Abstract

Testosterone products are prescribed to males for a variety of possible health benefits, but causal effects are unclear. Evidence from randomized trials are difficult to obtain, particularly regarding effects on long-term or rare outcomes. Mendelian randomization analyses were performed to infer phenome-wide effects of free testosterone on 461 outcomes in 161,268 males from the UK Biobank study. Lifelong increased free testosterone had beneficial effects on increased bone mineral density, and decreased body fat; adverse effects on decreased HDL, and increased risks of prostate cancer, androgenic alopecia, spinal stenosis, and hypertension; and context-dependent effects on increased haematocrit and decreased C-reactive protein. No benefit was observed for type 2 diabetes, cardiovascular or cognitive outcomes. Mendelian randomization suggests benefits of long-term increased testosterone should be considered against adverse effects, notably increased prostate cancer and hypertension. Well-powered randomized trials are needed to conclusively address risks and benefits of testosterone treatment on these outcomes.

Data availability

Individual-level data cannot be provided, but it is available to all researchers by application to the UK Biobank. Summary-level GWAS data will be returned to the UK Biobank Access Team for use by other researchers. All MR results and genome-wide significant SNPs have been provided in Supplementary Tables 4 to 12.

Article and author information

Author details

  1. Pedrum Mohammadi-Shemirani

    Medical Sciences, McMaster University, Hamilton, Canada
    Competing interests
    No competing interests declared.
  2. Michael Chong

    Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
    Competing interests
    No competing interests declared.
  3. Marie Pigeyre

    Medicine, McMaster University, Hamilton, Canada
    Competing interests
    No competing interests declared.
  4. Robert W Morton

    Kinesiology, McMaster University, Hamilton, Canada
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-0099-4167
  5. Hertzel C Gerstein

    Medicine, McMaster University, Hamilton, Canada
    Competing interests
    Hertzel C Gerstein, HCG reports research grants from Eli Lilly, AstraZeneca, Merck, Novo Nordisk, and Sanofi; honoraria for speaking from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi; and consulting fees from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck, Novo Nordisk, Janssen, Sanofi, Kowa, and Cirius..
  6. Guillaume Paré

    Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
    For correspondence
    pareg@mcmaster.ca
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6795-4760

Funding

Canadian Institutes of Health Research (Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award)

  • Michael Chong

Canadian Institutes of Health Research (Post-Doctoral Fellowship)

  • Robert W Morton

McMaster University (E.J. Moran Campbell Internal Career Research Award)

  • Marie Pigeyre

McMaster University (McMaster-Sanofi Population Health Institute Chair in Diabetes Research and Care)

  • Hertzel C Gerstein

Cisco Systems (Professorship in Integrated Health Biosystems)

  • Guillaume Paré

Canada Research Chairs (Canada Research Chair in Genetic and Molecular Epidemiology)

  • Guillaume Paré

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: UK Biobank received ethical approval from the North West Multi-Centre Research Ethics Committee (REC reference: 11/NW/0382). This research was conducted using the UK Biobank under Application Number 15255.

Copyright

© 2020, Mohammadi-Shemirani et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Pedrum Mohammadi-Shemirani
  2. Michael Chong
  3. Marie Pigeyre
  4. Robert W Morton
  5. Hertzel C Gerstein
  6. Guillaume Paré
(2020)
Effects of lifelong testosterone exposure on health and disease: a Mendelian randomization study
eLife 9:e58914.
https://doi.org/10.7554/eLife.58914

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https://doi.org/10.7554/eLife.58914

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