Abstract
The accumulation of heavy metals in the human body may interfere with the synthesis of sex hormones, thereby negatively impacting male reproductive health. This study aims to explore the association between urinary cesium levels and testosterone deficiency in adult males. The study cohort included men aged 20 years and older, with data sourced from the National Health and Nutrition Examination Survey conducted between 2011 and 2016. Researchers employed multivariate logistic regression analysis to investigate the association between urinary cesium levels and testosterone deficiency in adult men. In addition, the stability and characteristics of the association between urinary cesium and testosterone deficiency were further explored through subgroup analysis, interaction testing, and smooth curve fitting analysis. This study included a total of 2059 participants, of whom 27.87% had testosterone deficiency. After full adjustment for confounders, each unit increase in urinary cesium was associated with a 4% higher risk of testosterone deficiency (odds ratio = 1.04, 95% confidence interval: 1.01-1.08, P = .0054). A significant negative correlation was also observed between urinary cesium and total testosterone levels (Spearman ρ = -0.1160, P < .0001). Smooth curve fitting indicated a nonlinear positive correlation between urinary cesium levels and the prevalence of testosterone deficiency. Subgroup analyses confirmed consistency across populations, with no significant interaction effects (P > .05). Elevated urinary cesium is associated with an increased risk of testosterone deficiency. These findings highlight the need for enhanced safety measures for individuals occupationally exposed to cesium to protect male reproductive health.