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A 2026 study of 659 men aged 18–35 found that lower total testosterone and sex hormone-binding globulin (SHBG) levels were associated with higher obesity measures, blood pressure and triglycerides, plus lower HDL cholesterol. The findings identify a cardiometabolic pattern—not proof that low testosterone causes disease or that testosterone treatment prevents it.
What the 2026 study found
Researchers conducted a single-center, retrospective, cross-sectional cohort study of 659 community-dwelling men aged 18–35. They measured body size, blood pressure, metabolic blood markers and reproductive hormones, then compared results across tertiles (thirds) of total testosterone and SHBG.
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Across progressively higher total-testosterone tertiles, BMI, generalized obesity, waist circumference, abdominal or visceral obesity, diastolic blood pressure and triglycerides declined, while HDL cholesterol rose. The same direction appeared across SHBG tertiles for weight, BMI, waist circumference, systolic and diastolic blood pressure and triglycerides; HDL also increased with higher SHBG.
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| Measure | Total testosterone (r) | SHBG (r) |
|---|---|---|
| Weight | -0.149 | -0.154 |
| BMI | -0.204 | -0.165 |
| Waist circumference | -0.234 | -0.225 |
| Systolic blood pressure | -0.112 | -0.142 |
| Triglycerides | -0.117 | -0.204 |
| HDL cholesterol | 0.167 | 0.251 |
In adjusted regression models, total testosterone and SHBG remained independently associated with HDL cholesterol (β=0.151 and β=0.186). SHBG was independently associated with systolic blood pressure (β=-0.177) and diastolic blood pressure (β=-0.204).
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Men below the study’s normal testosterone range had a significantly higher prevalence of generalized and abdominal obesity. Men classified as overweight or obese had lower total testosterone and more testosterone deficiency.
Why the association does not establish cause
The investigators explicitly cautioned that “causality and temporal directionality cannot be inferred because of the cross-sectional design of the study.” Hormones and cardiometabolic measurements were captured at one point, so the study cannot show whether low androgenic markers precede weight gain, result from it, or reflect shared influences.
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A proposed biological loop may run in both directions. Visceral fat and insulin resistance can lower SHBG and suppress the hypothalamus–pituitary–gonadal axis through inflammatory mediators, leptin resistance and increased conversion to estradiol. Reduced androgen signaling might also favor additional visceral fat. This is a mechanistic hypothesis, not a causal conclusion demonstrated by this cohort.
The single-center setting, participant selection, local laboratory reference ranges and assay methods also limit how directly the results apply to other populations. The study did not test testosterone therapy, cardiovascular-event prevention or long-term outcomes.
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When testosterone testing is appropriate
Feeling tired or carrying extra weight alone does not diagnose hypogonadism. The Endocrine Society recommends diagnosing testosterone deficiency only when compatible symptoms or signs coexist with unequivocally and consistently low serum total and/or free testosterone.
Use two morning measurements
- Discuss symptoms and examination findings with a clinician, including sexual symptoms and other possible causes of low results.
- Measure total testosterone on two separate fasting mornings using a reliable assay. Morning timing matters because concentrations vary during the day.
- If the result is near the laboratory’s lower limit, or SHBG is likely to be altered, obtain free testosterone by equilibrium dialysis or a validated calculation using total testosterone, SHBG and albumin.
- Do not rely on direct analog free-testosterone immunoassays; the Endocrine Society considers them inaccurate.
- If low testosterone is confirmed, measure luteinizing hormone (LH) to help distinguish a primary testicular problem from secondary suppression, as recommended by the European Academy of Andrology (EAA).
The Endocrine Society cites a CDC-harmonized lower limit of 264 ng/dL (9.2 nmol/L) for total testosterone in healthy, nonobese young men when CDC-certified assays are used. This is a harmonized reference point, not a universal diagnosis cutoff: laboratories use different methods and populations. The EAA highlights free testosterone when SHBG is altered or total testosterone is borderline, approximately 8–12 nmol/L.
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How obesity and metabolic health change interpretation
Weight, waist circumference, blood pressure, glucose-related risk, lipid levels, sleep, medications and other illnesses can all affect the clinical picture. A low result in a man with obesity may represent functional suppression rather than irreversible testicular failure, but laboratory confirmation and evaluation are still required.
For men who are overweight or obese and have functional hypogonadism, EAA guidance places lifestyle changes and weight reduction first because losing weight may raise testosterone. It recommends against using testosterone replacement solely to reduce weight or improve glycometabolic control.
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Does testosterone replacement prevent heart disease?
There is no evidence from this young-men cohort that testosterone treatment prevents heart attacks, strokes or other cardiovascular events. The study measured associations, not treatment outcomes, and did not follow participants long enough to establish event reduction.
The American Urological Association (AUA) notes that low testosterone is associated with a higher incidence of major adverse cardiac events and atherosclerotic cardiovascular risk factors. That association supports checking modifiable risks—not assuming that replacement therapy removes them.
Risk checks to discuss with a clinician
- Blood pressure, confirmed with repeated measurements rather than a single reading.
- Lipid abnormalities, including triglycerides and HDL cholesterol.
- Diabetes or other dysglycemia.
- Smoking and other modifiable cardiovascular risks.
- Fertility plans, prostate considerations and the need for ongoing monitoring before any treatment decision.
Choosing an evaluation or management path
| Situation | Practical next step | Evidence and trade-off |
|---|---|---|
| Symptoms absent, isolated concern about weight | Address diet, activity, sleep and cardiovascular risk; test only after clinical discussion. | Guidelines do not diagnose hypogonadism from body weight alone. |
| Symptoms present with a possible low result | Repeat fasting morning total testosterone on a different day. | Two consistent measurements reduce misclassification. |
| Total testosterone borderline or SHBG altered | Use equilibrium-dialysis or calculated free testosterone with SHBG and albumin. | Free testosterone can clarify results; direct analog immunoassays are inaccurate. |
| Confirmed low testosterone | Measure LH and investigate primary versus secondary causes; assess obesity and reversible contributors. | Cause determines whether treatment is appropriate and what follow-up is needed. |
| Overweight or obese with functional hypogonadism | Prioritize structured weight reduction and lifestyle treatment. | EAA says weight loss may raise testosterone and advises against replacement solely for weight or metabolic control. |
| Considering testosterone therapy | Review fertility goals, cardiovascular and prostate risks, expected benefits, uncertainties and monitoring with a qualified clinician. | No trial here shows prevention of cardiovascular events. |
What you can monitor at home
A validated upper-arm blood-pressure monitor can help track readings over time, and a measuring tape can track waist circumference. These tools support a clinician’s assessment; neither diagnoses hypogonadism, obesity-related disease or cardiovascular risk on its own. Persistent abnormal readings should be confirmed in medical care.
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Key takeaways
- In 659 men aged 18–35, higher testosterone and SHBG tracked with a healthier pattern of adiposity, blood pressure and lipids.
- The cross-sectional design cannot determine whether low testosterone contributes to metabolic disease, results from it, or reflects both.
- Diagnosis requires symptoms or signs plus two separate fasting morning measurements, with free-testosterone assessment when SHBG or borderline total testosterone makes interpretation uncertain.
- For overweight or obese men with functional hypogonadism, guideline-based care starts with weight reduction and risk-factor management.
- The available study does not show that testosterone replacement prevents heart disease.
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