Differences in testosterone levels in perianal diseases: A comparative study of abscesses and fistulas

Table 1 Baseline characteristics and comparison of sex hormone levels among the three groups

Group	Hemorrhoids (n = 64)	Anorectal abscess (n = 64)	Anal fistula (n = 121)	Test statistic	P value
Age (years)	37.50 (31.00, 49.00)	35.00 (29.25, 49.75)	36.00 (29.00, 49.00)	0.8091	0.667
Symptom duration (months)	48.00 (24.00, 120.00)a	0.23 (0.18, 1.00)2	10.00 (3.00, 24.00)a,2	119.8911	< 0.001
BMI (kg/m2)	24.25 ± 5.49	25.00 ± 4.06	25.60 ± 3.48	2.1722	0.116
E2 (pg/mL)	21.78 ± 7.12	21.87 ± 7.90	23.57 ± 7.88	1.6062	0.203
FSH (IU/L)	5.42 ± 4.13	5.36 ± 3.92	5.09 ± 4.20	0.1842	0.173
LH (IU/L)	4.31 (2.73, 6.55)	4.51 (3.14, 7.56)	4.08 (2.76, 5.50)	3.8211	0.148
T (nmol/L)	13.94 ± 5.53a	10.68 ± 4.84	13.08 ± 5.25a,b	6.9322	< 0.001
Hypertension	9 (14.06)	9 (14.06)	16 (13.22)	0.0373	0.982
Diabetes mellitus	14 (21.88)	14 (21.88)	18 (14.88)	2.0233	0.364

^aP < 0.05 vs the abscess group.

^bP < 0.05 vs the hemorrhoids group.

¹Kruskal-Wallis test.

²One-way ANOVA.

³χ² test.

Data were showed as mean ± SD, n (%) or median (P25, P75). BMI: Body mass index; E₂: Estradiol; FSH: Follicle-stimulating hormone; LH: Luteinizing hormone; T: Testosterone.

Table 2 Independent association between anorectal abscess and lower testosterone levels in the overall study population

Predictor	B	SE	β	t value	P value	B diff (95%CI)	VIF
Constant	23.946	2.161	-	11.081	< 0.001	19.69-28.20	-
Age	-0.032	0.027	-0.074	-1.156	0.249	-0.09 to 0.02	1.17
BMI	-0.368	0.076	-0.292	-4.850	< 0.001	-0.52 to -0.22	1.04
Hypertension	-0.377	0.999	-0.024	-0.378	0.706	-2.35 to 1.59	1.19
Diabetes mellitus	1.056	0.815	0.077	1.296	0.196	-0.55 to 2.66	1.01
Anorectal abscess1	-2.999	0.880	-0.246	-3.408	< 0.001	-4.73 to -1.27	1.49
Anal fistula1	-0.346	0.778	-0.032	-0.444	0.657	-1.88 to 1.19	1.53

¹The reference group for disease category is the hemorrhoids group.

Model summary: Adjusted R² = 0.136, F (6, 242) = 7.485, P < 0.001. Multicollinearity: All variance inflation factor values were < 1.6, indicating no substantial multicollinearity. BMI: Body mass index; 95%CI: 95% confidence interval; VIF: Variance inflation factor.

Table 3 Univariate analysis between disease characteristics and testosterone levels in the patients with anorectal abscess

Grouping category	n (%)	T (nmol/L; mean ± SD)	Mean/median diff (95%CI)	Test statistic	P value
Hypertension
No	55 (85.9)	11.07 ± 4.95	Reference	2.142	0.050
Yes	9 (14.1)	8.27 ± 3.37	2.80 (0.00-5.60)
Diabetes mellitus
No	50 (78.1)	10.08 ± 4.18	Reference	-1.921	0.059
Yes	14 (21.9)	12.83 ± 6.41	-2.75 (-5.61 to 0.11)
BMI (kg/m2)
≤ 24	28	11.75 ± 5.29	Reference	1.983	0.056
> 24	36	9.84 ± 4.34	1.91 (-0.50 to 4.31)
Symptom duration (days)
< 7	21 (32.8)	8.51 ± 3.62	Reference	-2.627	0.011
≥ 7	43 (67.2)	11.74 ± 5.03	-3.23 (-5.69 to -0.77)
Type of abscess
Perianal subcutaneous	48 (75.0)	10.61 ± 4.99	Reference	0.224	0.879
Ischioanal abscess	10 (15.6)	10.2 8 ± 5.47	0.33 (-3.09 to 3.76)
Intersphincteric abscess	5 (7.8)	12.33 ± 2.15	-1.72 (-6.35 to 2.92)
Submucosal abscess	1 (1.6)	9.721	0.891
Fistula formation
No	18 (28.1)	8.82 ± 5.56	Reference	-2.226	0.032
Yes	46 (71.2)	11.35 ± 5.09	-2.53 (-4.83 to -0.23)
Abscesses involving more than two perianal quadrants
No	40 (62.5)	11.62 ± 4.17	Reference	2.057	0.044
Yes	24 (37.5)	9.11 ± 5.52	2.50 (0.07-0.49)

¹There was only one sample in the group, so no pairwise comparisons were conducted.

T: Testosterone; 95%CI: 95% confidence interval; BMI: Body mass index.

Table 4 Correlation analysis of disease characteristics and testosterone levels in the patients with anorectal abscess (n = 64)

Variable	r value1	95%CI	P value
Age	-0.018	-0.27 to 0.24	0.886
WBC (109/L)	-0.467	-0.64 to -0.24	< 0.001

¹Pearson correlation coefficient.

95%CI: 95% confidence interval; WBC: White blood cell.

Table 5 Multivariate linear regression analysis of testosterone levels in the patients with perianal abscess (n = 64)

Predictor	B	SE	β	t value	P value	B diff (95%CI)	VIF
Constant	14.995	2.138		7.014	< 0.001	10.71-19.28
WBC (109/L)	-0.565	0.160	-0.441	-3.540	< 0.001	-0.885 to -0.245	1.165
BMI	-2.879	1.088	-0.298	-2.647	0.011	-5.058 to -0.700	1.138

Model summary: R² = 0.377, adjusted R² = 0.300, F (7, 56) = 4.851, P < 0.001. Multicollinearity: All variance inflation factor values were < 1.2, indicating no substantial multicollinearity. 95%CI: 95% confidence interval; VIF: Variance inflation factor WBC: White blood cell; BMI: Body mass index.

Table 6 Univariate analysis between disease characteristics and testosterone levels in the patients with anal fistula (n = 121)

Grouping category	n (%)	T (nmol/L), mean ± SD or median (P25, P75)	Mean/median diff (95%CI)	Test statistic	P value
Diabetes mellitus
No	103 (85.1)	12.30 (9.25, 16.60)	Reference	0.328	0.743
Yes	18 (14.9)	12.95 (9.93, 16.15)	-0.41 (-3.05 to 2.10)
Hypertension
No	105 (86.8)	13.37 ± 5.33	Reference	1.631	0.105
Yes	16 (13.2)	11.02 ± 4.17	2.34 (-0.50 to 5.19)
BMI (kg/m2)
≤ 24	44 (36.4)	15.84 ± 4.88	Reference	4.766	0.001
> 24	77 (63.6)	11.45 ± 4.80	4.35 (2.54-6.16)
Type of anal fistula
Trans sphincteric	84 (69.4)	13.25 ± 5.23	Reference	8.897	0.064
Inter sphincteric	17 (14)	13.09 ± 6.07	0.16 (-3.78 to 4.10)
Supra sphincteric	8 (6.6)	14.62 ± 4.65	-1.37 (-6.85 to 4.11)
Extra sphincteric	10 (8.3)	9.43 ± 3.23	3.82 (-1.13 to 8.77)
Submucosal	2 (1.7)	17.75 ± 1.63	-4.50 (-15.10 to 6.10)
Internal opening above the dentate line
No	112 (92.6)	13.42 ± 5.27	Reference	4.460	0.001
Yes	9 (7.4)	8.81 ± 2.72	4.61 (2.38-6.84)
Number of fistula tracts
< 2	97 (80.2)	12.97 ± 5.17	Reference	-0.462	0.645
≥ 2	24 (19.8)	13.52 ± 5.65	-0.55 (-2.93 to 1.82)
Intestinal inflammatory manifestations (n = 73)
No	55 (75.3)	11.7 (9.25, 15.30)	Reference	-0.557	0.578
Yes	18 (24.7)	13.10 (8.13, 16.00)	-0.07 (-3.40 to 2.10)

T: Testosterone; 95%CI: 95% confidence interval; BMI: Body mass index.

Table 7 Correlation analysis of disease characteristics and testosterone levels in the patients with anal fistula (n = 121)

Category	Correlation coefficient (ρ)1	95%CI	P value
Age	-0.201	-0.37 to -0.02	0.027
Symptom duration (months)	-0.029	-0.21 to 0.16	0.775

¹Spearman's rank correlation coefficient.

95%CI: 95% confidence interval.

Table 8 Correlation analysis of disease characteristics and testosterone levels in the patients with anal fistula

Predictor	B	SE	β	t value	P value	B diff (95%CI)	VIF
Constant	18.030	1.492		12.083	< 0.001	(15.07-20.99)
BMI	-3.866	0.917	-0.356	-4.214	< 0.001	(-5.68 to -2.05)	1.054
Internal opening above the dentate line	-4.479	2.238	-0.225	-2.001	0.048	(-8.91 to -0.05)	1.866

Model summary: R² = 0.215, adjusted R² = 0.188, F (4, 116) = 7.941, P < 0.001. Durbin-Watson ratio = 1.992. 95%CI: 95% confidence interval; VIF: Variance inflation factor; BMI: Body mass index.