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This paper reports a systematic review focusing on published estimates for testosterone associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Community-dwelling men.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>20\u2009180 adult men participated in the final set of studies identified and selected from a systematic review. Eligible studies included prospective cohort studies with plasma or serum testosterone concentrations measured for adult men using mass spectrometry with at least 5 years of follow-up data and one of the specified outcome measures recorded. Only published or grey literature items written in English were considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>Planned prospective outcome measures: cardiovascular disease (CVD) events, CVD deaths, all-cause mortality, cancer deaths, cancer diagnoses, cognitive decline, dementia. Meta-analyses were of the most frequently reported outcomes in selected studies: CVD deaths and all-cause mortality. Succinct characterisations of testosterone associations with other outcomes are also presented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Screening of 1994 deduplicated items identified 9 suitable studies, with an additional 2 identified by colleagues (11 in total). Summary estimates of mean testosterone concentration and age at recruitment for 20\u2009180 adult men were 15.4\u00b10.7\u2009nmol\/L and 64.9\u00b13.3\u2009year. Despite considerable variation in mean testosterone, a metaregression estimated no significant dependence on mean age at recruitment among studies (slope=\u22120.03, 95%\u2009CI \u22120.11 to 0.06). Meta-analyses demonstrated negligible heterogeneity and no significant effect of a 5\u2009nmol\/L increase in testosterone on the risk of all-cause mortality (HR=0.96, 95%\u2009CI 0.89 to 1.03) or death from CVD (HR=0.95, 95%\u2009CI 0.83 to 1.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Analyses of published estimates did not demonstrate associations of endogenous testosterone with CVD deaths or with all-cause mortality. Suggested further research includes the planned individual participant data meta-analyses for selected studies, enabling the investigation of non-linear summary effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>PROSPERO: CRD42019139668.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048013","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T19:09:25Z","timestamp":1635880165000},"page":"e048013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Systematic review and meta-analyses on associations of endogenous testosterone concentration with health outcomes in community-dwelling men"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8805-8498","authenticated-orcid":false,"given":"Ross 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