Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate-Frail and Frail Elderly Men: A Randomized, Double-Blind, Placebo-Controlled Study

Srinivas-Shankar, Upendram; Roberts, Stephen A.; Connolly, Martin J.; O’Connell, Matthew; Adams, Judith E.; Oldham, Jacqueline; Wu, Frederick C. W.

doi:10.1210/jc.2009-1251

Cited by 568 publications

(427 citation statements)

References 49 publications

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“…In part, the discrepant results may be due to the fact men in the Vigen cohort (Vigen et al 2013) had a higher burden of comorbidities. Given that one (Basaria et al 2010), but not all (Srinivas-Shankar et al 2010), RCTs in men with a similarly high burden of comorbidities reported an increase in cardiovascular events in men randomised to testosterone treatment (see section on Testosterone therapy: potential risks below) (Basaria et al 2010), testosterone should be used with caution in frail men with multiple comorbidities. The retrospective, non-randomised and non-blinded design of these studies (Shores et al 2012, Muraleedharan et al 2013, Vigen et al 2013) leaves open the possibility for residual confounding and multiple other sources of bias.…”

Section: Testosterone Treatment In Men With Metabolic Disordersmentioning

confidence: 99%

Testosterone and glucose metabolism in men: current concepts and controversies

Grossmann¹

2013

Journal of Endocrinology

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A wealth of observational studies show that low testosterone is associated with insulin resistance and with an increased risk of diabetes and the metabolic syndrome. Experimental studies have identified potential mechanisms by which low testosterone may lead to insulin resistance. Visceral adipose tissue is an important intermediate in this relationship. Actions of testosterone or its metabolite oestradiol on other tissues such as muscle, liver, bone or the brain, and body composition-independent effects may also play a role. However, definitive evidence from randomised controlled trials (RCTs) to clarify whether the association of low testosterone with disordered glucose metabolism is causative is currently lacking. It therefore remains possible that this association is due to reverse causation, or simply originates by association with common health and lifestyle factors. RCTs of testosterone therapy in men with or without diabetes consistently show modest metabolically favourable changes in body composition. Despite this, testosterone effects on glucose metabolism have been inconsistent. Recent evidence suggests that the hypothalamic-pituitary-testicular axis suppression in the majority of obese men with metabolic disorders is functional, and may be, at least in part, reversible with weight loss. Until further evidence is available, lifestyle measures with emphasis on weight reduction, treatment of comorbidities and optimisation of diabetic control should remain the first-line treatment in these men. Such measures, if successful, may be sufficient to normalise testosterone levels in men with metabolic disorders, who typically have only modest reductions in circulating testosterone levels.

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Section: Testosterone Treatment In Men With Metabolic Disordersmentioning

confidence: 99%

Testosterone and glucose metabolism in men: current concepts and controversies

Grossmann¹

2013

Journal of Endocrinology

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“…Age related T decline has been associated with low muscle mass [33][34][35] and strength [11,14,33], impaired balance, falls and higher dependency in activities of daily living [34,36]. FT is positively related to lean mass, muscle strength and mobility [37].…”

Section: Musculoskeletal Disordersmentioning

confidence: 99%

“…A positive effect of TRT on muscle mass has been observed in older patients [8,20,[35][36][37]. Studies of TRT on muscle strength are less clear, most showing a positive effect [8,[35][36][37][39][40][41] but others none [20].…”

Section: Musculoskeletal Disordersmentioning

confidence: 99%

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A view of geriatrics through hormones. What is the relation between andropause and well-known geriatric syndromes?

Samaras

Lang

et al. 2013

Maturitas

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a b s t r a c tAge related male hypogonadism, or "andropause", is increasingly recognized as of frequent occurrence in older patients. Diagnosis requires both the presence of clinical symptoms and low testosterone levels. However, diagnosing andropause in this age group may be challenging since symptoms are frequently non specific and testosterone levels are influenced by a multitude of parameters such as lifestyle factors and chronic diseases. In this article we discuss the pathophysiology, definition and diagnostic difficulties of andropause in geriatric patients. Moreover, we review the relation between testosterone levels and frequent geriatric syndromes such as falls, osteoporosis, cognitive and mood disorders, anemia and cardiovascular disease. Finally, we examine the potential benefits and risks of testosterone replacement therapy in this age group.

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“…Testosterone therapy was associated with a greater improvement in grip strength than placebo [37,74,75]. A recent double-blind placebo-controlled study showed benefits of testosterone administration on skeletal muscle performance in elderly men with chronic heart failure [76], and another one found positive effects on the prevention of loss of muscle strength of the lower limbs [77]. Changes in lowerextremity muscle strength and measures of physical function were reported in only a few studies and were inconsistent.…”

Section: Muscle Mass and Strengthmentioning

confidence: 99%

Androgens and male aging: current evidence of safety and efficacy

Gooren¹

2010

Asian J Androl

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Many signs of aging, such as sexual dysfunction, visceral obesity, impaired bone and muscle strength, bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens, and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence, the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism, in the best case reversed by testosterone treatment, has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome, bone mineral density, of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry: double-blind, placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.

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Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate-Frail and Frail Elderly Men: A Randomized, Double-Blind, Placebo-Controlled Study

Cited by 568 publications

References 49 publications

Testosterone and glucose metabolism in men: current concepts and controversies

Testosterone and glucose metabolism in men: current concepts and controversies

A view of geriatrics through hormones. What is the relation between andropause and well-known geriatric syndromes?

Androgens and male aging: current evidence of safety and efficacy

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