Statins, testosterone, and urological diseases in men
Men in the United States (U.S.) experience disproportionately higher rates of morbidity than women. Key health indicators that affect men’s health are related to urological diseases (UD), e.g.; erectile dysfunction (ED) and kidney stones (KS). 18.4% of adult men have ED and more than 10% of adult men have KS in the United States. ED and KS are multifactorial urological diseases, among significant risk factors of which are race/ethnicity, diabetes, overall obesity, and dyslipidemia. Men with diabetes, obesity, and dyslipidemia are likely to have low testosterone levels, and are prone to be treated with statins due to statins’ antidyslipidemic effects. Prevalence of statin use was 26% of adults aged 20 years and older in 2011. 17% of men aged 20 years and older used statins in 2012. Statins inhibit biosynthesis of cholesterol, which is the biologic source for testosterone. Prevalence of testosterone levels less than 3 ng/mL (Low-T) was estimated 2.4 million in 2004 for men aged 40–70 years, and 481,000 new cases were projected per year. Statins and testosterone levels could play a significant role in men’s health. Although testosterone is the end product in the cascade of cholesterol synthesis, literature lacks on how the association between statin use and UD vary by testosterone levels. Evidence is also needed how stratification by race/ethnicity, diabetes, obesity, and dyslipidemia has an impact on the association between statin use and UD, and between Low-T and UD. To fill these gaps in the literature, we aimed to investigate (i) the association between statins and UD, (ii) the association between testosterone and UD, and (iii) how the association between statins and UD varied when stratified by testosterone levels. We also stratified the associations between statins and UD, and the association between Low-T and UD, by race/ethnicity, diabetes, obesity, and serum cholesterol levels. We found that men who reported use of statins are approximately three times more likely to report ED (OR: 2.71, 95% CI: 1.11-6.61), 78% less likely to report KS (OR: 0.22, 95% CI: 0.06-0.82) when compared to men who didn’t, and men who had Low-T were approximately four times more likely to report ED (OR: 3.75, 95% CI: 1.10-12.69) and 42% less likely to report KS (OR: 0.58, 95% CI: 0.36-0.95) as compared to men who had testosterone levels ?3ng/mL. We also stratified by race/ethnicity, diabetes, obesity, and total serum cholesterol levels. We didn’t find any significant association stratified by obesity and cholesterol levels. We found significant associations when stratified by race/ethnicity and diabetes. Finally, we also found significant association between statin use and UD in men when stratified by Low-T. Men in the cohort of men with Low-T using statins are approximately ten and a half times more likely to have ED (OR: 10.58, 95% CI: 2.34-47.71), and 78% less likely to have KS (OR: 0.22, 95% CI: 0.05-0.91) as compared to non-statin users. In the cohort of men with testosterone levels more than or equal to 3ng/mL, men using statins were 66% more likely to have ED (OR: 1.66, 95% CI: 1.02-2.70), and 70% less likely to have KS (OR: 0.30, 95% CI: 0.14-0.63) as compared to men not using statins. Our findings need to be confirmed by prospective studies.^
Yucel, Emre, "Statins, testosterone, and urological diseases in men" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10245886.