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Androgens and Diabetes in Men

Results from the Third National Health and Nutrition Examination Survey (NHANES III)

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
² Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
³ Dana Center for Preventive Ophthalmology, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
⁴ Division of Clinical Epidemiology, Deutsches Krebsforschungzentrum, Heidelberg, Germany
⁵ Department of Laboratory Medicine, Brigham and Women’s Hospital, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
⁶ Departments of Oncology, Urology, Pharmacology, Medicine, and Pathology, Johns Hopkins University, Baltimore, Maryland
⁷ Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
⁸ Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
⁹ Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland

Address correspondence and reprint requests to Elizabeth A. Platz, ScD, MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E6138, Baltimore, MD 21205. E-mail: eplatz{at}jhsph.edu

OBJECTIVE—Low levels of androgens in men may play a role in the development of diabetes; however, few studies have examined the association between androgen concentration and diabetes in men in the general population. The objective of this study is to test the hypothesis that low normal levels of total, free, and bioavailable testosterone are associated with prevalent diabetes in men.

RESEARCH DESIGN AND METHODS—The study sample included 1,413 adult men aged 20 years who participated in the morning session of the first phase of the Third National Health and Nutrition Examination Survey, a cross-sectional survey of the civilian, noninstitutionalized population of the U.S. Bioavailable and free testosterone levels were calculated from serum total testosterone, sex hormone–binding globulin, and albumin concentrations.

RESULTS—In multivariable models adjusted for age, race/ethnicity, and adiposity, men in the first tertile (lowest) of free testosterone level were four times more likely to have prevalent diabetes compared with men in the third tertile (odds ratio 4.12 [95% CI 1.25–13.55]). Similarly, men in the first tertile of bioavailable testosterone also were approximately four times as likely to have prevalent diabetes compared wth men in the third tertile (3.93 [1.39–11.13]). These associations persisted even after excluding men with clinically abnormal testosterone concentrations defined as total testosterone <3.25 ng/ml or free testosterone <0.07 ng/ml. No clear association was observed for total testosterone after multivariable adjustment (P for trend across tertiles = 0.27).

CONCLUSIONS—Low free and bioavailable testosterone concentrations in the normal range were associated with diabetes, independent of adiposity. These data suggest that low androgen levels may be a risk factor for diabetes in men.

Abbreviations: AAG, androstanediol glucuronide • NHANES III, Third National Health and Nutrition Examination Survey • SHBG, sex hormone–binding globulin

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