Low Testosterone Levels and the Risk of Anemia in Older Men and Women

Overview

Journal Arch Intern Med

Specialty General Medicine

Date 2006 Jul 13

PMID 16832003

Citations 88

Authors

Luigi Ferrucci

Marcello Maggio

Stefania Bandinelli

Shehzad Basaria

Fulvio Lauretani

Alessandro Ble

Giorgio Valenti

William B Ershler

Jack M Guralnik

Dan L Longo

Affiliations

Soon will be listed here.

Abstract

Background: Anemia is a frequent feature of male hypogonadism and anti-androgenic treatment. We hypothesized that the presence of low testosterone levels in older persons is a risk factor for anemia.

Methods: Testosterone and hemoglobin levels were measured in a representative sample of 905 persons 65 years or older without cancer, renal insufficiency, or anti-androgenic treatments. Hemoglobin levels were reassessed after 3 years.

Results: At baseline, 31 men and 57 women had anemia. Adjusting for confounders, we found that total and bioavailable testosterone levels were associated with hemoglobin levels in women (P = .001 and P = .02, respectively) and in men (P<.001 and P = .03, respectively). Men and women in the lowest quartile of total and bioavailable testosterone were more likely than those in the highest to have anemia (men, 14/99 vs 3/100; odds ratio [OR], 5.4; 95% confidence interval [CI], 1.4-21.8 for total and 16/99 vs 1/99; OR, 13.1; 95% CI, 1.5-116.9 for bioavailable testosterone; women, 21/129 vs 12/127; OR, 2.1; 95% CI, 0.9-5.0 for total and 24/127 vs 6/127; OR, 3.4; 95% CI, 1.2-9.4 for bioavailable testosterone). Among nonanemic participants and independent of confounders, men and women with low vs normal total and bioavailable testosterone levels had a significantly higher risk of developing anemia at 3-year follow-up (21/167 vs 28/444; relative risk, 2.1; 95% CI, 1.1-4.1 for total and 26/143 vs 23/468; relative risk, 3.9; 95% CI, 1.9-7.8 for bioavailable testosterone).

Conclusion: Older men and women with low testosterone levels have a higher risk of anemia.

Citing Articles

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References

Snyder P, Peachey H, Berlin J, Hannoush P, Haddad G, Dlewati A . Effects of testosterone replacement in hypogonadal men. J Clin Endocrinol Metab. 2000; 85(8):2670-7. DOI: 10.1210/jcem.85.8.6731. View

Wang C, Swerdloff R, Iranmanesh A, Dobs A, Snyder P, Cunningham G . Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab. 2000; 85(8):2839-53. DOI: 10.1210/jcem.85.8.6747. View

Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris T . Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc. 2000; 48(12):1618-25. DOI: 10.1111/j.1532-5415.2000.tb03873.x. View

Albareda M, Rodriguez-Espinosa J, Remacha A, Prat N, Webb S . Polycythemia in a patient with 21-hydroxylase deficiency. Haematologica. 2000; 85(E-letters):E08. View

Navarro J, Mora C, Macia M, Garcia J . Randomized prospective comparison between erythropoietin and androgens in CAPD patients. Kidney Int. 2002; 61(4):1537-44. DOI: 10.1046/j.1523-1755.2002.00271.x. View

Chaves P, Ashar B, Guralnik J, Fried L . Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated?. J Am Geriatr Soc. 2002; 50(7):1257-64. DOI: 10.1046/j.1532-5415.2002.50313.x. View

Balducci L . Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc. 2003; 51(3 Suppl):S2-9. DOI: 10.1046/j.1532-5415.51.3s.4.x. View

Penninx B, Guralnik J, Onder G, Ferrucci L, Wallace R, Pahor M . Anemia and decline in physical performance among older persons. Am J Med. 2003; 115(2):104-10. DOI: 10.1016/s0002-9343(03)00263-8. View

Baillie F, Morrison A, Fergus I . Soluble transferrin receptor: a discriminating assay for iron deficiency. Clin Lab Haematol. 2003; 25(6):353-7. DOI: 10.1046/j.0141-9854.2003.00548.x. View

10.

Rhoden E, Morgentaler A . Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004; 350(5):482-92. DOI: 10.1056/NEJMra022251. View

11.

Cesari M, Penninx B, Lauretani F, Russo C, Carter C, Bandinelli S . Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2004; 59(3):249-54. DOI: 10.1093/gerona/59.3.m249. View

12.

Penninx B, Pahor M, Cesari M, Corsi A, Woodman R, Bandinelli S . Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004; 52(5):719-24. DOI: 10.1111/j.1532-5415.2004.52208.x. View

13.

Guralnik J, Eisenstaedt R, Ferrucci L, Klein H, Woodman R . Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004; 104(8):2263-8. DOI: 10.1182/blood-2004-05-1812. View

14.

Fried W, GURNEY C . The erythropoietic response to testosterone in male and female mice. J Lab Clin Med. 1966; 67(3):420-6. View

15.

Kilbridge T, Simone J, Fried W . The effect of testosterone on erythropoietin levels in anemic patients. Blood. 1968; 31(4):453-60. View

16.

NAETS J, Wittek M . Erythropoiesis in anephric man. Lancet. 1968; 1(7549):941-3. DOI: 10.1016/s0140-6736(68)90901-x. View

17.

Fried W, GURNEY C . The erythropoietic-stimulating effects of androgens. Ann N Y Acad Sci. 1968; 149(1):356-65. DOI: 10.1111/j.1749-6632.1968.tb15169.x. View

18.

NAETS J, Wittek M . The mechanism of action of androgens on erythropoiesis. Ann N Y Acad Sci. 1968; 149(1):366-76. DOI: 10.1111/j.1749-6632.1968.tb15170.x. View

19.

. Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser. 1968; 405:5-37. View

20.

SHAHIDI N . Androgens and erythropoiesis. N Engl J Med. 1973; 289(2):72-80. DOI: 10.1056/NEJM197307122890205. View