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Luigi Ferrucci, MD, PhD; Marcello Maggio, MD; Stefania Bandinelli, MD; Shehzad Basaria, MD; Fulvio Lauretani, MD; Alessandro Ble, MD; Giorgio Valenti, MD; William B. Ershler, MD; Jack M. Guralnik, MD, PhD; Dan L. Longo, MD

Arch Intern Med. 2006;166:1380-1388.

Background  Anemia is a frequent feature of male hypogonadism and anti-androgenic treatment. We hypothesized that the presence of low testosterone levels in older persons is a risk factor for anemia.

Methods  Testosterone and hemoglobin levels were measured in a representative sample of 905 persons 65 years or older without cancer, renal insufficiency, or anti-androgenic treatments. Hemoglobin levels were reassessed after 3 years.

Results  At baseline, 31 men and 57 women had anemia. Adjusting for confounders, we found that total and bioavailable testosterone levels were associated with hemoglobin levels in women (P = .001 and P = .02, respectively) and in men (P<.001 and P = .03, respectively). Men and women in the lowest quartile of total and bioavailable testosterone were more likely than those in the highest to have anemia (men, 14/99 vs 3/100; odds ratio [OR], 5.4; 95% confidence interval [CI], 1.4-21.8 for total and 16/99 vs 1/99; OR, 13.1; 95% CI, 1.5-116.9 for bioavailable testosterone; women, 21/129 vs 12/127; OR, 2.1; 95% CI, 0.9-5.0 for total and 24/127 vs 6/127; OR, 3.4; 95% CI, 1.2-9.4 for bioavailable testosterone). Among nonanemic participants and independent of confounders, men and women with low vs normal total and bioavailable testosterone levels had a significantly higher risk of developing anemia at 3-year follow-up (21/167 vs 28/444; relative risk, 2.1; 95% CI, 1.1-4.1 for total and 26/143 vs 23/468; relative risk, 3.9; 95% CI, 1.9-7.8 for bioavailable testosterone).

Conclusion  Older men and women with low testosterone levels have a higher risk of anemia.

Author Affiliations: Clinical Research Branch, National Institute on Aging, Baltimore, Md (Drs Ferrucci, Maggio, Ble, Ershler, and Longo); Azienda Sanitaria Firenze, Geriatric Rehabilitation, Florence, Italy (Dr Bandinelli); Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore (Dr Basaria); Tuscany Regional Health Agency, Florence (Dr Lauretani); Department of Internal Medicine and Biomedical Sciences, Geriatric Section, University of Parma, Parma, Italy (Dr Valenti); and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Md (Dr Guralnik).

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