Associations between endogenous sex hormones and FGF-23 among women and men in the Multi-Ethnic Study of Atherosclerosis

Oluseye Ogunmoroti, Olatokunbo Osibogun, Di Zhao, Rupal C. Mehta, Pamela Ouyang, Pamela L. Lutsey, Cassianne Robinson-Cohen, Erin D. Michos

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Elevated levels of testosterone and fibroblast growth factor 23 (FGF-23) are both independently associated with a higher risk of cardiovascular disease (CVD). However, the relationship between sex hormones and FGF-23 is not well established. We explored the association between sex hormones and FGF-23 among middle-aged to older men and women in MESA. We studied 3,052 men and 2,868 postmenopausal women free of CVD at the time of enrollment with baseline serum sex hormones [total testosterone (T), free T, estradiol (E2) and sex hormone binding globulin (SHBG)] and intact FGF-23. In sex-stratified analyses, we examined the cross-sectional associations between log-transformed sex hormones (per 1 SD) and log-transformed FGF-23 using multiple linear regression adjusted for socio-demographics, CVD risk factors, estimated glomerular filtration rate and mineral metabolites (25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone). The mean (SD) age of study participants was 64 (10) years. The median (IQR) of FGF-23 was similar in women and men [38 (30-46) vs 38 (31-47) pg/mL]. In adjusted analyses, among women, 1 SD increment in free T was associated with 3% higher FGF-23 while SHBG was associated with 2% lower FGF-23. In men, 1 SD increment in E2 was associated with 6% higher FGF-23 whereas total T/E2 ratio was associated with 7% lower FGF-23. In conclusion, this exploratory analysis found that a more androgenic sex hormone profile was directly associated with FGF-23 in women and inversely associated with FGF-23 in men. Longitudinal studies are required to determine whether FGF-23 mediates the relationship between sex hormones and CVD risk.

Original languageEnglish (US)
Article numbere0268759
JournalPloS one
Issue number5 May
StatePublished - May 2022

Bibliographical note

Publisher Copyright:
© 2022 Ogunmoroti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Adult
  • Aged
  • Atherosclerosis/blood
  • Cardiovascular Diseases/blood
  • Cross-Sectional Studies
  • Estradiol/blood
  • Female
  • Fibroblast Growth Factor-23/blood
  • Gonadal Steroid Hormones/blood
  • Humans
  • Male
  • Middle Aged
  • Sex Hormone-Binding Globulin/metabolism
  • Testosterone/blood

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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