Females and Males Have Different Associated Factors for Age-Related Hearing Loss

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The study found being underweight was linked to age-related hearing loss for males, but for females, both underweight and obese were linked to hearing loss.

Age-related hearing loss can be attributed to certain factors, and those factors differ for females and males, a study revealed. For instance, among females, age, hypertension, diabetes, dyslipidemia, obesity, sarcopenia, weight, height, age at menarche, and duration of hormone exposure were significant factors. Among men, age, underweight, weight, height, and alcohol consumption were factors.1,2

“Although numerous factors associated with [age-related hearing loss] have been reported, in practice it is necessary to prioritize associated factors according to sex to help prevent [age-related hearing loss],” investigators, led by Dong Woo Nam, MD, from the department of otorhinolaryngology at Chungbuk National University Hospital, in the Republic of Korea, wrote. “Through [augmented backward elimination], it was identified that common associated factors for ARHL differ between sexes.

Age-related hearing loss affects about 1 in 5 people worldwide have hearing loss, and the percentage is expected to grow as the population ages.

As of now, chronic noise exposure and ototoxic drugs are well-known risk factors for hearing loss. Hearing loss has also been associated with Caucasian ethnicities, lower socioeconomic status, smoking, alcohol, hypertension, diabetes, dyslipidemia, obesity, being underweight, sarcopenia, and adiposity. Since age-related hearing loss is irreversible, identifying risk factors and taking preventative measures can prevent hearing loss from occurring in the first place.

Investigators sought to identify associated factors for age-related hearing loss and evaluate sex differences regarding the associated factors. The cross-sectional study included data from 2,349 adults aged > 60 years—60% male and 40% female—who underwent check-up health examinations with the standard hearing tests from 2011 – 2021.

The team also collected data on the participants’ medical history, blood tests, a body composition test, and a basic hearing test. Age-related hearing loss was defined as a 2kHz threshold greater than 25 dB in the better year and a 4 kHz threshold ≥ 2 kHz threshold in the same ear.

Investigators found, among participants with age-related hearing loss, 57% had hypertension, 51% had dyslipidemia, 44% had visceral adiposity, 35% had obesity, 23% had diabetes, 17% had sarcopenia, and 5.1% were underweight. Additionally, 77% were alcohol consumers, 56% were non-smokers, 27% were former smokers, and 17% were current smokers.

The age-related hearing loss group had a greater age (P < .001) and a taller height (P = .021). The prevalence of age-related hearing loss was greater in males, hypertension, diabetes, and sarcopenia (P < .001).

Body Mass Index (BMI) (P < .001) and smoking (P < .001) also had a significant association with age-related hearing loss. The team observed no significant difference in body weight (P = .611), dyslipidemia (P = .249), visceral adiposity (P = .214), and alcohol consumption (P = 1.000).

After analyzing the data with univariate and multiple regression, investigators found some factors, such as age, were associated with age-related hearing loss regardless of gender. However, some factors only increased the risk of age-related hearing loss for males and not females, as well as vice versa.

Among males, age (P < .001), being underweight, (P = .001), alcohol consumption (P = .039), weight (P < .001), and height (P < .001), were associated factors of hearing loss. However, among females, age (P < .001), hypertension (P < .001), diabetes (P = .003), dyslipidemia (P = .003), obesity (P = .002), sarcopenia (P < .001), age at menarche (P < .001), weight (P = .034), height (P < .001), and hormone exposure duration (P < .001) were significant factors.

The analyses showed being underweight was significantly associated with age-related hearing loss in males (odds ratio [OR,] 3.020; 95% confidence interval [CI], 1.350 – 7.311). However, both low weight (OR, 0.995; 95% CI, 0.412 – 2.309) and obesity (OR, 2.102; 95% CI, 1.315 – 3.434) were significantly associated with hearing loss in females.

Additionally, current (OR, 1.953; 95% CI, 1.342 – 2.854) and past (OR, 1.066; 95% CI, 0.770 – 1.480) smoking was associated with an increased hearing loss risk in males but not in females. However, the sample included a lot more male smokers than female smokers.

Furthermore, females who began menstruating at a younger age were less likely to develop age-related hearing loss. This suggests a potential protective effect of the hormone estrogen.

Investigators highlighted multiple limitations, including the cross-sectional design not allowing for the conclusion of casual relationships, the limited sample size, and not evaluating for sudden hearing loss or history of hearing loss.

“Assessment and counseling regarding smoking, obstetric history, underweight, and obesity may be helpful in the management of patients with [age-related hearing loss],” investigators concluded.


  1. Nam DW, Park M-H, Jeong SJ, Lee KL, Kim JW, Jeong JB (2024) Sex differences in associated factors for age-related hearing loss. PLoS ONE 19(3): e0298048.
  2. Factors Associated with Age-Related Hearing Loss Differ Between Males And Females. EurekAlert! March 6, 2024. Accessed March 6, 2024.