Association between sex hormone levels and sarcopenia risk among older adults over 65 years old in longevity areas of China

Objective: To investigate the association and dose-response relationship between sex hormone levels (testosterone, estradiol, and follicle-stimulating hormone) and the risk of sarcopenia among older adults in China's longevity regions. Methods: Data were derived from the 2021 cross-sectional survey of the Health and Aging Biomarker Cohort Study (HABCS) in China, including older adults aged ≥65 years. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Restricted cubic spline (RCS) models were employed to evaluate the associations between sex hormone levels and the risk of sarcopenia. In the multivariable logistic regression analysis, indicators exhibiting nonlinear associations were categorized into tertiles, whereas those demonstrating linear trends were analyzed as continuous variables. Results: A total of 4 695 older adults were included in this study, comprising 2 240 men (47.7%) and 2 455 women (52.3%), with an overall sarcopenia prevalence of 46.6%. Multivariable logistic regression analysis revealed that, compared to the medium-testosterone group, older men in the low-testosterone group exhibited an increased risk of sarcopenia (OR=1.57, 95%CI:1.03-2.40, P=0.034). Conversely, older women in the high-testosterone group demonstrated a decreased risk of sarcopenia (OR=0.67, 95%CI:0.48-0.92, P=0.014). Furthermore, each 1-standard deviation (1-SD) increment in follicle-stimulating hormone levels among older women was associated with a 21% higher risk of sarcopenia (OR=1.21, 95%CI:1.05-1.40, P=0.010). Conclusion: In older men, low testosterone levels are associated with an increased risk of sarcopenia; in older women, high testosterone levels are associated with a decreased risk of sarcopenia, while elevated follicle-stimulating hormone levels are linked to an increased risk.