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CLINICAL STUDIES |
PathWest, Department of Biochemistry, Fremantle Hospital, Western Australia, 6160 Australia1 WA Centre for Health and Ageing, 2 School of Psychiatry and Clinical Neurosciences,, 3 School of Medicine and Pharmacology and 4 School of Surgery and Pathology,, University of Western Australia, Western Australia, 6009 Australia5 School of Population Health and Clinical Practice,, University of Adelaide, Adelaide, 5005 Australia and 6 Department of Endocrinology,, Fremantle Hospital, Western Australia, 6160 Australia
(Correspondence should be addressed to B B Yeap who is now at School of Medicine and Pharmacology, Level 2, T Block, Fremantle Hospital, Western Australia 6160, Australia; Email: byeap{at}cyllene.uwa.edu.au)
Background: Reduced circulating testosterone and sex hormone-binding globulin (SHBG) are implicated as risk factors for metabolic syndrome. As SHBG increases with age while testosterone declines, we examined the relative contributions of SHBG and testosterone to the risk of metabolic syndrome in older men.
Methods: We conducted a cross-sectional study of 2502 community-dwelling men aged 
70 years without known diabetes. Metabolic syndrome was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) criteria. Early morning fasting sera were assayed for total testosterone, SHBG and LH. Free testosterone was calculated using mass action equations.
Results: There were 602 men with metabolic syndrome (24.1%). The risk of metabolic syndrome increased for total testosterone <20 nmol/l, SHBG <50 nmol/l and free testosterone <300 pmol/l. In univariate analyses SHBG was associated with all five components of metabolic syndrome, total testosterone was associated with all except hypertension, and free testosterone was associated only with waist circumference and triglycerides. In multivariate analysis, both total testosterone and especially SHBG remained associated with metabolic syndrome, with odds ratios of 1.34 (95% confidence interval (CI): 1.18–1.52) and 1.77 (95% CI: 1.53–2.06) respectively. Men with hypogonadotrophic hypogonadism (total testosterone <8 nmol/l, LH 
12 IU/l) had the highest prevalence of metabolic syndrome (53%, P<0.001).
Conclusions: Lower SHBG is more strongly associated with metabolic syndrome than lower total testosterone in community-dwelling older men. SHBG may be the primary driver of these relationships, possibly reflecting its relationship with insulin sensitivity. Further studies should examine whether measures that raise SHBG protect against the development of metabolic syndrome in older men.
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  A. E. Heufelder, F. Saad, M. C. Bunck, and L. Gooren Fifty-two-Week Treatment With Diet and Exercise Plus Transdermal Testosterone Reverses the Metabolic Syndrome and Improves Glycemic Control in Men With Newly Diagnosed Type 2 Diabetes and Subnormal Plasma Testosterone J Androl, November 1, 2009; 30(6): 726 - 733. [Abstract] [Full Text] [PDF]
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 B. B Yeap, S A P. Chubb, Z. Hyde, K. Jamrozik, G. J Hankey, L. Flicker, and P. E Norman Lower serum testosterone is independently associated with insulin resistance in non-diabetic older men: the Health In Men Study Eur. J. Endocrinol., October 1, 2009; 161(4): 591 - 598. [Abstract] [Full Text] [PDF]
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 B. B. Yeap, Z. Hyde, O. P. Almeida, P. E. Norman, S. A. P. Chubb, K. Jamrozik, L. Flicker, and G. J. Hankey Lower Testosterone Levels Predict Incident Stroke and Transient Ischemic Attack in Older Men J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2353 - 2359. [Abstract] [Full Text] [PDF]
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 C. Maric Sex, diabetes and the kidney Am J Physiol Renal Physiol, April 1, 2009; 296(4): F680 - F688. [Abstract] [Full Text] [PDF]
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