Androgen-related symptoms are associated with functional vulnerability in midlife men

Androgens influence musculoskeletal and neurocognitive function, yet whether androgen bioavailability and androgen-related symptoms relate to cognitive and physical performance in midlife men remains unclear. We tested 329 men aged 40–91 years (62.16 ± 8.06 years, 67.8% midlife) in a cross-sectional design. Calculated bioavailable testosterone (cBT) was derived from fasting morning blood samples, and androgen-related symptoms were measured using the quantitative Androgen Deficiency in the Aging Male questionnaire (qADAM). Cognition was assessed using a computerized battery, and a composite physical-performance score was derived from strength, power, mobility, and balance measures. In midlife men, qADAM, but not cBT, was independently associated with global cognition (standardized-β = .20, p=.003) and physical performance (standardized-β = .22, p<.001). In older men, qADAM was associated with cognition (standardized-β = .25, p=.015), while cBT was associated with physical performance (standardized-β = .21, p=.030). Androgen-related symptoms may reflect functional vulnerability not captured by testosterone alone. Functional evaluation of middle-aged men should consider these symptoms alongside biochemical measures.