Testosterone Replacement in Older Hypogonadal Men: A 12-Month Randomized Controlled Trial
Tóm tắt
A decline in testicular function is recognized as a common occurrence in older men. However data are sparse regarding the effects of hypogonadism on age-associated physical and cognitive declines. This study was undertaken to examine the year-long effects of testosterone administration in this patient population.
Fifteen hypogonadal men (mean age 68 ± 6 yr) were randomly assigned to receive a placebo, and 17 hypogonadal men (mean age 65± 7 yr) were randomly assigned to receive testosterone. Hypogonadism was defined as a bioavailable testosterone <60 ng/dL. The men received injections of placebo or 200 mg testosterone cypionate biweekly for 12 months. The main outcomes measured included grip strength, hemoglobin, prostate-specific antigen, leptin, and memory.
Testosterone improved bilateral grip strength (P < 0.05 by ANOVA) and increased hemoglobin (P < 0.001 by ANOVA). The men assigned to testosterone had greater decreases in leptin than those assigned to the control group (mean ± sem: −2.0 ± 0.9 ng/dL vs. 0.8 ± 0.7 ng/dL; P < 0.02). There were no significant changes in prostate-specific antigen or memory. Three subjects receiving placebo and seven subjects receiving testosterone withdrew from the study. Three of those seven withdrew because of an abnormal elevation in hematocrit.
Testosterone supplementation improved strength, increased hemoglobin, and lowered leptin levels in older hypogonadal men. Testosterone may have a role in the treatment of frailty in males with hypogonadism; however, older men receiving testosterone must be carefully monitored because of its potential risks.
Từ khóa
Tài liệu tham khảo
1991, Endocrine factors in geriatric sexuality., Clin Geriatr Med, 7, 85, 10.1016/S0749-0690(18)30567-6
Nankin, 1986, Decreased bioavailable testosterone in aging, normal and impotent men., J Clin Endocrinol Metab, 63, 1418, 10.1210/jcem-63-6-1418
Bremner, 1983, Loss of circadian rhythmicity in blood testosterone levels with aging in normal men., J Clin Endocrinol Metab, 56, 1278, 10.1210/jcem-56-6-1278
Vermeulen, 1972, Testosterone secretion and metabolism in male senescence., J Clin Endocrinol Metab, 34, 730, 10.1210/jcem-34-4-730
Gray, 1991, An examination of research design effects on the association of testosterone and male aging: results of a meta-analysis., J Clin Epidemiol, 44, 671, 10.1016/0895-4356(91)90028-8
Korenman, 1990, Secondary hypogonadism in older men: its relationship to impotence., J Clin Endocrinol Metab, 71, 963, 10.1210/jcem-71-4-963
Shimokata, 1989, Studies in the distribution of body fat, I. Effects of age, sex and obesity. J Gerontol Med Sci., 44, M66, 10.1093/geronj/44.2.M66
Griggs, 1989, 39, 219
Griggs, 1989, 66, 498
Bhasin, 1996, 335, 1
1992, Effects of testosterone supplementation in the aging male., J Clin Endocrinol Metab, 75, 1092
Morley, 1993, Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study., J Am Geriatr Soc, 41, 149, 10.1111/j.1532-5415.1993.tb02049.x
Frontera, 1988, Strength conditioning in older men: skeletal muscle hypertrophy and improved function., J Appl Physiol, 64, 1038, 10.1152/jappl.1988.64.3.1038
Fleg, 1988, Role of muscle loss in the age-associated reduction in VO2 max., J Appl Physiol, 65, 1147, 10.1152/jappl.1988.65.3.1147
1990, The scientific basis of exercise prescribing for the very old., J Am Geriatr Soc, 38, 62, 10.1111/j.1532-5415.1990.tb01600.x
Borkowski, 1967, Word fluency and brain damage., Neuropsychologia, 5, 135, 10.1016/0028-3932(67)90015-2
Yesavage, 1983, Development and validation of a geriatric depression screening scale: a preliminary report., J Psychiatr Res, 17, 37, 10.1016/0022-3956(82)90033-4
Kaiser, 1988, Impotence and aging: clinical and hormonal factors., J Am Geriatr Soc, 36, 511, 10.1111/j.1532-5415.1988.tb04021.x
Negoro, 1988, Utility of serum fructosamine as a measure of glycemia in young and old diabetic and non-diabetic subjects., Am J Med, 85, 360, 10.1016/0002-9343(88)90587-6
Carlson, 1964, Electromyographic study of aging in skeletal muscle., Am J Phys Med, 43, 141, 10.1097/00002060-196408000-00001
Kochakian, 1956, The effects of castration on the weight and composition of the muscles of the guinea pig., Endocrinology, 58, 315, 10.1210/endo-58-3-315
Kochakian, 1957, Influence of several c19 steroids on the growth of individual muscles of the guinea pig., Endocrinology, 60, 607, 10.1210/endo-60-5-607
Ensrud, 1994, Correlates of impaired function in older women., J Am Geriatr Soc, 42, 481, 10.1111/j.1532-5415.1994.tb04968.x
Sunderland, 1989, Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator., J Neurol Neurosurg Psychiatry, 52, 1267, 10.1136/jnnp.52.11.1267
Nikolaus, 1995, The timed test of money counting: a short physical performance test for manual dexterity and cognitivie capacity., Age Ageing, 24, 257, 10.1093/ageing/24.3.257
Hughes, 1995, Predictors of hand function in older persons: a two year longitudinal analysis., J Am Geriatr Soc, 43, 122, 10.1111/j.1532-5415.1995.tb06376.x
Spiegel, 1987, What are we measuring? An examination of walk time and grip strength., J Rheumatol, 14, 80
Laukkanen, 1994, Factors related to carrying out everyday activities among elderly people aged 80., Aging, 6, 433
Minor, 1995, Physical fitness and work capacity in women with rheumatoid arthritis., Arthritis Care Res, 8, 146, 10.1002/art.1790080306
Weber, 1991, Effects of reversible androgen deprivation on hemoglobin and serum immunoreactive erythropoietin in men., Am J Hematol, 36, 190, 10.1002/ajh.2830360306
Janne, 1975, DNA-dependent RNA polymerase I, and II from kidney. Effect of polyamines on the in vitro transcription of DNA and chromatin., Biochemistry, 14, 3589, 10.1021/bi00687a012
Wade, 1979, Theoretical review. Gonadal effects on food intake and adiposity: metabolic hypothesis., Physiol Behav, 22, 583, 10.1016/0031-9384(79)90028-3
1982, Brief report. Dose dependent effects of testosterone on feeding and body weight in male rats., Behav Neural Biol, 34, 445, 10.1016/S0163-1047(82)91888-X
Kochakian, 1958, Effect of testosterone propionate on the appetite, body weight and composition of the normal rat., Endocrinology, 63, 737, 10.1210/endo-63-6-737
Leshner, 1973, The effects of gonadectomy on the sex differences in dietary self selection patterns and carcass compositions of rats., Physiol Behav, 11, 671, 10.1016/0031-9384(73)90253-9
Zhang, 1994, Positional cloning of the mouse obese gene and its human homologue., Nature, 372, 425, 10.1038/372425a0
Reid, 1996, Testosterone therapy in glucocorticoid treated men., Arch Intern Med, 156, 1173, 10.1001/archinte.1996.00440100065008
Halaas, 1995, Weight reducing effects of the plasma protein encoded by the obese gene., Science, 269, 543, 10.1126/science.7624777
Considine, 1996, Studies of circulating leptin by radioimmunoassay in humans with and without obesity., N Engl J Med, 334, 292, 10.1056/NEJM199602013340503
Christiansen, 1987, Sex hormones and cognitive functioning in men., Neuropsychobiology, 18, 27, 10.1159/000118389
Flood, 1992, Memory enhancing effects in male mice of pregnenolone and steroids metabolically derived from it., Proc Natl Acad Sci USA, 89, 1567, 10.1073/pnas.89.5.1567
Flood, 1995, Age related decrease of plasma testosterone in SAM-P8 mice: replacement improves age related impairment of learning and memory., Physiol Behav, 57, 669, 10.1016/0031-9384(94)00318-1
Janowsky, 1994, Testosterone influences spatial cognition in older men., Behav Neurosci, 108, 625, 10.1037/0735-7044.108.2.325
Finkelstein, 1989, Increases in bone density during treatment of men with idioipathic hypogonadotropic hypogonadism., J Clin Endocrinol Metab, 69, 776, 10.1210/jcem-69-4-776
Somjen, 1989, Modulation by vitamin D status of the responsiveness of rat bone to gonadal steroids., Endocrinology, 125, 1870, 10.1210/endo-125-4-1870