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Background <p>Sex hormones are critical health determinants in both sexes. Some studies have found the association between sex hormones and all-cause mortality. However, the evidence of these association is limited and there is a lack of comprehensive investigation of various sex hormones.</p> Methods <p>Our study included a total of 7,294 participants from the 2013 to 2016 National Health and Nutrition Examination Survey (NHANES). The total testosterone (TT), estradiol (E2), and sex hormone-binding globulin (SHBG) levels were obtained from laboratory data, free testosterone (FT), free estradiol (FE2), free androgen index (FAI) and the ratio of TT to E2 (TT/E2) were calculated. Cox proportional hazards regression models and restricted cubic spline were used to analysis the association between various sex hormones and all-cause mortality, and stratified analyses according to age, sex, race, and history of diabetes and hypertension were performed.</p> Results <p>The final study sample included 3,473 male and 3,821 female from the NHANES. In the multivariate-adjusted model, male participants with higher FT and higher FAI had an obvious lower incidence of all-cause mortality [FT: HR, 0.41 (95% CI, 0.36–0.79); FAI: HR, 0.34 (95% CI, 0.25–0.92)], but these associations were not significant in female. And there was a positive correlation between SHBG concentration and mortality rate in both male and female participants, but the HR in males was higher than that in females [2.45 (95% CI, 1.69–6.23) vs 1.81 (95% 1.53–3.21)].</p> Conclusion <p>Our study found sex differences in the association of sex hormones and their related indicators with all-cause mortality, providing new insights for future research in this field.</p>

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Sex difference of the associations of sex hormone and their related indicators with all-cause mortality

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月7日

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  • Yu Sun,
  • Meng Zhang,
  • Mengying Niu,
  • Xiaofei Zhang,
  • Zhi Mao,
  • Chang He,
  • Shiyin Ma,
  • Chucheng Jiao,
  • Jiahao Chen,
  • Xudong Pan,
  • Xiaoyan Zhu

摘要

Background

Sex hormones are critical health determinants in both sexes. Some studies have found the association between sex hormones and all-cause mortality. However, the evidence of these association is limited and there is a lack of comprehensive investigation of various sex hormones.

Methods

Our study included a total of 7,294 participants from the 2013 to 2016 National Health and Nutrition Examination Survey (NHANES). The total testosterone (TT), estradiol (E2), and sex hormone-binding globulin (SHBG) levels were obtained from laboratory data, free testosterone (FT), free estradiol (FE2), free androgen index (FAI) and the ratio of TT to E2 (TT/E2) were calculated. Cox proportional hazards regression models and restricted cubic spline were used to analysis the association between various sex hormones and all-cause mortality, and stratified analyses according to age, sex, race, and history of diabetes and hypertension were performed.

Results

The final study sample included 3,473 male and 3,821 female from the NHANES. In the multivariate-adjusted model, male participants with higher FT and higher FAI had an obvious lower incidence of all-cause mortality [FT: HR, 0.41 (95% CI, 0.36–0.79); FAI: HR, 0.34 (95% CI, 0.25–0.92)], but these associations were not significant in female. And there was a positive correlation between SHBG concentration and mortality rate in both male and female participants, but the HR in males was higher than that in females [2.45 (95% CI, 1.69–6.23) vs 1.81 (95% 1.53–3.21)].

Conclusion

Our study found sex differences in the association of sex hormones and their related indicators with all-cause mortality, providing new insights for future research in this field.