Salivary testosterone measurement does not identify biochemical hypogonadism in aging men: a ROC analysis

Hayes, Lawrence, Sculthorpe, Nicholas, Herbert, Peter, Baker, Julien S., Hullin, David A., Kilduff, Liam P., Reed, Dewi, Spagna, Roberto and Grace, Fergal M. (2014) Salivary testosterone measurement does not identify biochemical hypogonadism in aging men: a ROC analysis. Endocrine, 50 (1). pp. 256-259. Full text not available from this repository.

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The age-associated gradual decline of systemic testosterone (T) production in men is widely known [1] and further intensified by a concomitant increase in concentrations of sex hormone binding globulin (SHBG) [2] with a resultant pronounced decline in ‘free testosterone’ (free-T) fraction [3]. The estimated prevalence of clinically low T (biochemical hypogonadism) is not known with certainty for reasons partly due to clinically defined thresholds and variability in measurement [4]. However, a recent report suggested the prevalence to be 0.1 % in men aged 40–49 and 5.1 % aged 70–79 in the European Male Aging Study (EMAS) [5] with other authors suggesting prevalence as high as 49 % in men over 80 years of age [1]. When considered with report of a possible population-level decline in T, independent of aging [6], and a World Health Organization (WHO) estimation of 2 billion of the world’s inhabitants being over 60 years by 2050, convenient methods for determining T levels become increasingly attractive. In recent years, determination of T in saliva has gained popularity as a research tool in the fields of experimental research. This method to determine systemic steroid hormones has advantages over serum including; speed, ease of collection, avoidance of stress, and specialist training associated with venepuncture. Since the initial determination of T in saliva by Landman and colleagues [7], studies have reported varying levels of agreement with serum values [8, 9] and in some instances, no relationship at all [10–13]. It has previously been suggested that salivary testosterone (sal-T) could be used to screen for hypogonadism [8]. Despite the possible advantages over serum detection of T, numerous analytical and technical issues remain to be resolved. Indeed, sal-T is purported to represent the ‘‘free’’ fraction of T as SHBG is supposedly unable to enter saliva [9]; however, SHBG has been observed in saliva [14] and given that SHBG is known to increase with age [15], the influence of advancing age on the serum-saliva T relationship is unclear. In practice, total T (TT) measurement is suggested as the initial test to evaluate male hypogonadism [16], and therefore, the aim of this study was to determine the discriminative ability of sal-T to predict biochemical hypogonadism based on serum TT in a cohort of aging men.

Item Type: Article
Journal / Publication Title: Endocrine
Publisher: Humana Press
ISSN: 1559-0100
Departments: Academic Departments > Medical & Sport Sciences (MSS) > Sports and Physical Activity
Depositing User: Lawrence Hayes
Date Deposited: 16 Mar 2016 15:07
Last Modified: 05 Jul 2021 11:12
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