Low free testosterone predicts frailty in older men: the health in men study

J Clin Endocrinol Metab. 2010 Jul;95(7):3165-72. doi: 10.1210/jc.2009-2754. Epub 2010 Apr 21.


Context: The prevalence of frailty increases, whereas testosterone decreases, as men age. Low testosterone may be a risk factor for development of this syndrome.

Objective: Our objective was to determine whether testosterone levels are associated with frailty.

Design: We conducted a prospective cohort study.

Setting and participants: Between 2001 and 2004, frailty was assessed in 3616 community-dwelling men aged 70-88 yr. Frailty was reassessed in 1586 men aged 76-93 yr in 2008-2009.

Main outcome measures: Frailty was assessed with the FRAIL scale, comprising five domains: fatigue, difficulty climbing a flight of stairs, difficulty walking more than 100 m, more than five illnesses present, or weight loss greater than 5%. Testosterone, SHBG, and LH were assayed at baseline. Free testosterone was calculated using mass action equations.

Results: At baseline, 15.2% of men (n = 548) were frail (at least three deficits), increasing to 23.0% (n = 364) at follow-up. At baseline, each 1 sd decrease in total or free testosterone level was associated with increased odds of frailty [odds ratio (OR) = 1.23; 95% confidence interval (CI) = 1.11-1.38, and OR = 1.29; 95% CI = 1.15-1.44 for total and free testosterone, respectively]. Lower LH was associated with reduced odds of frailty (OR = 0.88; 95% CI = 0.81-0.95). Adjustments were made for age, body mass index, smoking, diabetes, social support, and other covariates. At follow-up, only lower free testosterone levels (OR = 1.22; 95% CI = 1.05-1.42) predicted frailty.

Conclusions: Lower free testosterone was independently associated with frailty at baseline and follow-up. Randomized trials should explore whether testosterone therapy can prevent the development of frailty.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / physiology
  • Body Mass Index
  • Frail Elderly*
  • Geriatric Assessment
  • Humans
  • Male
  • Muscle Strength / physiology
  • Postural Balance / physiology
  • Prospective Studies
  • Regression Analysis
  • Surveys and Questionnaires
  • Testosterone / blood*
  • Walking / physiology


  • Testosterone