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RELATIONSHIP BETWEEN TESTOSTERONE DEFICIENCY AND  THE CARDIOVASCULAR RISK FACTORS, DIABETES, AND HYPERTENSION

  • Min Hyuk Park1
  • Seong Eon Kim2
  • Youngin Won3

1Department of Sports Medicine, Biomedical Science, Korea University, Sejong-si, Republic of Korea

2Department of Physical Education, Sejong University, Seoul, Republic of Korea

3Department of Football Management, Munkyung College, Munkyung, Republic of Korea

DOI: 10.31083/jomh.v16i4.328 Vol.16,Issue 4,October 2020 pp.97-106

Published: 01 October 2020

*Corresponding Author(s): Youngin Won E-mail: 4684645@naver.com

Abstract

Background and objective

Testosterone deficiency (TD) increases the incidence of cardiovascular risk factors such as diabetes and hypertension. Conversely, TD is reported in people with obesity and diabetes. Therefore, this study exam-ines the relationship between TD, diabetes, and hypertension by following a longitudinal design.

Material and methods

In this study, 2242 (1490 middle-aged and 752 elderly) healthy men were followed up for 8 years and the incidence of hypertension or diabetes was determined.

The diagnostic criteria for hypertension were systolic pressure ≥140 mmHg and diastolic pressure ≥90 mmHg, and the criterion for diabetes was a fasting blood glucose level ≥126 mg/dL; the men who took medication for hypertension or diabetes were considered diseased. The threshold for TD was 2.5 ng/mL of serum testosterone. Subsequently, the relative risk (RR) of disease according to the testosterone level was analyzed. In addition, the RR of TD according to glucose and blood pressure levels was analyzed for men with normal testosterone at the initial examination.

Results

The TD incidence rates were 12.2 and 16.8% for middle-aged and elderly men, respectively. Among the middle-aged men, the diabetes incidence rates were 11.7 and 5.7% in the TD and non-TD (NTD) groups, respectively; the RR of diabetes increased by 1.771 times in the TD group relative to the NTD group (p<0.001). Among the elderly men, the RR of hypertension and diabetes increased by 1.573 and 1.649 times, respectively, in the TD group, compared to the NTD group. Among those with normal testosterone levels at the initial examination, prehypertension (PHTN) increased the RR of TD by 2.421 and 3.091 times for middle-aged and elderly men, respectively, compared to those with normal blood pressure. Moreover, an impaired fasting glucose level at baseline increased the RR of TD by 1.710 times in middle-aged men and 2.187 times in elderly men, compared to those with normal glucose levels.

Conclusion

In men, TD increased the risk of diabetes and hypertension, which are cardiovascular risk factors.

Keywords

cardiovascular disease; diabetes; hypertension; risk; testosterone

Cite and Share

Min Hyuk Park,Seong Eon Kim,Youngin Won. RELATIONSHIP BETWEEN TESTOSTERONE DEFICIENCY AND THE CARDIOVASCULAR RISK FACTORS, DIABETES, AND HYPERTENSION. Journal of Men's Health. 2020. 16(4);97-106.

References

1. Cho N, Shaw J, Karuranga S, et al. Idf diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81. https://doi.org/10.1016/j.diabres. 2018.02.023

2. Beaney T, Schutte AE, Tomaszewski M, et al. May measurement month 2017: An analysis of blood pressure screening results worldwide. Lancet Glob Health 2018;6:e736–43.

3. Winters SJ. Monitoring testosterone levels in testosterone-treated men. Curr Med Res Opin 2016;32:271-2. http://

doi.org/10.1185/03007995.2015.1118023

4. Srinivas-Shankar U, Roberts SA, Connolly MJ, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: A randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2010;95:639–50. https://doi.org/10.1210/jc.2009-1251

5. Shea JL, Wong PY, Chen Y. Free testosterone: clinical utility and important analytical aspects of measurement. Adv Clin Chem 2014;63:59-84. http://doi.org/10.1016/b978-0-12-800094-6.00002-9

6. Erenpreiss J, Fodina V, Pozarska R, et al. Prevalence of testosterone deficiency among aging men with and without morbidities. Aging Male 2019; 1:1–5. https://doi.org/10.1080/13685538.2019.1621832

7. Saad F, Roehrig G, von Haehling S, et al. Testosterone deficiency and testosterone treatment in older men. Gerontology 2017;63:144–56. https://doi.org/10.1159/000452499

8. Tostain JL, Blanc F. Testosterone deficiency: A com-mon, unrecognized syndrome. Nat Clin Pract Urol 2008;5:388–96. https://doi.org/10.1038/ncpuro1167

9. Moon DG, Kim JW, Kim JJ, et al. Prevalence of symptoms and associated comorbidities of testos-terone deficiency syndrome in the korean general population. J Sex Med 2014;11:583–94. https://doi. org/10.1111/jsm.12393

10. Halpern JA, Brannigan RE. Testosterone defi-ciency. JAMA 2019;322:1116. https://doi.org/10.1001/jama.2019.9290

11. McBride JA, Carson III CC, Coward RM. Testosterone deficiency in the aging male. Therapeut Adv Urol 2016;8:47–60. https://doi.org/10.1177/1756287215612961

12. Corona G, Rastrelli G, Morgentaler A, et al. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. Eur Urol

2017;72:1000-1011. http://doi.org/10.1016/

j. eururo.2017.03.032

13. Traish AM, Miner MM, Morgentaler A, et al. Testosterone deficiency. Am J Med 2011;124:578–

87. https://doi.org/10.1016/j.amjmed.2010.12.027

14. Chobanian AV, Roccella EJ. The jnc 7 hyperten-sion guidelines. JAMA 2003;290:1312. https://doi. org/10.1001/jama.290.10.1312-a

15. Ahn KT, Jin S-A, Jeong J-O. Diagnosis and treatment of hypertension: Based on the guidelines of the korean society of hypertension. J Korean Neurol Assoc 2019;37:123–34. https://doi.org/10.17340/jkna.2019.2.2

16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33:S62–9. https://doi.org/10.2337/dc10-S062

17. Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010;363:123–35. https://doi.org/10.1056/NEJMoa0911101

18. Bashyal R, Koirala B, Jha B, et al. Relationship between serum total testosterone and coronary artery disease in men. J Nepal Health Res Council 2019;17:26–

31. https://doi.org/10.33314/jnhrc.v17i01.1207

19. Kim M, Kyung YS, Ahn TY. Cross-sectional asso-ciation of metabolic syndrome and its components with serum testosterone levels in a korean-screened population. World J Mens Health 2020;38:85–

94. https://doi.org/10.5534/wjmh.190030

20. Fui MN, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl 2014;16:223-31. https://doi.org/ 10.4103/1008-682X.122365

21. Svartberg J, Von Mühlen D, Mathiesen E, et al. Low testosterone levels are associated with carotid ath-erosclerosis in men. J Intern Med 2006;259:576–82. https://doi.org/10.1111/j.1365-2796.2006.01637.x

22. Yang Q, Li Z, Li W, et al. Association of total testos-terone, free testosterone, bioavailable testosterone, sex hormone–binding globulin, and hyperten-sion. Medicine 2019;98:e15628–33. https://doi. org/10.1097/MD.0000000000015628

23. Orshal JM, Khalil RA. Gender, sex hormones, and vascular tone. Am J Physiol Regul, Integr Compar Physiol 2004;286:R233–49. https://

doi.org/10.1152/ajpregu.00338.2003

24. Hall J, Jones R, Jones T, et al. Selective inhibition of

l- type ca2+ channels in a7r5 cells by physiological levels of testosterone. Endocrinology 2006;147:2675–80.

https://doi.org/10.1210/en.2005-1243

25. Laaksonen DE, Niskanen L, Punnonen K, et al. Testosterone and sex hormone–binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes care 2004;27:1036–41. https://doi.org/10.2337/diacare.27.5.1036

26. Grossmann M, Thomas MC, Panagiotopoulos S, et al. Low testosterone levels are common and associated with insulin resistance in men with dia-betes. J Clin Endocrinol Metab 2008;93:1834–40. https://doi.org/10.1210/jc.2007-2177

28. Rao PM, Kelly DM, Jones TH. Testosterone and insulin resistance in the metabolic syndrome and t2dm in men. Nat Rev Endocrinol 2013;9:479. https://doi.org/10.1038/nrendo.2013.122

29. Singh R, Artaza JN, Taylor WE, et al. Androgens stimulate myogenic differentiation and inhibit adi-pogenesis in c3h 10t1/2 pluripotent cells through an androgen receptor-mediated pathway. Endocrinology 2003;144:5081–8. https://doi.org/10.1210/en.2003-0741

30. Ottarsdottir K, Nilsson AG, Hellgren M, et al. The association between serum testosterone and insulin resistance: A longitudinal study. Endocr Connect 2018;7:1491–500. https://doi.org/10.1530/EC-18-0480

31. Farias JM, Tinetti M, Khoury M, et al. Low tes-tosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. J Clin Endocrinol Metab 2014;99:4698–703. https://doi.org/10.1210/jc.2014-2585

32. Grossmann M. Low testosterone in men with type 2 diabetes: Significance and treatment. J Clin Endocrinol Metab 2011;96:2341–53. https://doi. org/10.1210/jc.2011-0118

33. Al Hayek AA, Khader YS, Jafal S, et al. Prevalence of low testosterone levels in men with type 2 diabetes mellitus: A cross-sectional study. J Fam Community Med 2013;20:179. https://doi. org/10.4103/2230-8229.122006

34. Barrett-Connor E, Khaw K-T, Yen S. Endogenous sex hormone levels in older adult men with diabe-tes mellitus. Am J Epidemiol 1990;132:895–901. https://doi.org/10.1093/oxfordjournals.aje.a115732

35. Shi Z, Araujo AB, Martin S, et al. Longitudinal changes in testosterone over five years in community- dwelling men. J Clin Endocrinol Metab 2013;98:3289–97. https://doi.org/10.1210/jc.2012-3842

36. Chahla EJ, Hayek ME, Morley JE. Testosterone replacement therapy and cardiovascular risk factors modification. Aging Male 2011;14:83–90. https://doi.org/10.3109/13685538.2010.541538

37. Gagliano-Jucá T, Basaria S. Testosterone replace-ment therapy and cardiovascular risk. Nat Rev Cardiol 2019;16:555–74. https://doi.org/10.1038/s41569-019-0211-4

38. Cicchetto LA, Polegato BF, Zornoff LA. Hormone Therapy to Treat Cardiac Remodeling: Is There Any Evidence? Arq Bras Cardiol 2016;107:2-3. http://doi.org/10.5935/abc.20160106

39. Hackett G, Cole N, Mulay A, et al. Long-term tes-tosterone therapy in type 2 diabetes is associated with decreasing waist circumference and improv-ing erectile function. World J Mens Health 2020;38: 68–77. https://doi.org/10.5534/wjmh.180052M

40. Osterberg EC, Bernie AM, Ramasamy R. Risks of testosterone replacement therapy in men. Indian J Urol 2014;30:2–7. https://doi.org/10.4103/ 0970-1591.124197

41. Morgentaler A. Testosterone, cardiovascular risk, and hormonophobia. J Sex Med 2014;11:1362–

6. https://doi.org/10.1111/jsm.12556

42. Carson III CC, Rosano G. Exogenous testos-terone, cardiovascular events, and cardiovas-cular risk factors in elderly men: A review of trial data. J Sex Med 2012;9:54–67. https://doi. org/10.1111/j.1743-6109.2011.02337.x 

43. Shea JL, Wong P-Y, Chen Y. Free testosterone: Clinical utility and important analytical aspects of measurement. Advances in clinical chemistry 2014;63:59–84. https://doi.org/10.1016/

B978-0-12-800094-6.00002-9

44. Moon KH, Park SY, Kim YW. Obesity and erectile dysfunction: From bench to clinical implication. World J Men Health 2019;37:138–47. https://doi. org/10.5534/wjmh.180026

45. Rizk PJ, Kohn TP, Pastuszak AW, et al. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol

2017;27511-515. http://doi.org/10.1097/MOU.0000000000000442

46. Westley CJ, Amdur RL, Irwig MS. High rates of depression and depressive symptoms among men referred for borderline testosterone levels. J Sex Med 2015;12:1753–60. https://doi.org/10.1111/jsm.12937

47. Lee C-P, Chiu Y-W, Chu C-L, et al. A reliability generalization meta-analysis of coefficient alpha and test–retest coefficient for the aging males’ symptoms (ams) scale. Aging Male 2016;19:244–53. https://doi.org/10.1080/13685538.2016.1246525 



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