J Clin Endocrinol Metab. 2010 Jan 8;
Authors: Srinivas-Shankar U, Roberts SA, Connolly MJ, O’ Connell MD, Adams JE, Oldham JA, Wu FC
Context: Physical frailty is associated with reduced muscle strength, impaired physical function, and quality of life.
Testosterone (T) increases muscle mass and strength in hypogonadal patients.
It is unclear whether T has similar effects in intermediate-frail and frail elderly men with low to borderline-low T.
Objective: Our objective was to determine the effects of 6 months T treatment in intermediate-frail and frail elderly men, on muscle mass and strength, physical function, and quality of life.
Design and Setting: We conducted a randomized, double-blind, placebo-controlled, parallel-group, single-center study.
Participants: Participants were community-dwelling intermediate-frail and frail elderly men at least 65 yr of age with a total T at or below 12 nmol/liter or free T at or below 250 pmol/liter.
Methods: Two hundred seventy-four participants were randomized to transdermal T (50 mg/d) or placebo gel for 6 months.
Outcome measures included muscle strength, lean and fat mass, physical function, and self-reported quality of life.
Results: Isometric knee extension peak torque improved in the T group (vs. placebo at 6 months), adjusted difference was 8.6 (95% confidence interval, 1.3-16.0; P = 0.02) Newton-meters.
Lean body mass increased and fat mass decreased significantly in the T group by 1.08 +/- 1.8 and 0.9 +/- 1.6 kg, respectively.
Physical function improved among older and frailer men.
Somatic and sexual symptom scores decreased with T treatment; adjusted difference was -1.2 (-2.4 to -0.04) and -1.3 (-2.5 to -0.2), respectively.
Conclusions: T treatment in intermediate-frail and frail elderly men with low to borderline-low T for 6 months may prevent age-associated loss of lower limb muscle strength and improve body composition, quality of life, and physical function. Further investigations are warranted to extend these results.
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“Borderline-Low Testosterone” was defined as Total Testosterone < 345 ng/dL Testosterone treatment not only prevented, but it reversed loss of muscle strength, improved lean body mass, decreased fat mass, improved physical function, improve sexual function, and improved quality of life in elderly men.
The dose used was 50 mg of Transdermal Testosterone. At this dose, there are a significant number of men who would become worse in testosterone level. Further, reduction in testicular thyroid releasing hormone production from exogenous testosterone can worsen absorption of transdermal testosterone due to the development of mild myxedema. Thus, my preferred transdermal dose would be 100 mg/day (i.e. two packets of Androgel or equivalent) to significantly improve testosterone dosing, plus management of thyroid hormone signaling to avoid reduction in testosterone absorption when using the transdermal route. With these additions, perhaps the improvements found in the study would have been greater.