The effects of atorvastatin on testosterone levels in males and females : a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Statins are one of the most prescribed classes of drugs worldwide. Atorvastatin, the most prescribed statin, is currently used to treat conditions such as hypercholesterolemia and dyslipidemia. Testosterone and other androgens play important roles in biological functions. A potential reduction in androgens levels caused by atorvastatin might cause negative effects except for conditions such as polycystic ovary syndrome (PCOS), where reduction of excessive levels of androgens is potentially beneficial. Objectives: To quantify the magnitude of the effects of atorvastatin as compared to placebo or no treatment on total testosterone, free testosterone, sex hormone binding globin (SHBG), androstenedione, dehydroepiandrosterone sulfate (DHEAS) concentrations, free androgen index (FAI), and withdrawal due to adverse effects (WDAEs). Methods: We searched major databases (CENTRAL, MEDLINE, EMBASE) and other sources for randomized controlled trials (RCTs) comparing atorvastatin with placebo or no treatment on testosterone levels in males and females. Two authors independently screened the citations, extracted the data and assessed the quality of the included studies. We used mean difference with 95% confidence interval to report effect size of continuous outcomes and a fixed effect model to combine the effect sizes across studies, and risk ratio to report effect size of the dichotomous outcome (WDAEs). iv Results: We included six RCTs involving 265 participants. Participants in two of the studies were male with normal or mild dyslipidemia (N=140). Participants in four of the studies were female with PCOS (N=125). Compared to placebo, atorvastatin had no significant effect on total testosterone levels (MD -0.20 [-0.77, 0.37] nmol/L in males. Atorvastatin may reduce total testosterone, FAI, androstenedione, and DHEAS in females by -0.27 (-0.50, -0.04) nmol/L, -2.59 (-3.62, -1.57), -1.37 nmol/L (-2.26, -0.49), and -0.64 μmol/l (-1.12, -0.16), respectively. Furthermore, atorvastatin increased SHBG concentrations in females by 3.11 nmol/L [0.23, 5.99] compared to placebo. Conclusions: Compared to placebo atorvastatin had no significant effect on the levels of total testosterone in males. In females with PCOS, atorvastatin lowered the total testosterone, FAI, androstenedione, and DHEAS. The certainty of evidence ranged from low to very low for both comparisons. More RCTs studying the effect of atorvastatin on testosterone are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.034 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".