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

Hayes, Lawrence D.; 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.

View this record at http://insight.cumbria.ac.uk/1833/
Official URL: 10.1007/s12020-014-0516-3

Abstract

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
Keywords: 571 Physiology & related subjects
Members: University of Cumbria
Depositing User: ULCC Admin
Date Deposited: 08 Nov 2016 13:05
Last Modified: 08 Nov 2016 13:05
URI: http://collections.crest.ac.uk/id/eprint/12486

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