Low serum testosterone and mortality in male veterans

Background: Low serum testosterone is a common condition in aging associated with decreased muscle mass and insulin resistance. This study evaluated whether low testosterone levels are a risk factor for mortality in male veterans. Methods: We used a clinical database to identify men older than 40 years with repeated testosterone levels obtained from October 1, 1994, to December 31, 1999, and without diagnosed prostate cancer. A low testosterone level was a total testosterone level of less than 250 ng/dL (< 8.7 nmol/L) or a free testosterone level of less than 0.75 ng/dL (< 0.03 nmol/L). Men were classified as having a low testosterone level ( 166 [ 19.3%]), an equivocal testosterone level ( equal number of low and normal levels) ( 240 [ 28.0%]), or a normal testosterone level ( 452 [ 52.7%]). The risk for all-cause mortality was estimated using Cox proportional hazards regression models, adjusting for demographic and clinical covariates over a follow-up of up to 8 years. Results: Mortality in men with normal testosterone levels was 20.1%( 95% confidence interval [ CI], 16.2%-24.1%) vs 24.6%( 95% CI, 19.2%-30.0%) in men with equivocal testosterone levels and 34.9% ( 95% CI, 28.5%-41.4%) in men with low testosterone levels. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality ( hazard ratio, 1.88; 95% CI, 1.34-2.63; P < . 001) while equivocal testosterone levels were not significantly different from normal testosterone levels ( hazard ratio, 1.38; 95% CI, 0.99%-1.92%; P=.06). In a sensitivity analysis, men who died within the first year( 50[ 5.8%]) were excluded to minimize the effect of acute illness, and low testosterone levels continued to be associated with elevated mortality. Conclusions: Low testosterone levels were associated with increased mortality in male veterans. Further prospective studies are needed to examine the association between low testosterone levels and mortality.