Exogenous Testosterone (T) Alone or with Finasteride Increases Physical Performance, Grip Strength, and Lean Body Mass in Older Men with Low Serum T

Abstract

Testosterone (T) therapy in older men with low serum T levels increases lean body mass and decreases fat mass. These changes might improve physical performance and strength; however, it has not been established whether T therapy improves functional outcome in older men. Moreover, concerns exist about the impact of T therapy on the prostate in older men. The administration of finasteride (F), which partially blocks the conversion of T to the more potent androgen, dihydrotestosterone, attenuates the impact of T replacement on prostate size and prostate-specific antigen. We hypothesized that T replacement in older, hypogonadal men would improve physical function and that the addition of F to this regimen would continue to provide the T-induced improvements in physical performance, strength, and body composition. Seventy men with low serum T (<350 ng/dl), age 65 yr and older, were randomly assigned to receive one of three regimens for 36 months: 1) T enanthate, 200 mg im every 2 wk, with placebo pills daily (T-only); 2) T enanthate, 200 mg every 2 wk, with 5 mg F daily (T + F); or 3) placebo injections and pills (placebo). We obtained serial measurements of timed physical performance, grip strength, lower extremity strength, body composition (by dual-energy x-ray absorptiometry), fasting cholesterol profiles, and hormones. Fifty men completed the 36-month protocol. After 36 months, T therapy significantly improved performance in a timed functional test when compared with baseline and placebo [4.3 +/- 1.6% (mean +/- sem, T-only) and 3.8 +/- 1.0% (T + F) vs. -5.6 +/- 1.9% for placebo (P < 0.002 for both T and T + F vs. placebo)] and increased handgrip strength compared with baseline and placebo (P < 0.05). T therapy increased lean body mass [3.77 +/- 0.55 kg (T-only) and 3.64 +/- 0.56 kg (T + F) vs. -0.21 +/- 0.55 kg for placebo (P < 0.0001)], decreased fat mass, and significantly decreased total cholesterol, low-density lipoprotein, and leptin, without affecting high-density lipoprotein, adiponectin, or fasting insulin levels. These results demonstrate that T therapy in older men with low serum T improves physical performance and strength over 36 months, when administered alone or when combined with F, and suggest that high serum levels of dihydrotestosterone are not essential for these beneficial effects of T in men.

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

“…Relative contraindications to be considered include elevated hematocrit, abnormal liver function studies, LUTS, and sleep apnea. A rare adverse event is the enlargement of prostate size, which can be prevented by the administration of finasteride [147,148]. It has also been suggested that large numbers of men with low to lownormal testosterone levels would benefit from testosterone screening when they are evaluated for ED and that testosterone therapy may improve the response of PDE5 inhibitors [70,71,73].…”

Effects of testosterone on lean mass gain in elderly men: systematic review with meta-analysis of controlled and randomized studies

“…Therapies associated to testosterone and other androgenic hormone treatment favor changes in body composition, especially in lean mass gain and neuromuscular adaptation (Allan et al 2008;Schroeder et al 2004;Page et al 2005;Kenny et al 2001;Schroeder et al 2003a). However, the effects of these types of treatment are not fully understood, since their objectives, dosages and duration as well as the association with physical activity adds complexity to the data provided by the studies on this theme (Kenny et al 2000;Morley et al 2003;Snyder et al 1999;Tenover 1998).…”

Androgens and male aging: current evidence of safety and efficacy

“…Testosterone replacement may be effective in reversing age-dependent body composition changes and associated morbidity [71]. Testosterone administration improves body composition: a decrease of fat mass, increase of LBM [37,72,73]. In most of these studies, the body weight change did not differ significantly.…”

“…In the past decade evidence has been produced of the benefit of androgen treatment on multiple target organs of hypogonadal men, and recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men [34][35][36][37].…”

“…In most of these studies, the body weight change did not differ significantly. 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].…”