Response to Comment on: Wehr et al. Low Free Testosterone Levels Are Associated With All-Cause and Cardiovascular Mortality in Postmenopausal Diabetic Women. Diabetes Care 2011;34:1771–1777
We appreciate the thoughtful comment by Kuhadiya et al. (1). The remark that total androgen concentrations are important for practitioners is well taken. The overall median total testosterone (TT) and free testosterone (FT) concentrations were 2.43 nmol/L (0.7 μg/L) and 0.0093 ng/mL, respectively. Because the FT and TT concentrations for all quartiles are given in Tables 1 and 2 (2), median levels can also be seen in Tables 1 and 2. Concentrations for TT levels are correct. However, there was a typing error (decimal places) regarding FT concentrations. The correct units and FT levels are now shown in the corrected tables, which are published as erratum. It should, however, be underlined, that this typing error does not have further impact on any of our reported results.
We acknowledge the concern regarding the measurement of total testosterone. As already stated in the limitation section of the article (2), we did not measure TT levels by means of mass spectrometry, which would have been, of course, a gold standard method. However, these methods (immunoassays) are frequently and commonly used in large-scale studies in which assay of TT by mass spectrometry and FT via equilibrium dialysis might be impractical. Moreover, this technique has been calibrated against mass spectrometry showing a strong correlation.
The number of diabetic women is 53 women in the first FT quartile, 76 women in second quartile, 71 women in the third quartile, and 102 women in the fourth quartile. The severity of coronary artery disease is stated in the Research Design and Methods section (2): “Coronary artery disease was defined based on angiographic criteria as the occurrence of at least one stenosis of at least 50% in at least one of 15 coronary segments, using the maximal luminal narrowing estimated by standardized visual analysis.” Moreover, the prevalence of coronary artery disease was similar across FT quartiles when different definitions were used (20% [P = 0.964] and 10% [P = 0.798], respectively). Likewise, the prevalence of 1-, 2-, or 3-vessel disease was similar across FT quartiles (P = 0.119).
There is no change in the main message of this article, though typing errors have been corrected. We hope that these changes clarify the question of the readers and that our article (2) will stimulate further research to explore the effect of androgens on mortality in women.
No potential conflicts of interest relevant to this article were reported.
- © 2012 by the American Diabetes Association.
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