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Schederecker, F. ; Cecil, A. ; Prehn, C. ; Nano, J. ; Koenig, W.* ; Adamski, J. ; Zeller, T.* ; Peters, A. ; Thorand, B.

Sex hormone-binding globulin, androgens and mortality: The KORA-F4 cohort study.

Endocr. Connect. 9, 326–336 (2020)

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Objective: Sex hormone-binding globulin (SHBG) and androgens have been associated with mortality in women and men, but controversy still exists. Our objective was to investigate associations of SHBG and androgens with all-cause and cause-specific mortality in men and women.Design: 1006 men and 709 peri- and postmenopausal women (age range: 45-82 years) from the German population-based KORA F4 cohort study were followed-up for a median of 8.7 years.Methods: SHBG was measured with an immunoassay, total testosterone (TT) and dihydrotestosterone (DHT) with mass-spectrometry in serum samples and we calculated free testosterone (cFT). To assess associations between SHBG and androgen levels and mortality, we calculated hazard ratios (HRs) with 95% Cls using Cox proportional-hazards models.Results: In the cohort, 128 men (12.7%) and 70 women (9.9%) died. In women, we observed positive associations of SHBG with all-cause (HR: 1.54, 95% CI: 1.16-2.04) and with other disease-related mortality (HR: 1.86, 95% CI: 1.08-3.20) and for DHT with all-cause mortality (HR: 1.32, 95% CI: 1.00-1.73). In men, we found a positive association of SHBG (HR: 1.24 95% CI: 1.00-1.54) and inverse associations of TT (HR: 0.87, 95% CI: 0.77-0.97) and cFT (HR: 0.84, 95% CI: 0.73-0.97) with all-cause mortality. No other associations were found for cause-specific mortality.Conclusions: Higher SHBG levels were associated with increased risk of all-cause mortality in men and women. Lower TT and cFT levels in men and higher DHT levels in women were associated with increased risk of all-cause mortality. Future, well-powered population-based studies should further investigate cause-specific mortality risk.

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