Association Between Sex Hormones and Adiposity: Qualitative Differences in Women and Men in the Multi-Ethnic Study of Atherosclerosis

Context: Sex hormones may influence adipose tissue deposition, possibly contributing to sex disparities in cardiovascular disease risk. Objective: We hypothesized that associations of sex hormone levels with visceral and subcutaneous fat differ by sex. Design, Setting, and Participants: Participants were from the Multi-Ethnic Study of Atherosclerosis with sex hormone levels at baseline and visceral and subcutaneous fat measurements from computed tomography at visit 2 or 3 (n = 1835). Main Outcome Measures: Multivariable linear regression was used to investigate the relationships between sex hormones and adiposity. Testing for interaction by sex, race/ethnicity, and age was conducted. Results: In adjusted models, there was a modest significant positive association between estradiol and visceral fat in both sexes (percent difference in visceral fat for 1% difference in hormone [95% confidence interval] in women, 5.44 [1.82, 9.09]; and in men, 8.22 [0.61, 16.18]). Higher bioavailable T was significantly associated with higher visceral and subcutaneous fat in women and with the reverse in men (women, 14.38 [10.23, 18.69]; men, -7.69 [-13.06, -1.00]). Higher dehydroepiandrosterone was associated with higher visceral fat in women (7.57 [1.71, 13.88]), but not in men (-2.47 [-8.88, 4.29]). Higher SHBG was associated with significantly lower levels of adiposity in both sexes (women, -24.42 [-28.11, -20.55]; men, -27.39 [-32.97, -21.34]). There was no significant interaction by race/ethnicity or age. Conclusion: Sex hormones are significantly associated with adiposity, and the associations of androgens differ qualitatively by sex. This heterogeneity may help explain the complexity of the contribution of sex hormones to sex differences in cardiovascular disease.