Introduction:
Water-pipe (WP) smoking is the most widespread tobacco use in the Middle-East, and is rapidly spreading globally. Meanwhile, changes in testosterone levels have been linked to various diseases including type 2 diabetes and erectile dysfunction. This investigation addresses an important gap in the outcome of WP smoking on testosterone levels.

Aim:
To explore the outcome of WP smoke on serum levels of total testosterone (TT), free testosterone (FT), bioavailable testosterone (bioT) and sex hormone-binding globulin (SHBG) among men in Qatar.

Methods:
This is a cross-sectional cohort study based on data gathered from a total of 1000 volunteer men from Qatar BioBank (QBB). To determine the WP and Cigarette smoking status, a self-reported questionnaire was used. TT and SHBG were measured clinically, whereas FT and BioT were calculated using Vermeulen’s equation. Hormone values were compared using multiple regression analysis based on WP smoking status after adjusting for appropriate confounding factors.

Results:
Once exclusion criteria were applied, 541 males (277 WP smokers and 264 non-smokers) were included in the analysis. After adjustment for cofounding factors, no statistical significant difference was observed in TT, FT, SHBG, and BioT between WP smokers and non-smokers (all p > 0.05). Furthermore, Similar results were found in non-adjusted regression model, while only age was shown to significantly affect androgens level (P= 0.014).

Conclusions:
In this study we report, for the first time, that there was no significant change in TT, FT, BioT and SHBG in WP smokers when compared to non-WP smokers.

Funding:
This study was supported by a Qatar University Student Grant.