Association between sex hormones and colorectal cancer risk in men and women

Jennifer H. Lin, Shumin M. Zhang, Kathryn M. Rexrode, Jo Ann E. Manson, Andrew T. Chan, Kana Wu, Shelley S. Tworoger, Susan E. Hankinson, Charles Fuchs, J. Michael Gaziano, Julie E. Buring, Edward Giovannucci

Research output: Contribution to journalArticlepeer-review

110 Scopus citations


Background & Aims: There is observational and clinical evidence that indicates that sex hormones affect development of colorectal cancer in men and women. However, the relationship between endogenous sex hormone levels and colorectal cancer is unclear. Methods: We collected data on lifestyle, medical history, and diet (through 2008), along with blood samples, from the Nurses' Health Study, the Women's Health Study, the Health Professional Follow-up Study, and the Physicians' Health Study II. We measured plasma levels of estrone, estradiol, testosterone, sex hormone binding globulin (SHBG), and C-peptide among 730 women (293 cases of colorectal cancer and 437 healthy individuals as controls) and 1158 men (439 colorectal cancer cases and 719 controls) and used unconditional logistic regression to estimate relative risks (RRs) and 95% confidence intervals. All statistical tests were 2-sided. Results: Total testosterone, SHBG, and the ratio of estradiol to testosterone were associated with colorectal cancer in men after adjustments for matching and risk factors for colorectal cancer, including body mass index and plasma levels of C-peptide. The RRs in the highest relative to the lowest quartile were 0.62 for testosterone (95% confidence interval, 0.40-0.96), 0.65 for SHBG (95% confidence interval, 0.42-0.99), and 2.63 for the ratio (95% confidence interval, 1.58-4.36) (P values for trend ≤ .02). However, in women, only the ratio of estradiol to testosterone was (inversely) associated with colorectal cancer after adjustments for all factors (RR, 0.43; 95% confidence interval, 0.22-0.84; P value for trend = .03). Conclusions: On the basis of combined data from 4 population studies, there appears to be an association between levels of sex hormones and colorectal cancer risk in men. There also appears to be an inverse association between the ratio of estradiol to testosterone and colorectal cancer in postmenopausal women.

Original languageEnglish
Pages (from-to)419-424.e1
JournalClinical Gastroenterology and Hepatology
Issue number4
StatePublished - Apr 2013
Externally publishedYes


  • Colorectal Cancer
  • Estrogen
  • Incidence
  • Testosterone


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