Women aged 65 years or older with high testosterone levels were more
likely to have insulin resistance, metabolic syndrome and cardiovascular
disease than women with normal levels of the hormone.
Researchers evaluated 344 women aged 65 to 98 enrolled in the
Cardiovascular Health Study. Researchers then performed cross-sectional
analyses to investigate the associations between total and free testosterone,
and insulin resistance, metabolic syndrome and CVD.
Mean total testosterone levels were 19.1 ng/dL and mean free
testosterone levels were 2.8 pg/mL. Mean BMI was 26.9.
The researchers reported a stepwise increase in insulin resistance
associated with increasing levels of total (P=.003) and free
testosterone (P=.02). There was a similar stepwise decrease in insulin
sensitivity as total (P≤.001) and free testosterone (P=.002)
They observed a strong relationship between total testosterone levels
and metabolic syndrome in both crude (P<.001) and adjusted models
(P=.007) when examining the prevalence of metabolic syndrome by quartile
of total testosterone level. The odds for metabolic syndrome for women in the
top quartile of total testosterone levels was three times greater than the odds
for those in the bottom quartile (OR=3.15; 95% CI, 1.576.35). That effect
held even when researchers adjusted for BMI (OR=2.81; 95% CI, 1.325.98).
The association between total testosterone levels and metabolic syndrome
persisted even when researchers excluded women with diabetes. Women in the
highest quartile for total testosterone levels still had a threefold greater
chance metabolic syndrome compared with women in the lowest quartile (OR=2.89;
95% CI 1.366.16).
Similarly, women in the top quartile for total testosterone levels had
threefold greater odds for CVD compared with women in the reference quartile
(OR=2.95; 95% CI, 1.27.3). The association was independent of
sociodemographic and traditional CV risk factors.
Free testosterone levels were also associated with high fasting glucose
(OR=2.37; 95% CI, 1.174.79) and abdominal obesity (OR 2.23; 95% CI,
Our findings suggest that even at the physiologically low levels
of testosterone found in these older women, the association between
testosterone and insulin resistance found in perimenopausal and early
postmenopausal women persists into old age, the researchers wrote.
Further studies are required to determine whether a causal relationship
exists between testosterone and insulin resistance and to provide more insight
into the role testosterone plays in the pathogenesis of CVD in women.
Patel SM. J Clin Endocrinol Metab.
These data are not surprising. Higher testosterone levels have been associated with higher CV risk in men so why not women?
- George Bakris, MD
Endocrine Today Editorial Board member