Aging-related increases in serum sex hormone-binding globulin levels in men might be related to increased synthesis

Hormones, Age, and Erectile Dysfunction: Should Routine Testing Be Part of the Initial Evaluation?

Background/Objectives: The aim of this study was to investigate the relationship between age, the severity of erectile dysfunction (ED), and the various hormones that may influence erectile function. Methods: A multicenter cross-sectional study was conducted between January 2015 and December 2023. The study assessed age, sexual function using the IIEF-15 questionnaire, and the levels of total testosterone (TT), free testosterone (FT), FSH, LH, estradiol, prolactin (PRL), and SHBG. Results: A total of 411 patients were included in the study. The mean age of the patients was 63.19 years. The vast majority (91.73%) exhibited some degree of ED. The severity of ED increases with age, ranging from 56.26 years for patients without ED to 73.12 years for those with severe ED. A statistically significant negative correlation was observed between IIEF and age, while a positive correlation was observed between IIEF and serum levels of TT and FT (p < 0.05). Age was significantly correlated with all evaluated hormones (p < 0.01), except estradiol and prolactin. Total testosterone levels progressively decreased with the increase in the severity of erectile dysfunction, from a median of 7.05 ng/mL in patients with normal erectile function to 3.56 ng/mL in those with severe symptoms, remaining above the normal minimum threshold across all groups, whereas free testosterone (FT) levels also declined progressively. All erectile dysfunction groups had median FT levels below the normal minimum threshold. FSH, LH, and SHBG showed an increase with each progressive severity of erectile dysfunction. The multivariate linear regression revealed that IIEF scores are significantly associated with age, TT, and FT levels, while FSH did not present a statistically significant association in this model. Conclusions: Age shows a significant statistical correlation with both the severity of erectile dysfunction and the levels of total testosterone, free testosterone, LH, FSH, and SHBG. Total and free testosterone levels are significantly associated with the severity of erectile dysfunction, with free testosterone median values remaining above the normal minimum threshold in all patients with erectile dysfunction. Therefore, free testosterone should be considered a routine test, alongside total testosterone. In contrast, LH, estradiol, SHBG, and prolactin do not demonstrate any statistical correlation with erectile dysfunction and should not be recommended as routine investigations.

Sex hormone imbalance and rheumatoid arthritis in American men: a cross-sectional analysis from NHANES 2011-2016

Background

Emerging evidence suggests that sex hormones, particularly testosterone and sex hormone-binding globulin (SHBG), play a critical role in the pathophysiology of Rheumatoid arthritis (RA). However, the precise relationship between these hormonal factors and RA risk in men remains underexplored.

Methods

We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. A total of 3,110 male participants were included after excluding those with missing data on testosterone, SHBG, RA, or key covariates. Serum testosterone and SHBG levels were measured, and RA status was determined based on self-reported physician diagnosis. Multivariate logistic regression models were used to assess the association between testosterone, SHBG, and RA. Restricted cubic spline (RCS) regression was applied to explore nonlinear relationships. Subgroup and interaction analyses were performed to assess effect modifications by age, race/ethnicity, body mass index (BMI), hypertension, and poverty-income ratio (PIR).

Results

Of the 3,110 men analyzed, 191 were diagnosed with RA. Low testosterone levels (<300 ng/dL) were significantly associated with increased RA risk (OR = 2.30, 95% CI: 1.65-3.21, p < 0.001), and elevated SHBG levels (>57 nmol/L) were also associated with a higher risk of RA (OR = 1.65, 95% CI: 1.14-2.39, p = 0.008). RCS analysis indicated a nonlinear relationship between testosterone, SHBG, and RA risk, with sharp increases in RA risk at the lower ends of testosterone and SHBG levels. Interaction analyses revealed that age, race/ethnicity, hypertension, and PIR significantly modified the relationship between these hormonal factors and RA, while BMI did not exhibit any significant interaction.

Conclusion

This study provides evidence that low testosterone and high SHBG levels are associated with an increased risk of RA in men. These associations are nonlinear and modified by factors such as age, race/ethnicity, hypertension, and PIR. Our findings highlight the importance of considering hormonal status in RA risk assessment and suggest potential avenues for targeted therapeutic strategies aimed at hormonal regulation.

Testosterone therapy for functional hypogonadism in middle-aged and elderly males: current evidence and future perspectives

Population aging is a global phenomenon driving research focus toward preventing and managing age-related disorders. Functional hypogonadism (FH) has been defined as the combination of low testosterone levels, typically serum total testosterone below 300-350 ng/dL, together with manifestations of hypogonadism, in the absence of an intrinsic pathology of the hypothalamic-pituitary-testicular (HPT) axis. It is usually seen in middle-aged or elderly males as a product of aging and multimorbidity. This age-related decline in testosterone levels has been associated with numerous adverse outcomes. Testosterone therapy (TTh) is the mainstay of treatment for organic hypogonadism with an identifiable intrinsic pathology of the HPT axis. Current guidelines generally make weak recommendations for TTh in patients with FH, mostly in the presence of sexual dysfunction. Concerns about long-term safety have historically limited TTh use in middle-aged and elderly males with FH. However, recent randomized controlled trials and meta-analyses have demonstrated safe long-term outcomes regarding prostatic and cardiovascular health, together with decreases in all-cause mortality and improvements in various domains, including sexual function, body composition, physical strength, bone density, and hematopoiesis. Furthermore, there are numerous insightful studies suggesting additional benefits of TTh, for instance in cardio-renal-metabolic conditions. Specifically, future trials should investigate the role of TTh in improving symptoms and prognosis in various clinical contexts, including sarcopenia, frailty, dyslipidemia, arterial hypertension, diabetes mellitus, fracture risk, heart failure, stable angina, chronic kidney disease, mood disorders, and cognitive dysfunction.

Diagnosing and treating the elderly individual with hypopituitarism

Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.

Aging in Ocular Blood Vessels: Molecular Insights and the Role of Oxidative Stress

Acknowledged as a significant pathogenetic driver for numerous diseases, aging has become a focal point in addressing the profound changes associated with increasing human life expectancy, posing a critical concern for global public health. Emerging evidence suggests that factors influencing vascular aging extend their impact to choroidal and retinal blood vessels. The objective of this work is to provide a comprehensive overview of the impact of vascular aging on ocular blood vessels and related diseases. Additionally, this study aims to illuminate molecular insights contributing to vascular cell aging, with a particular emphasis on the choroid and retina. Moreover, innovative molecular targets operating within the domain of ocular vascular aging are presented and discussed.

Causal relationship between sex hormone-binding globulin and major depression: A Mendelian randomization study

OBJECTIVE

This study aimed to explore the causal relationship between sex hormone-binding globulin (SHBG) and major depression using two-sample Mendelian randomization (MR) studies.

METHODS

Based on the genome-wide association study (GWAS) summary data of SHBG and major depression in the European population, which included 214,989 female SHBG samples, 185,221 male SHBG samples, and 500,199 major depression samples, we used genetic factors as instrumental variables to conduct two-sample MR analyses. We used methods including inverse variance weighted (IVW), weighted median, weighted mode, and MR Egger to evaluate the bidirectional causal relationship between SHBG and major depression.

RESULTS

The results showed that there was a causal relationship between female SHBG and major depression, which was positively correlated. The ORs were 1.056 (95% CI: 1.005-1.109, p = 0.031) for the weighted median and 1.067 (95% CI: 1.012-1.126, p = 0.021) for the weighted mode. There was no significant effect of male SHBG on major depression (p > 0.05), and there was no significant effect of major depression on female SHBG (p > 0.05). Major depression was negatively correlated with male SHBG, indicating that major depression could lead to a decrease in male SHBG. The OR was 0.954 (95% CI: 0.916-0.993, p = 0.023) for IVW.

CONCLUSION

Female SHBG was positively correlated with the risk of major depression, however, major depression was found to be negatively correlated with serum SHBG levels in men, indicating that SHBG plays distinct roles in patients with major depression of different genders.