Higher DHT was associated with lower IHD mortality (Q3:Q1, HR = 0.58, P = .002; Q4:Q1, HR = 0.69, P = .026). E2 was not associated with either all-cause or IHD mortality. Conclusions: Optimal androgen levels are abiomarker for survival because older men with midrange levels of T and DHT had the lowest death rates from any cause, whereas those with higher DHT had lower IHD mortality. Further investigations of the biological basis for these associations including randomized trials of T supplementation are needed. (J Clin Endocrinol Metab 99: E9-E18, 2014). © Copyright 2014 by The Endocrine Society.

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