Testosterone replacement therapy and hospitalization rates in men with COPD

Abstract

Testosterone deficiency is common in men with chronic obstructive pulmonary disease (COPD) and may exacerbate their condition. Research suggests that testosterone replacement therapy (TRT) may have a beneficial effect on respiratory outcomes in men with COPD. To date, however, no large-scale nationally representative studies have examined this association. The objective of the study was to assess whether TRT reduced the risk of respiratory hospitalizations in middle-aged and older men with COPD. We conducted two retrospective cohort studies. First, using the Clinformatics Data Mart-a database of one of the largest commercially insured populations in the United States-we examined 450 men, aged 40-63 years, with COPD who initiated TRT between 2005 and 2014. Second, using the national 5% Medicare database, we examined 253 men, aged ≥66 years, with COPD who initiated TRT between 2008 and 2013. We used difference-in-differences (DID) statistical modeling to compare pre- versus post-respiratory hospitalization rates in TRT users versus matched TRT nonusers over a parallel time period. DID analyses showed that TRT users had a greater relative decrease in respiratory hospitalizations compared with nonusers. Specifically, middle-aged TRT users had a 4.2% greater decrease in respiratory hospitalizations compared with nonusers (-2.4 decrease vs. 1.8 increase; p = 0.03); and older TRT users had a 9.1% greater decrease in respiratory hospitalizations compared with nonusers (-0.8 decrease vs. 8.3 increase; p = 0.04). These findings suggest that TRT may slow disease progression in patients with COPD. Future studies should examine this association in larger cohorts of patients, with particular attention to specific biological pathways.

Androgen and Androgen Receptors as Regulators of Monocyte and Macrophage Biology in the Healthy and Diseased Lung

“…In a clinical study of exercise and testosterone injection in men with COPD, the interventions did not significantly alter pulmonary function or blood gas variables (305). On the other hand, a retrospective study of two large cohorts of men who commenced testosterone replacement therapy within 12 months of a COPD diagnosis showed a 4.2-9.1% decrease in hospitalizations, dependent on age (306). More work is needed to understand how testosterone and its signaling pathways can be harnessed to alleviate lung disease without affecting reproductive systems or having unwanted metabolic effects.…”

Do Androgens Modulate the Pathophysiological Pathways of Inflammation? Appraising the Contemporary Evidence

“…The literature regarding the role of testosterone in chronic obstructive pulmonary disease (COPD) is sparser [78,112], but we call attention to one recent study performed by Baillargeon & colleagues [71], in which national-level data were reviewed for outcomes of COPD patients who were prescribed testosterone replacement therapy matched to non-users. Compared to non-users, middle-aged testosterone users had a 4.2% decrease in respiratory hospitalizations; older testosterone users had a 9.1% decrease.…”

Metabolic Effects of Testosterone Replacement Therapy in Patients with Type 2 Diabetes Mellitus or Metabolic Syndrome: A Meta-Analysis

“…TRT can improve all these comorbidities by its beneficial effect on metabolism. TRT may improve COPD by improving respiratory muscle function and by strengthening exercise capacity [ 48 – 51 ]. More studies are needed to further evaluate the effect of TRT on COPD.…”