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Objective Sociodemographic, lifestyle, and medical variables influence total testosterone (T) and sex hormone-binding globulin (SHBG) concentrations. The relationship between these factors and "free" T remains unclear. We examined 21 sociodemographic, lifestyle, and medical predictors influencing calculated free T (cFT) in community-dwelling men across ages. Design This is a cross-sectional analysis in 20 631 participants in the Androgens in Men Study. Methods Individual participant data (IPD) were provided by 9 cohorts. Total T was determined using mass spectrometry, SHBG using immunoassays, and cFT using the Vermeulen formula. Associations were analyzed using 2-stage random effects IPD meta-analyses. Results Cohort median ages ranged from 40 to 76 years and median cFT concentrations from 174.3 to 422.8 pmol/L. In men aged 17-99 years, there was a linear inverse association of cFT with age (−57.2 pmol/L [95% confidence interval, −69.4, −44.9] per 1 SD increase in age). Calculated free T increased with increasing baseline body mass index (BMI) among men with BMI < 23.6 kg/m2, but decreased among men with BMI > 23.6 kg/m2 (−24.7 pmol/L [−29.1, −20.3] per 1 SD increase in the 25.4-29.6 kg/m2 BMI range). Calculated free T was lower in younger men, who were married or in a de facto relationship (−18.4 pmol/L [−27.6, −9.3]) and in men who formerly smoked (−5.7 pmol/L [−8.9, −2.6]), were in poor general health (−14.0 pmol/L [−20.1, −7.8]), and had diabetes (−19.6 pmol/L [−23.0, −16.3]), cardiovascular disease (−5.8 pmol/L [−8.3, −3.2]), or cancer (−19.2 pmol/L [−24.4, −14.1]). Conclusions Calculated free T was most prominently associated with age and BMI. The linear, inverse association with age, nonlinear association with BMI, and presence of diabetes, cancer, and sociodemographic factors should be considered when interpreting cFT values. [ABSTRACT FROM AUTHOR]

Background: The Federal Aviation Administration's Age 60 Rule, promulgated in 1959, prohibits airline pilots from working in Part 121 operations once they have reached the age of 60. The Age 60 Rule remains a most contentious and politically sensitive topic, with challenges to the Rule currently mounted in both legislative and legal arenas., Methods: An extensive review of the medical literature was accomplished using MEDLINE. Pertinent Federal Regulations were examined. Legal proceedings and public domain documents were noted. Letters and personal communication were solicited where necessary information could not be ascertained by other means., Results: The Age 60 Rule was not based on any scientific data showing that airline pilots aged 60 and older were any less safe than younger pilots, and there is evidence to indicate that the choice of age 60 was actually based on economic rather than safety considerations. Airline pilots consistently exceed general population norms for longevity, physical health, and mental abilities. Fear of an adverse pilot health event causing a crash in standard multi-crew operations is not justified. For decades, airline pilots under age 60 have been granted the means to demonstrate their fitness for flying by taking medical, cognitive, and performance evaluations that are denied to airline pilots when they reach age 60. Actual flight experience demonstrates that older pilots are as safe as younger pilots. International aviation experience indicates that abolishing the Age 60 Rule will not compromise aviation safety., Conclusion: There appears to be no medical, scientific, or safety justification for the Age 60 Rule. As such, perpetuation of the Age 60 Rule, where age alone is used as the single criterion of older pilot fitness, represents age discrimination in commercial aviation.