Androgen Imbalance, Cardiovascular-Kidney-Metabolic Syndrome Stages, and Mortality in Men
Authors' conclusion
Low measured TT was associated with prevalent advanced CKM syndrome, but this association was strongly adiposity-dependent. The low-TT/high-SHBG profile showed an exploratory mortality association not observed for TT or cFT alone and may represent a distinct systemic-vulnerability phenotype. These findings underscore the noninterchangeability of androgen measures and support prospective evaluation of combined TT-SHBG profiles.
Study context
- Population
- Men aged ≥20 years in the National Health and Nutrition Examination Survey 2013 to 20164,005 had determinate cardiovascular-kidney-metabolic (CKM) status
- Participants
- 5,505 men
- Exposure
- Total testosterone, sex hormone-binding globulin (SHBG), calculated free testosterone and joint TT-SHBG phenotypes in relation to prevalent advanced CKM syndrome and mortality
- Outcome
- Prevalent advanced CKM syndrome, low measured TT
Methodological detailssurvey-weighted logistic and Cox regression models
- Survey-weighted logistic and Cox regression models
Main finding
As reported in the abstract
Low measured TTOdds ratio (95% CI)
Prevalent advanced CKM syndrome, low measured TT
1.78(1.31–2.42)
Adjusted for body mass index
1.27(0.90–1.79)
Adjusted for waist circumference
1.22(0.85–1.75)
Observational data: associations, not effects.
Further findings
All-cause mortality, low-TT/high-SHBG phenotype
| HR (95% CI) | ||
|---|---|---|
| low-TT/high-SHBG phenotypeHigher all-cause mortality · exploratory analyses | 2.06 (1.18–3.58) | |
| 0.20.5125Hazard ratio (log scale) |
All-cause mortality, low total testosterone (TT) and calculated free testosterone (cFT)
- Low TT and cFT measures showed no consistent association with all-cause mortality
Original publication
Androgen Imbalance, Cardiovascular-Kidney-Metabolic Syndrome Stages, and Mortality in Men. JACC Adv. Published 5 November 2026. doi:10.
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