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TOPLINE:

Elevated free estradiol index (FEI) is strongly linked to metabolic and inflammatory markers in men of all ages and older women, whereas a higher free androgen index (FAI) shows similar associations in women younger than 50 years.

METHODOLOGY:

• Imbalances in sex hormones are associated with the development of metabolic abnormalities and inflammatory diseases and, therefore, may serve as markers for these conditions.
• Researchers assessed the association of sex hormone ratios with metabolic syndrome (MS) and inflammation in 9167 adults (mean age, 45 years; 4807 women; 84.7% non-Hispanic) using data from the National Health and Nutrition Examination Survey cycles 2013-2016.
• The serum measurements for total testosterone, estradiol, and sex hormone-binding globulin were used to calculate the excess androgen index, FEI, and FAI.
• Adjusted associations were described using relative risk (RR).

TAKEAWAY:

• Elevated FEI levels showed positive associations with MS (RR, 1.48; P < .001) and high C-reactive protein ([CRP]; RR, 1.49) in men younger than 50 years, with similar findings observed in men 50 years and older.
• In women 50 years and older, elevated FEI levels were associated with increased MS prevalence (RR, 1.22; P < .001) and high CRP (RR, 1.68; P < .001).
• In women younger than 50 years, FAI levels were positively associated with increased MS prevalence (RR, 1.34; P < .001) and high CRP (RR, 1.13; P = .018).
• A weaker positive association was observed between increased FAI levels and MS in men younger than 50 years (RR, 1.09; P = .018).

IN PRACTICE:

"A regular evaluation of sex hormone ratios specific to sex is critical across age groups for [cardiovascular disease] risk stratification and early prevention," the authors wrote.

SOURCE:

The study was conducted by Pallavi Dubey, Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas. It was published online in Frontiers in Endocrinology.

LIMITATIONS:

The study could not establish a causal link between sex hormones and MS and inflammatory markers owing to its cross-sectional analysis. A single assessment of sex hormones may not appropriately represent the overall response because of variations in the timings of sex hormone measurements. Moreover, the study could not directly compute free testosterone or estradiol levels but estimated them indirectly by combining sex hormones with sex hormone-binding globulin.

DISCLOSURES:

The study did not receive any specific funding for this article. The authors declared no conflicts of interest.