In young men aged 18 to 35, lower total testosterone and sex hormone-binding globulin levels tie directly to increased body mass index, waist circumference, triglyceride levels, and blood pressure, alongside lower high-density lipoprotein cholesterol.
Italian Observational Cohort Examines 659 Men
Researchers conducted a retrospective observational cohort study with a cross-sectional design at a center in Italy to map the link between androgenic profile and metabolic cardiovascular risk factors. The team recruited 659 men aged 18 to 35 years, with a mean age of 22.7 years, through an awareness campaign run between 2013 and 2018.
The evaluation tracked anthropometric parameters including height, weight, BMI, and waist circumference. It also logged clinical parameters like systolic and diastolic blood pressure, alongside biochemical markers such as fasting glucose, total cholesterol, HDL cholesterol, low-density lipoprotein cholesterol, and triglycerides. Hormonal parameters measured total testosterone, SHBG, and calculated free testosterone.
Primary outcomes assessed these parameters at a single timepoint. Secondary outcomes tracked differences in parameters and the prevalence of obesity, dyslipidemia, hyperglycemia, hypertension, and metabolic syndrome between men with total testosterone levels of 12 nmol/L or lower against those with levels above 12 nmol/L.
Risk Factors Decline Across Testosterone and SHBG Tertiles
Weight, BMI, waist circumference, diastolic blood pressure, and triglyceride levels progressively decreased across total testosterone tertiles, while HDL cholesterol levels increased. Weight, BMI, waist circumference, triglyceride levels, and both systolic and diastolic blood pressure showed a decreasing trend across SHBG tertiles, whereas HDL cholesterol levels showed an increasing trend.
Multiple linear regression adjusted for age, waist circumference, and BMI identified both total testosterone and SHBG as independently associated with HDL cholesterol. SHBG also showed an association with systolic and diastolic blood pressure.
Men with total testosterone levels at or below 12 nmol/L showed a significantly higher prevalence of abdominal obesity at 13.86% compared with 4.94% for men above that threshold. Generalized obesity also ran higher in the lower testosterone group at 14.43% versus 3.68%. Participants classified as overweight or obese recorded lower total testosterone levels than normal-weight participants.
Assessing Androgenic Profiles in Clinical Practice
The study was led by Davide Menafra from the Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia at Università Federico II di Napoli in Naples, Italy, and was published online in the Journal of Endocrinological Investigation.
“The study findings support a consistent association between androgenic profile and mCVR factors in young men, as well as the clinical relevance of assessing androgenic profile in young men, particularly in those with overweight or obesity, especially visceral obesity,” the authors wrote. They added that careful metabolic profiling may prove clinically relevant in young men with testosterone deficiency, though sexual symptoms remain essential for diagnosing clinically defined hypogonadism.
The retrospective cross-sectional design could not establish cause-and-effect relationships. Low testosterone determinations relied on a single morning measurement taken without follow-up verification or a thorough evaluation of sexual symptoms.
