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Benefits of testosterone in frail old men fade soon after discontinuation

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Short-term testosterone treatment in frail elderly men improves muscle mass and strength, but the effects don’t last more than 6 months after treatment stops, new findings indicate.

“Since the use of testosterone in elderly men raises concerns regarding adverse effects on the prostate and cardiovascular system, it’s important to determine if short-term treatment can lead to prolonged benefits beyond the duration of testosterone exposure,” Dr. Frederick Wu pointed out in a press statement.

As described in the February 2011 issue of the Journal of Clinical Endocrinology and Metabolism (available online November 4), lead author Dr. Wu at the University of Manchester, UK, and colleagues tested the effects of 6-months’ testosterone supplementation versus placebo in 274 frail and intermediate-frail men age 65-90 years.

Testosterone levels increased from 11.1 nmol/L at baseline to 18.4 nmol/L at 6 months in the participants treated with testosterone gel or patches, but then levels dropped back to 10.5 nmol/L at 12 months, the team found.

Similarly, the gain in lean mass of 1.2 kg seen in the testosterone group compared with the placebo group declined to 0.3 kg after discontinuation of treatment, and the 8.1-Nm increase in knee extension torque decreased to 4.0 Nm at 12 months.

As for safety, “Haematocrit and PSA were raised and HDL-cholesterol slightly reduced during treatment in the testosterone-treated group compared to placebo. None of these changes persisted at 12 months,” the authors report.

The optimal duration of anabolic hormone intervention in this setting remains unknown, Dr. Wu and colleagues conclude. However, such agents may augment the effects of exercise, which can produce substantial gains in strength even in the very elderly.

“This underscores the importance of a multi-disciplinary interventional approach including resistance exercise, diet and other lifestyle options, in conjunction with pharmacological agents in the elderly to interrupt the downward spiral into frailty,” they advise.

J Clin Endocrinol Metab 2010.