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Trained study nurses collected information regarding history of chronic diseases and medication as well as performed anthropometric and blood pressure measurements. During 2012–2014, a second visit was carried out, and a representative sample was invited to participate with almost identical protocols as at visit one. This was a population-based, longitudinal, observational study. Due to the cross-sectional design of studies, it is challenging to understand the direction of these associations. Studies have proposed that obesity, comorbidities, and aging play a central role in this association, promoting androgen deficiency by the secretion of adipocytokines and CRP (5, 7).
To the best of our knowledge, no studies have examined a longitudinal association between high CRP concentration and the development of hypogonadism. It has previously been observed that testosterone, through its androgen receptors, regulates the expression of cytokines, providing a modulating role in the inflammatory response (2, 7). Testosterone concentration decreases with aging, and if reaching hypogonadic levels in adulthood, this is defined as late-onset hypogonadism (LOH), according to the European Association of Urology (EAU) (5). Serum concentrations of testosterone and C-reactive protein (CRP) were measured at both visits.
Results from the BACH study demonstrate, in a community-based sample of men, an inverse association of CRP with total and free testosterone as well as SHBG. Using data from the Boston Area Community Health (BACH) Survey, the objectives of this analysis were to investigate the association between CRP and sex hormone levels in a racially and ethnically diverse population-based sample of men. Further studies are needed to confirm the longitudinal association between CRP and androgen levels, adjusting for different confounding cytokines and underlying mechanisms to better understand the possible impact of inflammation on sexual hormonal secretion and male health. Finally, CRP was used as a marker for sub-inflammatory concentrations in this study. Other cross-sectional studies suggest that obesity largely could explain in most part the association between inflammatory markers and testosterone levels (27, 28, 29, 30, 31). There is a great number of studies investigating the association of testosterone levels with inflammatory markers, seemingly to confirm evidence of the association, remaining significant even after adjustments for obesity.
A recent report from the InCHIANTI study shows a similar null result for the E2 and CRP association; however, a positive and statistically significant association was observed between estradiol and IL-6 levels.14 Finally, in an occupation-based sample of 715 middle-aged men (35–59 yrs), no association was observed between CRP and sex hormone levels, including TT, FT, SHBG, and E2.15 An inverse association was observed, in both bivariate and multivariate analyses, between CRP and total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) levels. This study confirms earlier cross-sectional observations regarding the inverse association between hsCRP and testosterone concentrations in men (shown in Fig. 3A), including the decline of testosterone levels with aging (shown in Fig. 2A and B) (21, 22, 23, 24). The objective is to study the association between levels of C-reactive protein and testosterone and its role in predicting biochemical hypogonadism in men. Furthermore, hsCRP was observed to increase the risk of biochemical hypogonadism in men independent of age, obesity, and other confounders. Furthermore, Zhang et al. (1989 male participants) reported in their cross-sectional study an inverse association between CRP and total and free testosterone as well as SHBG, independent of obesity, insulin resistance, and metabolic syndrome (24).
A scatterplot presenting the association between baseline CRP and calculated bioavailable testosterone (A) and SHBG (B) at both visits. A constant and significant decrease in bioavailable testosterone was observed with increasing age, as well as increase of SHBG with age. Evaluation of the association between logCRP and testosterone was made through cross-sectional linear regression both at the first visit and in the longitudinal analyses. As measurement techniques changed during follow-up time, we compared similar age groups at both baseline and follow-up in order to estimate the change in concentration due to method change. Participants who did not participate in the second visit or had missing information on anthropometric measures, testosterone levels, sex hormone-binding globulin (SHBG), smoking, hypertension, leisure-time physical activity (LTPA), or diabetes were excluded, leaving a remainder of 641 men. The focus of this cohort study was the detection of early cardiometabolic disorders, and thus the age of participants ranged between 30 and 74, with oversampling of subjects between 30 and 50 years of age.
Non-fasting blood samples were collected close to waking time (median time since awakening 3 h 38 min) to control for diurnal variation in hormone levels. Interviews were completed with 63.3% of eligible subjects, resulting in a total sample of 5504 adults (2301 men, 3203 women, 1767 Black, 1877 Hispanic, 1859 White respondents). Detailed methods have been described elsewhere.9 In brief, BACH used a multi-stage stratified random sample to recruit approximately equal numbers of subjects according to age (30–39, 40–49, 50–59, 60–79 years), gender, and race/ethnic group (African American (Black), Hispanic, and Caucasian (White)). The BACH survey is a population-based epidemiologic survey of a broad range of urologic symptoms and risk factors in a randomly selected sample. A positive trend between estradiol (total and free) and CRP levels was not statistically significant. - https://deltasongs.com/antoniachen890
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