Research Paper Volume 13, Issue 4 pp 5226—5237

Associations between smoking, sex hormone levels and late-onset hypogonadism in men differ depending on age

Qian Liu1,2, , Xiangchi Peng1, , Yiqun Gu3, , Xuejun Shang4, , Yuanzhong Zhou5, , Huiping Zhang2,6, , Liandong Zuo7, , Guangan Mei8, , Chengliang Xiong2,6, , Honggang Li2,6, , Xiangbin Kong9, ,

  • 1 Center for Reproductive Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
  • 2 Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • 3 National Health and Family Planning Key Laboratory of Male Reproductive Health, National Research Institute for Family Planning, Beijing 100000, China
  • 4 Department of Andrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210093, China
  • 5 School of Public Health, Zunyi Medical University, Zunyi 563000, Guizhou, China
  • 6 Wuhan Tongji Reproductive Medicine Hospital, Wuhan 563000, China
  • 7 Guangzhou Women and Children’s Medical Center, Guangzhou 510000, China
  • 8 Technical Guidance Institute of Shanxi Province Family Planning Commission, Xi’an 710000, China
  • 9 Department of Reproductive Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China

Received: October 16, 2020       Accepted: December 10, 2020       Published: February 1, 2021
How to Cite

Copyright: © 2021 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Few studies have investigated whether associations between smoking, sex hormone levels, and symptoms of late-onset hypogonadism (LOH) in men are affected by age. This multi-center, cross-sectional study involving 6,296 men aged 40-79 years was conducted between June 1, 2013 and August 31, 2016 in 6 provinces of China. Total testosterone, free testosterone, and Aging Males’ Symptoms scale (AMS) scores were compared depending on smoking status and the number of cigarettes smoked. Total testosterone was higher in smokers than in non-smokers in all except the 70-79 year old subgroup. Free testosterone was higher in smokers than non-smokers for the 40-49 and 50-59 year old subgroups, but not the 60-69 and 70-79 year old subgroups. Total testosterone was positively associated with number of cigarettes consumed in smokers aged 40-49 and 50-59 years. Sexual and somatic AMS scores were higher in current and ex-smokers than in non-smokers in all age subgroups from 40 to 79 years and were negatively associated with cigarette consumption in smokers aged 40-49 years. These results indicate that, as men age, the positive association between smoking and testosterone weakens, while the positive association between smoking and LOH symptoms becomes stronger.


LOH: late-onset hypogonadism; AMS: Aging Males’ Symptoms; TT: total testosterone; SHBG: sex hormone-binding globulin; LH: luteinizing hormone; CFT: calculated free testosterone; GnRH: gonadotrophin-releasing hormone; SE: standard error.