Associating serum testosterone levels with African ancestral prostate cancer health disparities

TL;DR

This study explores how testosterone levels in Black South African men may contribute to higher prostate cancer risks and disparities compared to Black American men.

Contribution

The study identifies a significant association between testosterone levels and prostate cancer risk in Black South African men, highlighting potential racial disparities.

Findings

Black South African men had 1.24-1.3 times higher testosterone levels than Black Americans.

Lower testosterone levels in men over 65 were significantly linked to increased prostate cancer risk.

Testosterone levels were associated with advanced disease, regardless of age.

Abstract

Serum testosterone levels decrease in the aging male, while the risk for prostate cancer (PCa) increases concomitantly. Higher levels in younger men have been linked with racially driven PCa disparities, with African men disproportionately impacted. In turn, higher levels of serum lipids have been associated with aggressive disease, while racial disparity between serum testosterone, cholesterol and cancer mortality has been suggested. Having previously reported a 2.1-fold increased age-adjusted risk for aggressive PCa in Black South African over Black American men, we determined the serum testosterone and associated lipid levels in 250 Black South African men either with or without clinicopathologically diagnosed disease. Observing no associations with serum lipid levels, Black South Africans presented with testosterone levels between 1.24 (< 60 years) and 1.3-fold (≥ 60 years) greater than Black Americans. Notably, a rapid drop in total-, bioavailable- and free testosterone levels in men 65 years or older was significantly associated with PCa risk (P = 0.0057, 0.009 and 0.005, respectively), while irrespective of age, further associated with advanced disease (P = 0.004, 0.0012 and 0.0036, respectively). These preliminary data provide insights into the potential role of androgens in driving PCa health disparities, with important consequence for tailoring treatment for Black men.

The online version contains supplementary material available at 10.1038/s41598-025-92539-y.

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