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High serum zinc and serum testosterone levels were associated with excessive erythrocytosis in men at high altitudes


Chronic mountain sickness (CMS), a lack of adaptation to altitude characterized by excessive erythrocytosis (EE), is a health problem associated with life at high altitude. The erythropoietic process is regulated by both erythropoietin and testosterone. Zinc (Zn) is known to be related with testosterone and hemoglobin levels; meanwhile, nitric oxide was also associated with adaptation to high altitude. The aim of this study was to determine the relationship of hemoglobin and CMS score with serum levels of zinc, total testosterone (TT), calculated free testosterone (cFT), bioavailable testosterone (BAT), hemoglobin, and nitric oxide in men at high altitude with or without EE. Men residing in Lima (150 m) and Cerro de Pasco (4,340 m), Peru, were divided into three groups: (1) low altitude, (2) high altitude without EE (hemoglobin < 21 g/dl), and (3) high altitude with EE (hemoglobin ≥ 21 g/dl). Adjusted multivariable regression models showed that serum testosterone (total or free) and Zn levels were independently correlated with increased hemoglobin levels. Similarly, hemoglobin was positively related with signs/symptoms of CMS; however, both increased the serum Zn and the nitric oxide levels correlated with reduced risk for signs/symptoms of CMS. In conclusion, higher serum testosterone levels and Zn levels were associated with EE, and low scores of signs/symptoms of CMS were associated with higher Zn and nitric oxide levels.

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Body mass index


High altitude


Low altitude




Excessive erythrocytosis


Chronic mountain sickness


Total testosterone


Calculated free testosterone


Bioavailable testosterone




Nitric oxide




Delta-aminolevulinic acid dehydratase


Hypoxia-inducible factor


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This study was supported by a Grant from the Fogarty Program of The National Institutes of Health of the United States (NIH Research Grant # 5-D43TW005746-04 funded by the Fogarty International Center, National Institutes on Environmental Health Services, National Institute for Occupational Safety and Health, and the Agency for Toxic Substances and Disease Registry).

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The authors have no conflicts of interest or financial ties to disclose.

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Correspondence to Gustavo F. Gonzales.

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Gonzales, G.F., Tapia, V., Gasco, M. et al. High serum zinc and serum testosterone levels were associated with excessive erythrocytosis in men at high altitudes. Endocrine 40, 472–480 (2011). https://doi.org/10.1007/s12020-011-9482-1

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  • Testosterone
  • Zinc
  • Nitric oxide
  • High altitude
  • Chronic mountain sickness signs/symptoms
  • Excessive erythrocytosis