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Neurological manifestations are among the most concerning signs: Paraesthesia (pins and needles) in hands and feet Numbness or altered sensation in extremities Difficulty with balance or coordination Memory problems or difficulty concentrating Mood changes, including depression or irritability Visual disturbances in rare cases These symptoms may be particularly difficult to distinguish from diabetic neuropathy, making objective assessment through blood testing essential rather than relying solely on clinical presentation

Individuals with type 1 diabetes, thyroid cancer, multiple endocrine neoplasia, or end stage kidney disease at any time until cohort entry or individuals with dialysis or the latest eGFR 70 years, by males versus females, by insulin use, by atherosclerotic cardiovascular disease (i.e., myocardial infraction, angina, coronary artery disease, coronary revascularization, peripheral artery disease, aortic atherosclerotic disease, or cerebrovascular disease), by renal insufficiency (i.e., chronic kidney disease or the latest eGFR 70 years (HR [95% CI]: 0.95 [0.831.08])

Population testosterone levels, NHANES data

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