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

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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 andP = .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.

There is evidence that testosterone influences erythropoiesis during male puberty.1 Hemoglobin levels are similar in prepubertal boys and girls but increase in boys after age 13 years, mirroring changes in testosterone concentrations. Interestingly, boys with delayed puberty have hemoglobin levels similar to those of prepubertal boys and girls, and treatment with testosterone normalizes hemoglobin levels to those observed in the late male puberty.2,3 These data suggest that testosterone contributes to the 1- to 2-g/dL difference in hemoglobin concentration between adult men and women. If testosterone stimulates erythropoiesis in adults, it is reasonable to hypothesize that a decline in testosterone levels with aging may negatively affect erythropoiesis. Accordingly, men with hypogonadism or those taking anti-androgenic drugs frequently have anemia.4– 8 Conversely, diseases characterized by high testosterone levels and testosterone replacement therapy often produce a rise in hemoglobin levels that sometimes reaches the level of erythrocytosis.9– 14 However, whether older men and women with low testosterone levels are at higher risk for anemia has never been fully investigated.

Using data from a population-based sample, we tested the hypothesis that older men and women with low testosterone levels are more likely to be affected by anemia and to develop anemia over a 3-year follow-up period than women with normal testosterone levels. Understanding the causes of anemia in older persons is important because anemia in older persons is frequently unexplained15 and is associated with a high risk of disability and accelerated decline of physical function.16– 18

Article Source: http://archinte.jamanetwork.com/article.aspx?articleid=410603

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