Compared to total serum testosterone, calculated free testosterone has a stronger association with lean mass, muscle strength, power, and physical function in older men.

Background: Low serum testosterone concentrations have been associated with low muscle mass and strength in older men. However, the existing literature is inconclusive.

Aim: To investigate the differences in the relationship between total and calculated free serum testosterone and muscle status, in young vs. old men.

Methods: Body mass index (BMI), fat percentage, appendicular lean mass (ALM), percentage ALM (ALM%), skeletal muscle index (SMI), handgrip strength (HGS), leg extension power (LEP) and 30-s sit-to-stand performance (30-s STS) were measured in 557 healthy Danish men (326 younger (≤ 65 years) and 231 older (> 65 years)) aged 23-92 years. Total serum testosterone, sex hormone binding globulin and albumin were measured (ELISA) and subsequently, calculated free testosterone and free testosterone index (FTI) were computed. A general linear model examined the relationship between testosterone and individual muscle parameters, with age group-interaction, while a pooled effect model examined the relationship between testosterone and a compound of all muscle parameters, adjusted for age, BMI and fat percentage.

Results: Total testosterone was negatively associated with 30-s STS in younger men, and positively associated with LEP in older men. Calculated free testosterone was positively associated with LEP in younger and older men, as well as SMI, ALM%, HGS and 30-s STS in older men. Calculated Free testosterone and FTI, but not total testosterone, were positively associated with the muscle compound in older men.

Conclusion: The present data indicates that calculated free testosterone, compared to total testosterone, is more closely linked to muscle status and physical performance in older men.