Men's health and longevity. Why muscle strength weighs more than a single testosterone result

1. Why do men live statistically shorter lives? A healthspan perspective

In most countries average life expectancy is lower for men than for women — a gap often reduced to a single biological explanation, usually testosterone. Reality, as the following sections show, is more complex: it involves a statistically earlier onset of cardiovascular risk, more frequent higher-risk behaviours and — particularly relevant to longevity — weaker preventive habits. These are areas that can genuinely be influenced, regardless of purely biological factors.

2. Testosterone and longevity — what the large studies show, and what they do not

Testosterone declines gradually with age, on average by about 1–2% per year after the age of 30–40. The largest analysis to date — an individual participant data meta-analysis of more than 24,000 men from 11 cohort studies (Yeap et al., Annals of Internal Medicine, 2024) — found that all-cause mortality risk rises meaningfully only below a threshold of roughly 7.4 nmol/L (213 ng/dL), and cardiovascular mortality risk below about 5.3 nmol/L (153 ng/dL). That distinction matters: not every age-related decline in testosterone signals increased risk — only clearly low values carry statistical weight in these data. These are observational data, so they do not prove that raising testosterone pharmacologically lowers that risk. More on the parameter itself on the testosterone biomarker page.

3. Muscle strength as one of the best-documented predictors of longevity

Grip strength is often underrated as a health measure, and the data say otherwise. The PURE study (Prospective Urban Rural Epidemiology), covering nearly 140,000 participants across 17 countries of varying income levels (Leong et al., Lancet, 2015), found that each 5 kg reduction in grip strength was associated with a 16% higher risk of all-cause death and a 17% higher risk of cardiovascular death — and grip strength proved a stronger predictor of these events than systolic blood pressure, a standard element of risk assessment. The mechanism is not that hand strength itself protects against death; it is a simple, easily measured indicator of overall muscular reserve and physical capacity, closely tied to the ability to carry out daily activities in later life. More in our entry on muscle strength.

4. Sarcopenia: a quiet process that accelerates ageing

Sarcopenia — the progressive, age-related loss of muscle mass and strength — often develops unnoticed for years before it becomes clinically visible. A meta-analysis of six cohort studies including more than 7,300 people (Liu et al., Maturitas, 2017) found that sarcopenia was associated with roughly 60% higher all-cause mortality risk (pooled hazard ratio 1.60) compared with people without sarcopenia, with a stronger effect in studies with shorter follow-up. The good news: resistance training is one of the few interventions with well-documented effects on slowing this process — regular muscle-loading physical activity remains the best-supported tool against sarcopenia, available at any age.

5. Heart and vessels in men — risk starts earlier

Cardiovascular risk begins to rise statistically earlier in men than in women, for whom the protective influence of estrogens delays the process roughly until menopause — a phenomenon described in Women''s health and longevity. This is one reason why cardiovascular prevention in men — blood pressure control, lipid panel, lifestyle — makes sense relatively early, rather than only once symptoms appear. A detailed discussion of cardiovascular biomarkers (ApoB, Lp(a), LDL) and how to interpret them is in Heart health and longevity.

6. Is PSA testing worthwhile? Weighing the benefits and risks of prostate screening

There is no single universal answer, and the newest data show why. The European randomised screening trial ERSPC, including more than 162,000 men aged 55–69 at randomisation, after a median 23 years of follow-up (New England Journal of Medicine, 2025) found prostate cancer mortality 13% lower in the PSA screening group than in controls — an effect sustained over very long follow-up. At the same time the absolute risk reduction was just 0.22 percentage points, and screening carries a real risk of overdiagnosis: detecting and treating cancers that would never have caused clinical symptoms. That is why regular PSA testing should be a conversation with a clinician, accounting for age, family history and personal tolerance for overdiagnosis — exactly in the spirit of our article on preventive medicine: the test alone is not enough; what counts is choosing the right test and acting on it thoughtfully.

Study limitations

The association between low testosterone and mortality comes from observational research — reverse causation is possible, in which chronic disease and declining health lower testosterone rather than the other way round; evidence that raising testosterone pharmacologically improves hard endpoints is far weaker than the evidence for the association itself (discussed further in Hormones and longevity). PURE, despite its size, is also observational — grip strength is a marker of general capacity rather than a fully isolated cause of longevity, and part of the association may reflect hidden illness affecting both strength and mortality. The Liu sarcopenia meta-analysis included relatively few studies (6) and showed substantial heterogeneity depending on how muscle mass was measured — different definitions of sarcopenia produced different risk estimates. The ERSPC result applies to one specific screening protocol and to men aged 55–69 at enrolment; it should not be generalised automatically to younger or older men or to other schedules, and the balance of benefit and harm in PSA screening remains under active clinical debate.

One small step

If you do not currently do any strength work, add two short resistance sessions a week (simple bodyweight exercises are enough) — a single, well-documented intervention against sarcopenia, independent of your current hormone results.