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A 2026 study of 659 men aged 18–35 found that lower total testosterone and sex hormone-binding globulin (SHBG) were associated with higher obesity measures, blood pressure and triglycerides, while HDL cholesterol was lower. The study shows a cardiometabolic pattern—not that low testosterone causes heart disease or that testosterone treatment prevents it.
What the 2026 study found
Researchers conducted a single-center, retrospective, cross-sectional study of 659 men aged 18–35 recruited from the community. They recorded anthropometric, biochemical, clinical and hormonal measurements, then compared cardiometabolic measures across tertiles of total testosterone and SHBG.
Higher testosterone was linked to a healthier measured profile
BMI, generalized obesity, waist circumference, abdominal (visceral) obesity, diastolic blood pressure and triglycerides decreased progressively across higher total-testosterone tertiles. HDL cholesterol increased across those tertiles.
SHBG showed a similar pattern
Across higher SHBG tertiles, weight, BMI, waist circumference, systolic and diastolic blood pressure and triglycerides were progressively lower, while HDL cholesterol was higher. Men below the study’s normal testosterone range had a significantly higher prevalence of both generalized and abdominal obesity. Overweight or obese participants had lower total testosterone and more testosterone deficiency.
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Size of the reported associations
| Outcome | Total testosterone correlation | SHBG correlation |
|---|---|---|
| Weight | r = −0.149 | r = −0.154 |
| BMI | r = −0.204 | r = −0.165 |
| Waist circumference | r = −0.234 | r = −0.225 |
| Systolic blood pressure | r = −0.112 | r = −0.142 |
| Triglycerides | r = −0.117 | r = −0.204 |
| HDL cholesterol | r = 0.167 | r = 0.251 |
In adjusted regression models, total testosterone and SHBG remained independently associated with HDL cholesterol (β = 0.151 and β = 0.186, respectively). SHBG was also independently associated with systolic blood pressure (β = −0.177) and diastolic blood pressure (β = −0.204). These are study statistics, not individual risk predictions.
What the findings do—and do not—show
The study’s cross-sectional design measures exposure and outcomes at one point in time. Its authors state that “causality and temporal directionality cannot be inferred because of the cross-sectional design of the study.” Lower testosterone could contribute to unfavorable body composition, but obesity, insulin resistance, illness, sleep problems or other factors could also lower testosterone. Both may be consequences of a third factor.
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The cohort was single-center and its participant selection, assays and local reference ranges may not represent all young men. It did not test testosterone treatment, cardiovascular-event prevention or long-term outcomes. Therefore, the associations cannot be used to claim that testosterone replacement prevents heart attacks, strokes, diabetes or hypertension.
How SHBG, total testosterone and free testosterone fit together
Most circulating testosterone is bound to proteins, principally SHBG and albumin. Total testosterone includes bound and unbound hormone; free testosterone is the small unbound fraction available to tissues. A change in SHBG can alter total testosterone without the same change in free testosterone, which is why a borderline total result can be difficult to interpret.
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The study discusses a possible bidirectional loop: visceral adiposity and insulin resistance may reduce SHBG and suppress the hypothalamus–pituitary–gonadal axis through inflammatory mediators, leptin resistance and increased estradiol. Reduced androgenic signaling might, in turn, favor visceral fat accumulation. This is a biologic hypothesis, not proof supplied by the cohort.
When testosterone testing is appropriate
Do not diagnose hypogonadism from a single low result, obesity alone or an over-the-counter test. The Endocrine Society requires compatible symptoms or signs plus unequivocally and consistently low serum total and/or free testosterone.
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Recommended confirmation sequence
- Start with symptoms and examination. Discuss reduced libido, erectile difficulties, fewer spontaneous erections, infertility, reduced energy, loss of muscle or other signs with a clinician. These symptoms are nonspecific and need assessment for other causes.
- Measure total testosterone twice. Draw blood on two separate fasting mornings using a reliable assay. Testosterone varies by time of day, illness, sleep and calorie intake, so a non-morning or isolated result should not establish the diagnosis.
- Interpret the laboratory range. The Endocrine Society cites a CDC-harmonized lower limit of 264 ng/dL (9.2 nmol/L) for healthy nonobese young men when CDC-certified assays are used. Laboratories can have different methods, populations and reference intervals; the number must be interpreted with the assay and clinical picture.
- Add free testosterone when indicated. If SHBG is abnormal or total testosterone is near the lower limit, determine free testosterone by equilibrium dialysis or a validated calculation using total testosterone, SHBG and albumin. Direct analog free-testosterone immunoassays are inaccurate according to the Endocrine Society.
- Identify the source of low levels. European Academy of Andrology guidance recommends luteinizing hormone (LH) to help distinguish primary testicular failure from secondary hypothalamic or pituitary causes. Consider free testosterone when SHBG is altered or total testosterone is borderline, approximately 8–12 nmol/L.
What to do if weight or metabolic risk is present
Address reversible contributors first
For overweight or obese men with functional hypogonadism, European Academy of Andrology guidance recommends lifestyle changes and weight reduction first because losing weight may raise testosterone. Evaluate blood pressure, glucose or diabetes, lipids, sleep, medications, alcohol use and smoking as clinically appropriate. A validated upper-arm home blood-pressure monitor can help document readings for a clinician, but home measurements do not diagnose the cause of low testosterone.
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Do not use testosterone as a weight-loss or diabetes treatment
The guidance recommends against testosterone replacement solely for weight reduction or glycometabolic control. A low value without compatible symptoms and repeat confirmation is not an indication for treatment.
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Consider fertility before any replacement therapy
Exogenous testosterone can suppress gonadotropins and sperm production. Men who may want children should tell the prescriber before treatment so fertility-preserving approaches and specialist evaluation can be considered. This decision requires individualized follow-up rather than self-treatment.
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The American Urological Association counseling statement notes that low testosterone is associated with increased incidence of major adverse cardiac events and atherosclerotic cardiovascular risk factors. It recommends assessing modifiable risks, including dyslipidemia, hypertension, diabetes and smoking.
That association does not establish that raising testosterone lowers cardiovascular risk. The young-men study did not examine testosterone replacement or cardiovascular events, and it cannot answer whether treatment prevents disease. A clinician should assess cardiovascular and prostate considerations, symptom response, laboratory monitoring and fertility goals before prescribing therapy.
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| Situation | Reasonable next step | Key cautions |
|---|---|---|
| No suggestive symptoms, one low or borderline result | Repeat fasting morning total testosterone before labeling deficiency | Do not diagnose from one test or an unsupervised kit |
| Symptoms plus repeatedly low total testosterone | Confirm assay validity; add SHBG, albumin and calculated or equilibrium-dialysis free testosterone when indicated | Use the laboratory method and population-specific range |
| Overweight or obese with suspected functional hypogonadism | Prioritize weight reduction and evaluation of metabolic, sleep and medication contributors | Testosterone is not recommended solely for weight or glucose control |
| Confirmed low testosterone with fertility plans | Discuss fertility-preserving options with an experienced clinician before any replacement | Replacement can reduce sperm production |
| Low testosterone plus hypertension, diabetes, dyslipidemia or smoking | Address cardiovascular risk factors and obtain individualized treatment advice | Association with risk does not prove replacement prevents events |
What remains unanswered
Future prospective and randomized studies are needed to determine whether low androgenic markers precede metabolic deterioration, whether improving weight and insulin sensitivity normalizes testosterone, and which men benefit or are harmed by treatment. Until such evidence exists, testosterone and SHBG are best viewed as clinical clues that must be interpreted with symptoms, repeat testing, metabolic measurements and the patient’s goals—not as standalone forecasts of cardiovascular disease.
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