THE AGING MALE

2022, VOL. 25, NO. 1, 278–280

https://doi.org/10.1080/13685538.2022.2130236

LETTER

Prevalence of testosterone deficiency among US adult males

Dear Editor, can be defined as TD, according to 2018 American

Testosterone is a fundamental sex hormone made by
testicular Leydig cells and affects numerous sexual and
nonsexual functions. Testosterone deficiency (TD) is charac­
terized by low testosterone combined with one or more
symptoms including decreased muscle mass, libido and
energy, poor cognition, and depression [1]. Previous studies
indicated that about 7% of men would be affected by TD
followed by several sexual and nonsexual symptoms in
their 50 s, and the prevalence rate of TD in US males was
12.3% in the 40–69-year-old US male population (estimated
from the Massachusetts Male Aging Study) [1,2]. However,
the exact prevalent condition of TD in US adult males of all
ages is still not clear. Hence, we estimated the prevalence
of TD using data from the National Health and Nutrition
Examination Survey (NHANES), which represent the condi­
tion of the whole non-institutionalized US civilians.
We obtained data from NHANES 2013–2014 to
2015–2016, since only these two cycles were available for
complete testosterone information. NHANES is an
ongoing cross-sectional and multistage probability sample
survey to reflect the nutritional and health status of the
US population. Participants less than 20 years old or with­
out available testosterone data were excluded from our
analysis. And a man with a total testosterone <300 ng/dL
Urological Association (AUA) guidelines [3]. The preva­
lence rate and 95% confidence interval (95% CI) were pre­
sented in the overall sample and participants which were
stratified by age and body mass index (BMI) condition.
The p value for linear trends was calculated from linear
regression while treating the NHANES cycle or age and
BMI group into continuous variables. Weighted logistic
regressions were used to assess the association between
age and BMI group and the likelihood of testosterone. All
analyses were performed by R version 4.0.5[Q3] and SPSS
version 26.0 (IBM, Armonk, NY).
A total of 5000 adult males (weighted,
N ¼ 213,316,904) with an average age of 47.51 ± 19.68
(mean ± SD) were included in this study. The overall
prevalence rate TD was 26.2 (95% CI, 23.9, 28.6) for
NHANES 2013–2014 and 25.8 (95% CI, 22.5, 29.1) for
NHANES 2015–2016 (linear p ¼ 0.8340) (Table 1). And the
prevalence rate was significantly higher in elder, over­
weight, or obese males in both two NHANES cycles.
Figure 1 presented the results of multivariable logistic
regressions with combined cycles. In general, elder peo­
ple had a higher risk of TD, especially people aged over
70 years old (OR for age 70–79 ¼ 1.95, 95% CI, 1.34, 2.83;
OR for age �80 ¼ 4.04, 95% CI, 2.80, 5.80). Both

Table 1. Prevalence of testosterone deficiency in US adult males.

Prevalence of testosterone deficiency% (95% CI)
NHANES 2013–2014 NHANES 2015–2016
c,# # c,#
Cases N ¼2533 Cases N# ¼2467 pa Value
Overall
673 26.2 (23.9, 28.6) 683 25.8 (22.5, 29.1) 0.8340
Age group
20–29 71 16.6 (11.8, 21.4) 68 16.8 (10.2, 23.3)
30–39 105 24.2 (19.5, 28.9) 117 29.1 (21.5, 36.7)
40–49 129 31.3 (26.8, 35.9) 103 28.4 (21.8, 35.0)
50–59 105 23.6 (17.7, 29.5) 109 26.2 (20.3, 32.2)
60–69 126 32.6 (26.2, 39.0) 128 21.2 (16.0, 26.4)
70–79 74 30.1 (23.3, 36.9) 92 33.5 (24.8, 42.1)
�80 63 42.9 (35.9, 49.8) 66 44.3 (35.2, 53.2)
pb Value 0.0023 0.0259
BMId group
Normal 82 10.7 (7.4, 13.9) 80 11.2 (7.5, 14.8)
(18 � BMI < 25 kg/m2)
Overweight 232 23.3 (20.5, 26.2) 215 20.5 (16.8, 24.3)
(25 � BMI < 30 kg/m2)
Obese 359 40.4 (36.7, 44.0) 388 40.1 (35.9, 44.4)
(�30 kg/m2)
pb Value <0.001 <0.001
a
p Value for linear trends was calculated from linear regression while treating the NHANES cycle into continuous variables. bp
Value for linear trends was calculated from linear regression while treating age or BMI group into continuous variable independ­
ently. cCases, the number of testosterone deficiency participants. dBMI: body mass index. #unweighted. The prevalence rates
(95%CI) of testosterone deficiency were weighted.

Figure 1. Results of multivariable logistic regression.
Multivariable logistic regression predicting the association
among age, BMI group, and the likelihood of testosterone
deficiency, with the vertical line stands for a 95% confi­
dence interval.
overweight (OR ¼ 2.14, 95% CI, 1.66, 2.76) and obese (OR
¼ 5.33, 95% CI, 4.10, 6.94) males showed a higher likeli­
hood of TD.
Our results displayed that the prevalence rate of TD
was about 30% in US adult males, and it was higher in
males with elder age and higher BMI. These estimates
may arouse attention in male health management, espe­
cially considering that obesity is quite common among
US males [4]. And the occurrence of TD is not only asso­
ciated with higher age or BMI, but also related to
unhealthy dietary habits and environmental pollutant
exposure, etc. [5]. Testosterone therapy (TTh) was very
popular in treating TD in recent years. However, the clini­
cians should carefully consider TD diagnosis criteria and
individuals’ health conditions and maintain necessary
laboratory monitoring when carrying out TTh [3]. Our
study possessed several limitations. We simply defined
TD as a total testosterone level below 300 ng/dL without
considering symptoms and/or signs followed with TD [3].
Since only NHANES 2013–2014 and 2015–2016 were
available for testosterone data, the number of partici­
pants in this study was inevitably small.
Disclosure statement
No potential conflict of interest was reported
the author(s).
Data share statement
Data described in the manuscript, code book, and analytic
code will be made publicly and freely available without
restriction at www.cdc.gov/nchs/nhanes/.
THE AGING MALE 279
Ethical approval
The studies involving human participants were reviewed and
approved by the NCHS Ethics Review Board.
Informed consent
Informed consent was obtained from all individual partici­
pants enrolled in the study.
Author contributions
Concept and design: Nuozhou Liu; Ying Feng;
Acquisition, analysis, or interpretation of data: Nuozhou
Liu; Ying Feng;
Critical revision of the manuscript for important intellec­
tual content: Ying Feng; Fang Ma; Xue Ma;
Statistical analysis: Nuozhou Liu;
Administrative, technical, or material support: Nuozhou
Liu; Ying Feng;
Supervision: Fang Ma; Xue Ma.
ORCID
Xue Ma http://orcid.org/0000-0002-7650-6214
Fang Ma http://orcid.org/0000-0002-7781-821X
References
0[1] Halpern JA, Brannigan RE. Testosterone deficiency. JAMA.
2019;322(11):1116–1116.
0[2] Araujo AB, O’Donnell AB, Brambilla DJ, et al. Prevalence and
incidence of androgen deficiency in middle-aged and older
men: estimates from the Massachusetts male aging study. J
Clin Endocrinol Metab. 2004;89(12):5920–5926.
0[3] Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and
management of testosterone deficiency: AUA guideline. J
Urol. 2018;200(2):423–432.
0[4] Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in
obesity among adults in the United States, 2005 to 2014.
JAMA. 2016;315(21):2284–2291.
0[5] Lopez DS, Wulaningsih W, Tsilidis KK, et al. Environment-
wide association study to comprehensively test and validate
associations between nutrition and lifestyle factors and tes­
tosterone deficiency: NHANES 1988-1994 and 1999–2004.
Hormones (Athens). 2020;19(2):205–214.
Nuozhou Liu�
West China School of Medicine, West China Hospital,
Sichuan University, Chengdu, PR China
by Ying Feng�
West China School of Basic Medical Sciences & Forensic
Medicine, Sichuan University, Chengdu, PR China
Xue Ma
Department of Pediatric Urology, West China Hospital,
Sichuan University, Chengdu, PR China
medmaxue@163.com
280 N. LIU ET AL.
Fang Ma
Center for Translational Medicine, Key Laboratory of Birth
Defects and Related Diseases of Women and Children
(Sichuan University), Ministry of Education, West China
Second University Hospital, Sichuan University, Chengdu, PR
China
mafangmed@126.com
Received 11 July 2022; revised 1 September 2022; accepted 23
September 2022; Published online 3 October 2022
�The authors consider that these authors should be regarded as
joint first authors.
� 2022 The Author(s). Published by Informa UK Limited, trading as
Taylor & Francis Group
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