Frailty and testosterone level in older adults: a systematic review and meta-analysis

Key summary pointsAim To evaluate the relationship between levels of total testosterone, free testosterone, or sex hormone-binding globulin and frailty in older adults. Findings Total testosterone and free testosterone were significantly associated with frailty in men but not women. However, the association between sex hormone-binding globulin and frailty was not significant. Message Understanding that the association between frailty and androgen has important implications for frailty intervention. Purpose We conducted a systematic review to evaluate the relationship between total testosterone (TT), free testosterone (fT), or sex hormone-binding globulin (SHBG) and frailty in older adults. Methods We systematically searched nine databases (e.g. MEDLINE, Embase, ACP Journal Club, and the Cochrane library et al.) for papers on frailty and androgen levels published up to October 10, 2021. We calculated the odds ratio (OR) for the relationship between testosterone level and frailty by performing meta-analysis. Results The search strategy yielded 311 hits in all databases combined. Eleven (seven cross-sectional studies and four cohort studies) met the inclusion criteria for meta-analysis. Among cross-sectional studies, meta-analysis revealed a significant association between TT and frailty in men (OR = 1.37 [95% CI 1.09, 1.72]) not women (OR = 1.06 [0.84, 1.34]). The fT was also significantly association with frailty in men (OR = 1.55 [1.06, 2.25] not women (OR = 1.35 [0.91, 2.01]). Cohort studies showed the same result in TT (OR = 1.09 [1.02, 1.18]) and fT (OR = 1.15 [1.02, 1.30]) for men. We did not find a significant association between SHBG and frailty. Conclusion The findings of this systematic review and meta-analysis suggest that TT and fT were significantly associated with frailty in older men but not women.