Testosterone and Socioeconomic Differences in Mortality and Morbidity

Copyright 1997 by James Michael Howard, Fayetteville, Arkansas, U.S.A.


AP, Chicago, June 3, "Contrary to popular belief, getting America's poor to exercise and cut back on smoking, drinking and overeating won't do much to bring down their higher death rate, a study says. Poor people have a death rate as much as three times higher than that of other groups. But smoking, drinking, overeating and lack of exercise account, at most, for 13 percent of the gap, researchers concluded in a study in Wednesday's Journal of the American Medical Association." (JAMA 1998; 279: 1703-1708)

This sounds very similar to some earlier work comparing tuberculosis and mortality in whites and blacks. That is, the "unexpected finding that under the same social conditions, blacks are apparently infected more readily by Mycobacterium tuberculosis than whites" (New England J. Med. 1990; 322: 422) and the 31% unexplained differences in excess mortality in blacks compared to whites reported by the Centers for Disease Control in JAMA 1990; 263: 845. Both of these studies made adjustments to make the comparisons as similar as possible, i.e., socioeconomic levels in the first and risk factors, including smoking and drinking, among others, in the second study.

My work suggests that the hormone, DHEA, is necessary for proper growth and development, and, once the adult level is attained, for the proper maintenance of all tissues. A subordinate idea is that the hormone, testosterone, increases the use of DHEA for testosterone-target-tissues. This is why men are bigger and stronger than women. A by-product of this is that testosterone decreases the length of the lifetime supply of DHEA. Testosterone causes DHEA to be used more rapidly; testosterone makes the life span shorter. It is known that black males produce significantly more testosterone than white males (J. Natl. Cancer Inst. 1986; 76: 45). It is also known that testosterone is higher in black women compared to white women (J. Clin. Endocrinol. Metab. 1996; 81: 1108). In 1996, the average life expectancy of whites and blacks follows this exactly. That is, white women live longest, black women next, then white men, followed by black men. In the AP article, access to medical care is listed as one of the major reasons for the JAMA findings. It has long been suggested that white men have access to the best medical care in this country. However, in average life expectancy, white men are third. I suggest the real cause of the JAMA findings is due to the effects of testosterone.

I have been able to find comparisons of testosterone levels in blacks compared to whites. However, I have not been able to find this comparison between "poor" and "wealthy." However, it is known that crime and poor performance in school is a problem for poor people, regardless of race. Testosterone levels are directly correlated with severity of crimes. "Free testosterone was measured in the saliva of 89 male prison inmates. Inmates with higher testosterone concentrations had more often been convicted of violent crimes. The relationship was most striking at the extremes of the testosterone distribution, where 9 out of 11 inmates with the lowest testosterone concentrations had committed nonviolent crimes, and 10 out of 11 inmates with the highest testosterone concentrations had committed violent crimes. Among the inmates convicted of nonviolent crimes, those higher in testosterone received longer times to serve before parole and longer punishments for disciplinary infractions in prison. In the housing unit where peer ratings were most reliable, inmates rated as tougher by their peers were higher in testosterone." (Psychosom. Med. 1987; 49: 174).

Also, while "learning disabilities" cannot be accurately labeled as the main reason for poor school performance, testosterone is directly connected to learning disabilities. "Previous studies have indicated that the sex steroids have organizational effects upon neural tissue and that abnormal secretion during development may lead to functional anomalies. In this study, we explore the possibility of prepubertal steroid hormone involvement in the etiology of learning disabilities. Salivary testosterone levels in 264 children without learning disabilities (133 males, 131 females) were measured and compared to that in 32 children with learning disabilities (25 males, 7 females). The presence of learning disabilities was significantly associated with higher salivary testosterone. Data from equivalent samples of learning-disabled and control subjects also were compared separately because of disparities in sample size and variable distribution in the total group analysis. A 32-member sample of nonlearning-disabled children was created by randomly selecting individuals who exactly matched the age, race, and sex characteristics of the learning-disabled group. The matched analysis further substantiated the association between testosterone secretion and learning disabilities. Thus, it is possible that some learning disabilities may be associated in part with abnormal testosterone levels." (Physiol. Behav. 1993; 53: 583). Since it is known that actual administration of testosterone to hypogonadal [low testosterone] boys increases aggressive impulses, as well as physical aggression to peers and adults (J. Clin. Endocrinol. Metab. 1997; 82: 2433), it may well be that increased testosterone interferes with learning in school. My point is that increased aggression and problems in school may be increased by testosterone. People who cannot succeed in school cannot succeed in a technological society. They will probably be poor.

The difference in mortality rates between "poor" and "wealthy" may be partly due to "the harsh and adverse environment in which poorer people live." However, I suggest that this harsh environment is a secondary result of increased testosterone. I think the main cause of differences in life style, life result, and mortality and morbidity between poor and wealthy is due to differences in testosterone levels.