Low Testosterone, Higher Mortality: What Two Major Studies Reveal About Hormone Health and How to Boost It Naturally

Introduction

What if your hormone levels could predict how long you’ll live?

For years, testosterone was dismissed as merely the “sex hormone”—important for libido, muscle mass, and little else. But new large-scale studies suggest that low testosterone may be more than a quality-of-life issue—it could be a silent signal of higher risk for early death, especially in men with or without known cardiovascular disease.

In this article, we’ll explore two new studies that strongly support each other. One, published in the Annals of Internal Medicine in May 2024, analyzed data from over 255,000 participant-years and found that men with low testosterone, low estradiol, or high luteinizing hormone levels faced significantly higher risks of all-cause and cardiovascular death.

The second study, published in Cardiovascular Toxicology in March 2025, used data from the U.S. NHANES database and found a nearly 50% increase in all-cause mortality among men with cardiovascular disease and low testosterone levels, while noting no such pattern in women.

Together, these findings confirm what many clinicians and researchers have suspected: testosterone levels in aging men may serve as a powerful predictor of heart health and longevity.

In the sections that follow, we’ll summarize the findings of these studies on testosterone and mortality risk, clarify their implications for clinical practice, and conclude with evidence-based tips on how men and women can naturally support healthy testosterone levels.

II. Key Findings From the 2024 Meta-Analysis (Annals of Internal Medicine)

This comprehensive individual participant data (IPD) meta-analysis, published in Annals of Internal Medicine in May 2024, pooled hormone data from over 255,000 participant-years across multiple cohort studies of men.

Unlike many past studies that used immunoassays, this one used mass spectrometry, the gold standard for hormone measurement, adding significant credibility to its findings.

A. Hormones Studied

The researchers looked at five key sex hormones and regulators:

• Testosterone
• Dihydrotestosterone (DHT)
• Estradiol
• Sex Hormone–Binding Globulin (SHBG)
• Luteinizing Hormone (LH)

B. Main Results

• Low testosterone (<213 ng/dL or <7.4 nmol/L) was linked with higher all-cause mortality.
• Very low testosterone (<153 ng/dL or <5.3 nmol/L) predicted greater risk of death from cardiovascular disease (CVD).
• Low DHT (below 0.69 nmol/L) was associated with both higher all-cause and CVD mortality.
• However, very high DHT (above 2.45 nmol/L) also showed increased mortality risk, indicating a U-shaped relationship.
• Low estradiol (<5.1 pmol/L) and high LH (>10 IU/L) were associated with higher mortality.
• Interestingly, low SHBG was associated with lower mortality, suggesting that lower SHBG might mean more bioavailable (free) testosterone in circulation.

C. Key Takeaways

• Testosterone alone isn’t the full story—its interactions with DHT, SHBG, estradiol, and LH matter too.
• The findings support the role of testosterone not only in reproductive health but also in metabolic, vascular, and overall longevity.
• Low testosterone and hormonal imbalances may be early warning signs of declining systemic health.

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III. Key Findings From the 2025 NHANES-Based Study (Cardiovascular Toxicology)

This study, published in Cardiovascular Toxicology in March 2025, took a deep dive into real-world data from the U.S. National Health and Nutrition Examination Survey (NHANES). It looked specifically at 1,177 adults with cardiovascular disease (CVD)—689 males and 488 females—and examined how testosterone levels related to all-cause mortality over a median follow-up of 55 months.

A. Testosterone and Mortality in Men

• Low testosterone (≤300 ng/dL) was found in over 70% of male patients.
• Men with low testosterone had a 48% higher risk of all-cause death, even after adjusting for age, hypertension, education, income, SHBG, and estradiol levels.
• This higher mortality risk was consistent across:
  • Both younger (<65) and older (≥65) men
  • Men with or without hypertension

B. What About Women?

• Among women with CVD, low testosterone (≤20 ng/dL) did not predict higher mortality.
• However, age and low estradiol were both associated with greater risk, which may complicate the hormonal picture for postmenopausal women.
• The study noted that female hormone physiology is more complex, and the right testosterone “threshold” for women remains unclear.

C. What Happens in the Body When Testosterone Is Low?

Researchers believe that low testosterone isn’t just a number—it affects the body in many serious ways that can shorten a man’s life. Here’s how:

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1. Heart Rhythm Problems (QTc Interval Prolongation)

• What it means: Testosterone helps regulate the timing of your heartbeat.
• Why it matters: When levels are too low, the electrical signals in the heart slow down.
• This can prolong the QTc interval—a medical term for a delay in the heart’s rhythm.
• That delay increases the risk of irregular heartbeats (arrhythmias), which can lead to sudden death if severe.

🫀 In simple terms: Low testosterone can make your heart’s rhythm less stable, like a drummer losing track of the beat—sometimes with dangerous consequences.

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2. Worsened Insulin Resistance and Belly Fat

• What it means: Testosterone helps keep blood sugar and fat under control.
• When it’s low, your body becomes less sensitive to insulin, the hormone that manages blood sugar.
• That leads to higher blood sugar and more fat buildup—especially around the belly (visceral fat), which is the most dangerous kind.

⚠️ In simple terms: Low testosterone makes it easier to gain belly fat and harder to control blood sugar, raising your risk for diabetes, heart disease, and early death.

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3. More Inflammation and Damaged Blood Vessels

• Testosterone normally has anti-inflammatory effects—it helps calm down chronic inflammation.
• When levels are low, inflammation increases, which can damage the lining of your blood vessels over time.
• This damage can lead to narrowed arteries, high blood pressure, and more plaque buildup—setting the stage for heart attacks and strokes.

🔥 In simple terms: Without enough testosterone, your body stays in a low-level state of “fire,” which silently damages your heart and blood vessels.

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4. High LH: A Sign the Testicles Are Failing

• LH (luteinizing hormone) is a signal from the brain that tells the testicles to make testosterone.
• When testosterone is low and LH is high, it usually means the testicles aren’t responding well—this is called testicular failure.
• Some studies suggest that high LH itself may harm blood vessels directly or through imbalances in other hormones.

🧪 In simple terms: If your body keeps shouting “make more testosterone!” but the testicles don’t respond, it’s a sign something is wrong—and that failure may also stress your heart and blood vessels.

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✅ Bottom Line

Low testosterone affects more than energy, libido, or muscle mass. It can disrupt your heart rhythm, increase fat and blood sugar, inflame your arteries, and signal deeper problems with your hormone system. These effects combine to raise your risk of early death, especially from heart disease.

D. Clinical Relevance

• This study adds real-world population data to the growing body of evidence.
• It shows that monitoring testosterone in male CVD patients could help stratify risk.
• The results also lend cautious support to exploring testosterone replacement therapy (TRT) in appropriate cases, though individual risk-benefit analysis is essential.

IV. Synthesis: What Both Studies Confirm Together

Although the two studies analyzed different populations and used different methods, their results lead to the same powerful conclusion: low testosterone levels are linked with significantly higher risk of death in men, especially from cardiovascular causes.

A. Two Studies, One Message

• The 2024 IPD meta-analysis from Annals of Internal Medicine drew from prospective cohort studies of community-dwelling men. It demonstrated that men with testosterone levels below 213 ng/dL had a higher risk of all-cause mortality, and those with levels below 153 ng/dL had an even greater risk of cardiovascular death.
• The 2025 NHANES-based study focused specifically on male patients already diagnosed with cardiovascular disease. It found that men with testosterone levels ≤300 ng/dL had a 48% higher all-cause mortality rate.

Despite the differences in population (general vs. CVD patients) and methodology (prospective vs. retrospective), both studies point to the same biological vulnerability—that men with low testosterone are more likely to die sooner, often due to cardiovascular problems.

B. The Role of Other Hormones

Both studies also assessed related hormones like DHT, SHBG, estradiol, and LH, revealing that:

• High LH and low estradiol levels are additional red flags in men.
• SHBG and DHT levels show nonlinear relationships—not too low, not too high, seems to be optimal.
• For females, the data remains inconsistent, and further research is needed to define safe hormone thresholds and determine whether interventions are beneficial.

C. Clinical and Public Health Implications

Together, these studies raise important considerations:

• Routine testosterone screening in older men—especially those with existing heart disease—may help identify those at higher risk of death.
• Testosterone is not just a sex hormone. It plays roles in metabolism, vascular tone, inflammation, body composition, and mood—all of which affect mortality risk.
• The consistency across studies may push future guidelines to reconsider testosterone thresholds for men and revisit hormone replacement therapy (TRT) in carefully selected individuals.
• For women, the hormone story is more complex. Low testosterone doesn’t appear as harmful, but the balance with estradiol and menopausal status may matter more.

D. Not Just Numbers—A Marker of Aging and Health Decline

Testosterone might serve as a surrogate marker of overall physiological reserve. Declining levels often mirror:

• Chronic illness
• Muscle wasting
• Inflammation
• Frailty

In this sense, low testosterone isn’t just a cause—it’s a clue. Addressing it, whether through lifestyle or medical means, could help improve not only hormonal balance but also overall health outcomes.

V. How to Increase Testosterone Naturally in Males and Females

A. How Do You Know Your Testosterone Levels?

You can’t guess your testosterone level based on how you feel alone—you need a blood test. If you experience any of the following symptoms, it may be time to talk to your doctor:

In men:

• Low sex drive
• Fatigue or low energy
• Loss of muscle mass or strength
• Increased belly fat
• Depression or mood swings
• Difficulty concentrating
• Poor sleep

In women:

• Low libido
• Decreased muscle tone
• Poor motivation
• Low mood or fatigue
• Fragile bones (osteopenia or osteoporosis)

Your doctor may order a test for:

• Total testosterone
• Free testosterone
• Sex hormone–binding globulin (SHBG)
• Luteinizing hormone (LH)
• Estradiol
• DHEA-S

📋 Timing matters: For men, testosterone levels are highest in the early morning. Blood tests should be done before 10 AM for the most accurate results.

Once you know where you stand, you can begin to support your testosterone levels with safe, natural strategies.

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B. For Men

Natural testosterone production in men depends on several interrelated factors, including body composition, sleep quality, stress levels, and diet. Here are the most effective ways to enhance it:

1. Engage in Resistance Training

• Compound exercises like squats, deadlifts, and bench presses stimulate testosterone release.
• High-intensity interval training (HIIT) may also boost testosterone temporarily.

2. Prioritize Sleep

• Testosterone is primarily produced during deep sleep.
• Aim for 7–9 hours per night, with consistent sleep-wake cycles.
• Poor sleep can lower testosterone by 10–30% in just one week.

3. Lose Excess Body Fat

• Especially visceral (belly) fat, which increases aromatase activity—converting testosterone to estradiol.
• Obesity is strongly linked with low testosterone levels.

4. Eat Healthy Fats

• Include monounsaturated fats (olive oil, avocados) and omega-3 fatty acids (flaxseeds, fish).
• Avoid trans fats and ultra-processed foods that raise inflammation and suppress hormones.

5. Optimize Key Nutrients

• Vitamin D3: Often low in older adults. Aim for 2,000–5,000 IU/day if deficient.
• Zinc: Found in pumpkin seeds, beef, and oysters.
• Magnesium: Important for testosterone synthesis. Found in nuts, leafy greens, and legumes.
• Creatine: A natural supplement shown to support testosterone and muscle mass.

6. Manage Stress and Cortisol

• Chronic stress raises cortisol, which suppresses testosterone.
• Mindfulness, meditation, prayer, or nature walks help buffer stress hormones.

7. Limit Alcohol and Sugar

• Excess alcohol impairs Leydig cells in the testes and lowers testosterone.
• High-sugar diets promote insulin resistance, leading to lower T and more body fat.

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C. For Women

Although women produce much less testosterone, this hormone still plays important roles in bone strength, mood, muscle tone, and libido. Women can also benefit from lifestyle strategies that naturally support healthy testosterone levels.

1. Build Muscle With Strength Training

• Resistance training improves testosterone and DHEA levels in women.
• Even moderate strength workouts twice weekly can improve hormone balance.

2. Maintain a Healthy Weight

• Excess fat increases insulin resistance and disrupts hormone production.
• Weight loss in overweight women may restore ovulation and hormonal balance.

3. Eat Enough Healthy Fats

• Cholesterol is a building block for hormones.
• Include eggs, seeds, and fatty fish while avoiding trans fats.

4. Get Enough Protein

• Adequate protein supports muscle mass and hormone regulation.
• Aim for at least 1.2 g/kg/day depending on activity level and age.

5. Ensure Adequate Sleep and Stress Reduction

• Just like men, sleep loss and chronic stress blunt androgen production.
• Practices like yoga, breathing techniques, and quiet spiritual reflection can help restore balance.

6. Consider DHEA Supplementation (With Guidance)

• DHEA is a precursor to testosterone and may help in women with low androgen levels.
• Use only under the supervision of a knowledgeable physician, especially in postmenopausal women.

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VI. Conclusion

The findings from these two major studies—one from Annals of Internal Medicine and the other from Cardiovascular Toxicology—underscore an urgent and underappreciated truth: low testosterone is not just a quality-of-life issue in men—it’s a powerful predictor of death, particularly from cardiovascular causes.

Men with testosterone levels below 213 ng/dL were more likely to die of any cause. Those with levels below 153 ng/dL faced significantly higher cardiovascular death risk. And for men already diagnosed with heart disease, the presence of low testosterone was associated with a 48% higher risk of death. Together, these studies suggest that testosterone testing may soon become as routine as cholesterol checks in men over 40.

But the good news is this: testosterone is modifiable. Through consistent resistance training, proper nutrition, weight management, restorative sleep, and stress reduction, men and women alike can influence their hormonal health naturally and safely.

While testosterone replacement therapy (TRT) may benefit select individuals, especially those with diagnosed hypogonadism, lifestyle medicine remains the foundation. It’s accessible, sustainable, and improves not only hormone levels but also overall longevity, strength, and vitality.

As our understanding of hormones and aging evolves, one thing is becoming clear: testosterone is more than a sex hormone—it’s a vital sign of your body’s health trajectory. Pay attention to it, nourish it, and when necessary, treat it. Your heart—and your lifespan—may depend on it.

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References:

• Bu B. Yeap, Ross J. Marriott, Girish Dwivedi, et al. Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses. Ann Intern Med.2024;177:768-781. [Epub 14 May 2024]. doi:10.7326/M23-2781
• Jiang, R., Wang, Y. Association between Low Serum Testosterone Levels and All-cause Mortality in Patients With Cardiovascular Disease: A Study Based on the NHANES Database. Cardiovasc Toxicol 25, 604–613 (2025). https://doi.org/10.1007/s12012-025-09973-7 https://link.springer.com/article/10.1007/s12012-025-09973-7

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