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“Although increasing adiposity and lifestyle factors that were recorded in the [Massachusetts Male Aging Study] could not account for the secular trends in testosterone level, it is possible that other lifestyle factors, such as increasing use of tight-fitting underwear, increasing room temperatures in American homes and offices during the past three decades, decreased physical activity with increased body mass indices and decreased smoking could have contributed to the declining testosterone levels in men.” There are several limitations of this study, including a small age-matched trend and limited geographic region surveyed, but the researchers said these data should not be ignored