Serum total T (TT) and E2 levels were measured using an isotope dilution high-performance liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) in the NHANES, while the concentrations of sex hormone-binding globulin (SHBG) were quantified using chemo-luminescence measurements of the reaction products via a photomultiplier tube after binding to SHBG with immuno-antibodies (30 (link)). According to previous literature, we only indirectly assessed the approximate amount of circulating free testosterone (FT) (31 (link)) and the activity of aromatase (32 (link)) through the free androgen index (FAI) that was calculated as the value of TT (ng/dL) divided by SHBG (nmol/L) and the ratio of TT to E2 (TT/E2), respectively. Bioavailable testosterone was calculated according to the Vermeulen et al. formula (33 (link)).
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