Prevalence, incidence and risk factors of testosterone deficiency in a population-based cohort of men: results from the study of health in Pomerania

Figures & data

Table I.  Descriptive baseline characteristics.

Baseline characteristic	Men with complete TT data (N = 1490)	Men with incomplete TT data (N = 627)	P-value
Age, years	50.65 (15.41)	52.95 (18.96)	<0.001
Cohabitation, living alone	17.8	26.6	<0.001
Educational level			0.01
≤10 classes	81.5	86.1
>10 classes	18.5	13.9
Currently employed	57.6	38.9	<0.001
Equalized household income/month
<1000€	50.9	63.2	<0.001
1000–1500€	33.5	27.3
>1500€	15.6	9.5
Low physical activity	42.2	37.8	0.06
Current smoking	27.9	24.2	0.43
Alcohol consumption, high-risk (>30 g/day)	24.3	19.9	0.03
Self-rated health
Excellent or very good	18.6	15.2	<0.01
Good	64.8	62.1
Fair or poor	16.6	22.7
Dietary pattern
Unfavourable	40.7	36.4	0.55
Normal	22.8	24.8
Favourable	36.5	38.8
Healthy lifestyle characteristics
0	12.6	14.4	0.26
1	41.8	45.3
2	34.6	31.2
3	10.4	8.7
4	0.7	0.5
Healthy lifestyle score
≤2	11.7	9.5	0.33
3–4	55.2	58.5
5–6	30.1	30.4
7–8	3.0	1.7
Serum total testosterone, nmol/l	16.48 (5.70)	17.15 (6.58)	0.02
Waist circumference, cm	95.77 (11.52)	95.60 (12.05)	0.84
Body mass index, kg/m^2	27.68 (3.97)	27.59 (4.20)	0.69
Metabolic syndrome	40.7	40.8	0.97
Hypertension	61.6	64.4	0.22
Dyslipidaemia	56.3	50.7	0.02
Hepatic steatosis	12.0	12.8	0.64
Hyperechogenic liver ultrasound	39.0	36.0	0.19
Cancer	1.2	3.3	0.001
Type 2 diabetes mellitus	7.9	11.2	0.016
CVD score (1 of 5 conditions)	16.4	22.7	0.001
Acute inflammatory reaction	5.6	22.8	<0.001
Functional comorbidity index
0	36.4	35.4	0.03
1	32.2	26.6
2	16.9	21.2
3	8.9	9.4
>4	5.6	7.3
Number of medications used
0–2	71.5	64.9	0.001
3–5	20.0	22.0
6+	8.5	13.1

Estimates shown are mean (SD) or N (%) as indicated.

To convert the values of total testosterone (TT) to ng/dL use factor 0.0347.

CVD, cardiovascular disease.

Figure 1.  Crude prevalence and incidence rates of TD by different TT cut-offs.

Figure 2.  Scatterplot for the mean of baseline and follow-up TT levels over baseline age with linear fit line (95% CI). T0, baseline; T1, follow-up.

Table II.  Estimates for the longitudinal association of socio-demographic and behavioural risk factors with incident testosterone deficiency.

Cut-off for the definition of testosterone deficiency	Continuous TT (nmol/l) ANCOVA^† β (95% CI)	TT < 8.0 nmol/l (230 ng/dl) RR (95% CI)	TT < 8.7 nmol/l (250 ng/dl) RR (95% CI)	TT < 10.4 nmol/l (300 ng/dl) RR (95% CI)	TT < 12.0 nmol/l (346 ng/dl) RR (95% CI)	<10^th per.(age-specific) RR (95% CI)
Age (10 year)	−0.47 (−0.64; −0.29)*	2.05 (1.51; 2.80)*	1.65 (1.36; 2.00)*	1.39 (1.21; 1.58)*	1.19 (1.06; 1.32)*	1.02 (0.90; 1.16)
Cohabitation	0.67 (−0.10; 1.44)	0.34 (0.05; 2.57)	1.26 (0.53; 2.97)	0.37 (0.13; 1.01)	1.13 (0.70; 1.81)	1.01 (0.58; 1.79)
High educational level (>10 year)	−0.47 (−1.16; 0.21)	1.28 (0.53; 3.06)	1.36 (0.72; 2.61)	1.21 (0.72; 2.01)	0.99 (0.64; 1.53)	1.31 (0.82; 2.09)
Currently employed	0.36 (−0.31; 1.02)	0.28 (0.10; 0.83)*	0.52 (0.23; 1.19)	0.73 (0.42; 1.26)	0.93 (0.59; 1.48)	0.94 (0.56; 1.57)
Household Income/Month
>1500€	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
1000–1500€	−0.91 (−1.52; −0.32)*	2.12 (0.89; 5.07)	1.22 (0.67; 2.23)	1.29 (0.80; 2.07)	1.34 (0.92; 1.96)	1.23 (0.78; 1.95)
<1000€	−1.09 (−1.87; −0.33)*	3.00 (1.12; 8.02)*	1.81 (0.89; 3.69)	1.53 (0.87; 2.71)	1.23 (0.75; 2.01)	1.48 (0.87; 2.52)
Physically active	0.08 (−0.54; 0.56)	0.69 (0.31; 1.56)	0.98 (0.56; 1.73)	1.26 (0.82; 1.93)	0.93 (0.65; 1.32)	0.90 (0.60; 1.35)
Current smoker	0.31 (−0.30; 0.92)	0.69 (0.22; 2.13)	0.76 (0.34; 1.69)	0.79 (0.45; 1.39)	0.95 (0.64; 1.42)	0.79 (0.49; 1.27)
High-risk alcohol consumption	0.31 (−0.32; 0.94)	0.75 (0.27; 2.09)	0.79 (0.38; 1.64)	0.69 (0.39; 1.22)	0.85 (0.56; 1.29)	0.58 (0.33; 1.02)
Dietary pattern
Favourable	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Normal	0.06 (−0.65; 0.78)	1.02 (0.42; 2.45)	0.79 (0.38; 1.61)	0.79 (0.44; 1.42)	0.86 (0.54; 1.36)	0.77 (0.42; 1.41)
Unfavourable	−0.43 (−1.07; 0.21)	1.23 (0.59; 2.58)	0.98 (0.54; 1.78)	1.08 (0.67; 1.75)	0.89 (0.60; 1.31)	1.26 (0.80; 1.98)
Self-rated health
Excellent & very good	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
Good	0.18 (−0.55; 0.91)	0.61 (0.20; 1.86)	0.97 (0.41; 2.32)	0.78 (0.43; 1.40)	1.06 (0.65; 1.73)	0.98 (0.58; 1.68)
Fair/poor	−0.05 (−0.99; 0.90)	0.81 (0.23; 2.79)	0.89 (0.32; 2.51)	0.61 (0.28; 1.34)	1.33 (0.74; 2.35)	0.84 (0.41; 1.75)
Healthy lifestyle score	0.42 (−0.07; 0.91)	0.93 (0.66; 1.32)	0.90 (0.70; 1.16)	0.81 (0.65; 1.01)	0.88 (0.75; 1.02)	0.90 (0.74; 1.09)
HLC (0–4)	0.26 (−0.60; 1.11)	0.87 (0.58; 1.32)	0.95 (0.69; 1.31)	0.90 (0.71; 1.15)	0.83 (0.69; 1.01)	0.82 (0.65; 1.01)

ANCOVA, analysis of covariance; TT, total testosterone; RR, relative risk; CI, 95% confidence interval; HLC, healthy lifestyle characteristics.

All models were adjusted for age and blood sampling time.

*P < 0.05.

^†Linear models used continuous versions of alcohol consumption (g/day), and were additionally adjusted for baseline total testosterone levels.

Table III.  Estimates for the longitudinal association of subclinical and clinical risk factors with incident testosterone deficiency.

Cut-off for the definition of testosterone deficiency	Continuous TT (nmol/l) ANCOVA^† β (95% CI)	TT < 8.0 nmol/l (230 ng/dl) RR (95% CI)	TT < 8.7 nmol/l (250 ng/dl) RR (95% CI)	TT < 10.4 nmol/l (300 ng/dl) RR (95% CI)	TT < 12.0 nmol/l (346 ng/dl) RR (95% CI)	<10^th per. (age-specific) RR (95% CI)
BMI ≥ 25 kg/m^2	−0.13 (−0.20; −0.06)*	2.09 (0.64; 6.82)	2.33 (0.93; 5.90)	2.82 (1.36; 5.84)*	2.46 (1.46; 4.13)*	2.48 (1.35; 4.56)*
WC ≥ 94 cm	−0.04 (−0.07; −0.01)*	1.17 (0.54; 2.53)	2.04 (1.03; 4.03)*	1.89 (1.13; 3.16)*	1.57 (1.08; 2.28)*	1.70 (1.08; 2.66)*
Metabolic syndrome	−0.44 (−1.00; 0.13)	1.46 (0.73; 2.95)	2.40 (1.36; 4.24)*	1.97 (1.28; 3.06)*	1.83 (1.30; 2.57)*	2.20 (1.47; 3.30)*
Hypertension	−0.49 (−1.08; 0.10)	1.66 (0.63; 4.33)	1.29 (0.67; 2.47)	1.36 (0.81; 2.27)	1.82 (1.23; 2.68)*	1.22 (0.82; 1.86)
Dyslipidaemia	−0.24 (−0.78; 0.31)	0.82 (0.39; 1.68)	1.57 (0.85; 2.88)	2.37 (1.40; 4.01)*	1.28 (0.90; 1.82)	1.74 (1.11; 2.69)*
Hyperechogenic liver US	−0.77 (−1.34; −0.20)*	1.00 (0.48; 2.09)	1.28 (0.74; 2.22)	1.67 (1.09; 2.55)*	1.86 (1.33; 2.60)*	1.25 (0.83; 1.88)
Hepatic steatosis	−0.11 (−0.94; 0.72)	0.78 (0.19; 3.25)	0.99 (0.40; 2.47)	1.09 (0.56; 2.12)	1.08 (0.64; 1.83)	0.75 (0.37; 1.53)
Cancer	0.56 (−1.88; 3.00)	1.32 (0.18; 9.44)	1.82 (0.47; 7.03)	3.26 (1.41; 7.56)*	2.16 (0.81; 5.76)	1.69 (0.44; 6.42)
Type 2 diabetes mellitus	0.05 (−0.96; 1.07)	1.78 (0.76; 4.12)	1.97 (1.01; 3.84)*	1.43 (0.56; 2.32)	1.03 (0.54; 1.97)	1.92 (1.04; 3.52)*
CVD score (1 of 5 conditions)	−0.53 (−1.05; 0.02)	1.60 (0.74; 3.44)	1.11 (0.57; 2.16)	0.86 (0.49; 1.54)	1.20 (0.75; 1.91)	1.67 (0.98; 2.85)
Acute inflammatory reaction	0.39 (−0.76; 1.54)	1.92 (0.64; 5.80)	1.02 (0.34; 3.06)	0.87 (0.33; 2.27)	1.28 (0.66; 2.50)	1.29 (0.62; 2.70)
Functional comorbidity index
0	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
1	−0.64 (−1.30; 0.01)	1.17 (0.37; 3.66)	1.42 (0.63; 3.24)	1.76 (0.97; 3.21)	1.51 (0.96; 2.39)	1.33 (0.79; 2.23)
2	−0.87 (−1.64; 0.21)	1.84 (0.61; 5.60)	1.91 (0.80; 4.59)	2.09 (1.08, 4.04)*	2.53 (1.57; 4.07)*	1.65 (0.92; 2.98)
≥3	−0.79 (−1.69; 0.12)	2.06 (0.68; 6.26)	2.48 (1.03; 5.94)*	1.70 (0.81; 3.55)	1.90 (1.07; 3.38)*	2.30 (1.21; 4.39)*
Medications (≥6 vs. < 6)	−0.16 (−0.29; −0.03)*	1.90 (0.80; 4.55)	2.04 (0.99; 4.17)*	1.25 (0.62; 2.55)	1.88 (1.07; 3.30)*	2.31 (1.15; 4.64)*

RR, relative risk; CI, 95% confidence interval; TT, total testosterone; BMI, body mass index; WC, waist circumference; US, ultrasound; CVD, cardiovascular disease; Medications, number of prescribed drugs.

All models were adjusted for age, household income, and blood sampling time.

*P < 0.05.

^†Linear models used continuous versions for the measures of BMI, WC and medications, and were additionally adjusted for baseline total testosterone levels.

Figure 3.  Absolute differences in TT levels between baseline and follow-up by baseline age with linear fit line (95% CI) for healthy subpopulations of men. T0, baseline; T1, follow-up.