title: Low testosterone and sex hormone-binding globulin levels and high estradiol levels are independent predictors of type 2 diabetes in men.
abstract: OBJECTIVE
  To study the impact of endogenous sex hormone levels in community-dwelling men on later risk for type 2 diabetes.
  
  
  METHODS
  Population-based prospective cohort study.
  
  
  METHODS
  For the analyses, 1454 men who participated in the fourth Tromsø study (1994-1995) were used. Cases of diabetes were retrieved and validated until 31.12.05 following a detailed protocol. The prospective association between sex hormones and diabetes was examined using Cox proportional hazard regression analysis, allowing for multivariate adjustments.
  
  
  RESULTS
  There was a significantly lowered multi-adjusted risk for later diabetes with higher normal total testosterone levels, both linearly per s.d. increase (hazard ratio (HR) 0.71, confidence interval (CI) 0.54-0.92) and in the higher quartiles of total testosterone than in the lowest quartiles (HR 0.53, CI 0.33-0.84). A reduced multi-adjusted risk for incident diabetes was also found for men with higher sex hormone-binding globulin (SHBG) levels, both linearly per s.d. increase (HR 0.55, CI 0.39-0.79) and when comparing the third (HR 0.38, CI 0.18-0.81) and the fourth quartile (HR 0.37, CI 0.17-0.82) to the lowest quartile. The associations with total testosterone and SHBG were no longer significant after inclusion of waist circumference to the multivariate models. Estradiol (E(2)) was positively associated with incident diabetes after multivariate adjustments including waist circumference when comparing the second (HR 0.49, CI 0.26-0.93) and the third (HR 0.51, CI 0.27-0.96) quartile to the highest quartile.
  
  
  CONCLUSIONS
  Men with higher E(2) levels had an increased risk of later diabetes independent of obesity, while men with lower total testosterone and SHBG had an increased risk of diabetes that appeared to be dependent on obesity.
authors.affiliation: Division of Internal Medicine, Department of Cardiology, University Hospital of North Norway, Tromsø 9038, Norway.
authors.forename: Torkel
authors.initials: T
authors.lastname: Vikan
authors.forename: Henrik
authors.initials: H
authors.lastname: Schirmer
authors.forename: Inger
authors.initials: I
authors.lastname: Njølstad
authors.forename: Johan
authors.initials: J
authors.lastname: Svartberg
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004958:Estradiol / Q000097:blood*; D006801:Humans; D008297:Male; D009664:Norway; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood*; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference / Q000502:physiology
chemical_list: D012738:Sex Hormone-Binding Globulin; D014280:Triglycerides; D013739:Testosterone; D004958:Estradiol; D002784:Cholesterol