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Determinants of Serum Total and Free Testosterone Levels in Women over the Age of 65 Years

Division of Endocrinology, Diabetes, and Metabolism (A.R.C.) and Center for Clinical Epidemiology and Biostatistics (A.R.C., S.J.R.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021; Section of Endocrinology (S.B.), Boston University, Boston, Massachusetts 02118; Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine (M.R.B.) and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging (T.H.), National Institutes of Health, Bethesda, Maryland 20892; Department of Epidemiology (J.C., J.M.Z.), University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of General Internal Medicine (J.R.), University of California, Davis, Sacramento, California 95817; and Division of Geriatric Medicine and Gerontology and Center on Aging and Health (L.P.F.), Johns Hopkins Medical Institutions, Baltimore, Maryland 21205

Address all correspondence and requests for reprints to: Anne R. Cappola, M.D., Sc.M., Division of Endocrinology, Diabetes, and Metabolism, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 718 Blockley, 423 Guardian Drive, Philadelphia, Pennsylvania 19104-6021. E-mail: acappola{at}cceb.med.upenn.edu.

Context: Little is known about testosterone (T) levels and their determinants in women of late postmenopausal age.

Objective: We describe levels of total and free T and selected factors that influence these levels in a random sample of older women.

Design: Levels of serum total T and free T by microdialysis were measured using ultrasensitive assays in 347 community-dwelling women aged 65–98 yr enrolled in the Cardiovascular Health Study. Cross-sectional analyses were performed to define factors associated with total and free T levels.

Results: In adjusted models: 1) total T levels declined with age until 80, whereas free T levels did not vary by age; 2) women with bilateral oophorectomy had 23% lower total T and 16% lower free T levels than those with at least one intact ovary; 3) oral estrogen users had total and free T levels that were 47% lower than never users; 4) obese women had 47% higher total T and 20% higher free T levels, and overweight women had 24% higher total T and 14% higher free T levels, than normal weight women; and 5) free T levels were 51% higher in black women. Corticosteroid users had 75% lower total T and 43% lower free T levels than nonusers.

Conclusions: Bilateral oophorectomy, estrogen use, corticosteroid use, and low body mass index are independent risk factors for lower T levels in women aged 65 yr and over. Although highly prevalent in women of this age, the physiological significance of low T levels in late postmenopausal women requires further investigation.

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