各种因素会调节男性体内的睾丸酮水平，这些因素会影响睾丸酮检测结果的解释。为了阐明与性激素浓度变化有关的因素，我们进行了系统文献搜索（截至2019年7月）。使用质谱法测量总睾丸酮的社区居住男性前瞻性队列研究。提取个人参与者数据（IPD）（9项研究；n = 21,074）和聚合数据（2项研究；n = 4075）。提取社会人口学、生活方式、健康因素以及总睾丸酮、性激素结合球蛋白（SHBG）、黄体刺激素（LH）、二氢睾丸酮和雌二醇浓度的数据。经过两阶段随机效应IPD荟萃分析发现，睾丸酮与年龄呈非线性关联，在17至70岁的男性中变化微乎其微（每个标准偏差变化约为中位数的-0.27 nmol/L [-7.8 ng/dL] [CI, -0.71 to 0.18 nmol/L {-20.5 to 5.2 ng/dL}]}），而70岁以上男性的睾丸酮水平随年龄的增长而下降（-1.55 nmol/L [-44.7 ng/dL] [CI, -2.05 to -1.06 nmol/L {-59.1 to -30.6 ng/dL}]}）。睾丸酮与体重指数（BMI）呈负相关（每个标准偏差增加，-2.42 nmol/L [-69.7 ng/dL] [CI, -2.70 to -2.13 nmol/L {-77.8 to -61.4 ng/dL}]}）。已婚男性的睾丸酮浓度较低（均值差异，-0.57 nmol/L [-16.4 ng/dL] [CI, -0.89 to -0.26 nmol/L {-25.6 to -7.5 ng/dL}]}）。每周进行最多75分钟剧烈体力活动的男性睾丸酮浓度较低（-0.51 nmol/L [-14.7 ng/dL] [CI, -0.90 to -0.13 nmol/L {-25.9 to -3.7 ng/dL}]}）。已戒烟者的睾丸酮浓度较低（-0.34 nmol/L [-9.8 ng/dL] [CI, -0.55 to -0.12 nmol/L {-15.9 to -3.5 ng/dL}]}）。患有高血压、心血管疾病、癌症或糖尿病的男性的睾丸酮水平较低（分别为-0.53 nmol/L [-15.3 ng/dL] [CI, -0.82 to -0.24 nmol/L {-23.6 to -6.9 ng/dL}]}、-0.35 nmol/L [-10.1 ng/dL] [CI, -0.55 to -0.15 nmol/L {-15.9 to -4.3 ng/dL}]}、-1.39 nmol/L [-40.1 ng/dL] [CI, -1.79 to -0.99 nmol/L {-51.6 to -28.5 ng/dL}]}和-1.43 nmol/L [-41.2 ng/dL] [CI, -1.65 to -1.22 nmol/L {-47.6 to -35.2 ng/dL}]}）。性激素结合球蛋白与年龄呈正相关，与BMI呈负相关。在70岁以上男性中，黄体刺激素与年龄呈正相关。横断面分析、研究之间的异质性以及血液采样时间的差异和缺失数据的插补方法。多种因素与男性睾丸酮、SHBG和LH浓度的变化相关。70岁以上年龄、肥胖、糖尿病和癌症可能导致睾丸功能受损，表现为睾丸酮降低和LH增高。解释个体睾丸酮测量结果时，尤其应考虑年龄大于70岁、肥胖、糖尿病和癌症等因素。澳大利亚医学研究未来基金（Medical Research Future Fund），西澳大利亚政府和劳利制药公司（Lawley Pharmaceuticals）资助（PROSPERO：CRD42019139668）。

Various factors modulate circulating testosterone in men, affecting interpretation of testosterone measurements.To clarify factors associated with variations in sex hormone concentrations.Systematic literature searches (to July 2019).Prospective cohort studies of community-dwelling men with total testosterone measured using mass spectrometry.Individual participant data (IPD) (9 studies; n = 21 074) and aggregate data (2 studies; n = 4075). Sociodemographic, lifestyle, and health factors and concentrations of total testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone, and estradiol were extracted.Two-stage random-effects IPD meta-analyses found a nonlinear association of testosterone with age, with negligible change among men aged 17 to 70 years (change per SD increase about the midpoint, -0.27 nmol/L [-7.8 ng/dL] [CI, -0.71 to 0.18 nmol/L {-20.5 to 5.2 ng/dL}]) and decreasing testosterone levels with age for men older than 70 years (-1.55 nmol/L [-44.7 ng/dL] [CI, -2.05 to -1.06 nmol/L {-59.1 to -30.6 ng/dL}]). Testosterone was inversely associated with body mass index (BMI) (change per SD increase, -2.42 nmol/L [-69.7 ng/dL] [CI, -2.70 to -2.13 nmol/L {-77.8 to -61.4 ng/dL}]). Testosterone concentrations were lower for men who were married (mean difference, -0.57 nmol/L [-16.4 ng/dL] [CI, -0.89 to -0.26 nmol/L {-25.6 to -7.5 ng/dL}]); undertook at most 75 minutes of vigorous physical activity per week (-0.51 nmol/L [-14.7 ng/dL] [CI, -0.90 to -0.13 nmol/L {-25.9 to -3.7 ng/dL}]); were former smokers (-0.34 nmol/L [-9.8 ng/dL] [CI, -0.55 to -0.12 nmol/L {-15.9 to -3.5 ng/dL}]); or had hypertension (-0.53 nmol/L [-15.3 ng/dL] [CI, -0.82 to -0.24 nmol/L {-23.6 to -6.9 ng/dL}]), cardiovascular disease (-0.35 nmol/L [-10.1 ng/dL] [CI, -0.55 to -0.15 nmol/L {-15.9 to -4.3 ng/dL}]), cancer (-1.39 nmol/L [-40.1 ng/dL] [CI, -1.79 to -0.99 nmol/L {-51.6 to -28.5 ng/dL}]), or diabetes (-1.43 nmol/L [-41.2 ng/dL] [CI, -1.65 to -1.22 nmol/L {-47.6 to -35.2 ng/dL}]). Sex hormone-binding globulin was directly associated with age and inversely associated with BMI. Luteinizing hormone was directly associated with age in men older than 70 years.Cross-sectional analysis, heterogeneity between studies and in timing of blood sampling, and imputation for missing data.Multiple factors are associated with variation in male testosterone, SHBG, and LH concentrations. Reduced testosterone and increased LH concentrations may indicate impaired testicular function after age 70 years. Interpretation of individual testosterone measurements should account particularly for age older than 70 years, obesity, diabetes, and cancer.Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).