Job demands as a potential modifier of the association between testosterone deficiency and andropause symptoms in Japanese middle-aged workers: A cross-sectional study
Introduction
Symptoms including lack of energy, depression, decreased libido, and erectile difficulties are often observed in middle-aged or elderly men. Those symptoms collectively are termed ‘andropause’ to imply a state of hormone deficiency secondary to gonadal failure and similar to menopause symptoms [1]. A progressive reduction in hypothalamic–pituitary–gonadal (HPG) function has been observed in aging men, and serum testosterone levels decline through both central and peripheral mechanisms [2], particularly after the age of 50 [3]. Age is negatively associated with free testosterone [4].
The causes of andropause are not clear because symptoms have been reported without testosterone deficiency [5], [6]. Therefore, there may be other factors causing andropause symptoms in addition to testosterone deficiency. For male adults, job stress is a major factor related to developing or exacerbating health problems. Previous studies have shown that a high level of job stress is associated with musculoskeletal symptoms [7], insomnia [8], and depression [9]. These physical and mental symptoms are often reported by men with andropause symptoms [10]. Thus, exposure to job stress may be a necessary condition for the manifestation of andropause symptoms in testosterone-deficient men.
Job demands represent a psychological stressor in the work environment [11]. It is noteworthy that Japanese men with high job demands (time pressure and excessive amount of work in general) often have high cholesterol [12], are obese [13], and have a high prevalence of low back pain [14], tension and anxiety as well as depression [15]. Job demands, as one of the indices of job stress, may be associated with andropause symptoms in Japanese male workers. The present study tested the hypothesis that an association between testosterone deficiency and andropause symptoms can be strengthened by high job demands.
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Procedure and participants
To enroll participants in the study, a physician working in the target middle-size company's occupational health services department provided a questionnaire about stress in May 2007. One week before the company's annual health check-up, the self-administered questionnaire was distributed to all employees to be completed on a voluntary basis and returned at the time of their health check-up. Among 754 questionnaires distributed, 584 were collected (response rate = 77.5%), and blood samples were
Results
Participants’ demographic variables and measured variables by testosterone level are shown in Table 1. There were 25 participants categorized as having low testosterone levels (13.7%). Participants with low testosterone levels showed a higher total score for andropause symptoms (t (181) = 2.18, p = 0.03) and psychological symptoms (t (181) = 2.59, p = 0.01) than those with normal levels.
Pearson's correlation coefficients are presented in Table 2. A continuous measure of testosterone (ng/dL) was
Discussion
Job demands were positively associated with total score for andropause symptoms and scores for somatic, psychological, and sexual symptoms when considering testosterone deficiency and lifestyle habits. Testosterone deficiency remained positively associated with psychological symptoms. Stratified analyses showed that in men with high job demands, testosterone deficiency was positively associated with the total score for andropause symptoms and the score for somatic symptoms, whereas no
Conclusions
The findings suggest that psychosocial job characteristics are related to andropause symptoms in Japanese middle-aged male workers. Specifically, high job demands could intensify the association between testosterone levels and andropause symptoms. Symptoms of andropause fatigue can be explained not only by hormonal changes but also by stress [1]. Adverse psychosocial job characteristics should be improved to prevent andropause symptoms and mental health disorders in middle-aged male workers.
Contributors
Kumi Hirokawa, Akizumi Tsutsumi were responsible for conception of the study; Kumi Hirokawa, Akizumi Tsutsumi designed the study; Kumi Hirokawa was responsible for study analyses; Kumi Hirokawa, Toshiyo Taniguchi, Yasuhito Fujii prepared the manuscript; Toshiyo Taniguchi, Yasuhito Fujii contributed to data collection; organization of structure of the manuscript was done by Jiro Takaki, Akizumi Tsutsumi; substantial revisions were done by Jiro Takaki, Akizumi Tsutsumi.
Competing interest
None of the authors have competing interests to declare with regard to this paper.
Funding
The study was supported by a Grant-in Aid from the Japanese Ministry of Education, Culture, Sports, Science, and Technology (Grant No. 21700681).
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2022, Comprehensive PsychoneuroendocrinologyCitation Excerpt :These estimations were conducted by BML, Inc. (Japan). Previous study methods related to job stress and blood sample collection have been reported in detail elsewhere [18–20]. The Japanese version of the Pittsburgh Sleep Quality Index ([PSQI] Buysse et al., 1989 [21]; was used to measure sleep quality.