Testosterone therapy does not improve most psychosocial measures for men with hypogonadism
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Key takeaways:
- Men receiving testosterone therapy had similar changes in psychosocial measures as those receiving placebo.
- Higher baseline mental health and coherence scores were linked to greater weight loss.
Testosterone replacement therapy did not improve most quality of life and psychosocial measures for men with pathological hypogonadism who were at high risk for type 2 diabetes, according to study findings.
“While for men enrolled in the T4DM study testosterone treatment had no effect on most measures of health-related quality of life or other measures of psychosocial function, it did improve sense of coherence and subjective social status in a time-limited fashion,” Mathis Grossmann, PhD, principal research fellow in the department of medicine at the University of Melbourne and head of men’s health in the department of endocrinology at Austin Health in Australia, and colleagues wrote in a study published in The Journal of Clinical Endocrinology & Metabolism. “Importantly, reductions in body weight and waist circumference occurring during the study irrespective of treatment status (placebo or testosterone) had positive effects on health-related quality of life and several indicators of psychosocial status.”
Researchers analyzed data from the T4DM trial, in which 1,007 men aged 50 to 74 years at high risk for type 2 diabetes and with a serum testosterone of less than 14 nmol/L were randomly assigned to injectable testosterone replacement therapy or placebo for 24 months. During the trial, five questionnaires were administered to assess health-related quality of life and psychosocial measures. The SF-12 questionnaire assessed physical and mental health-related quality of life, the MacArthur Scale of Subjective Social Status questionnaire measured social status relative to people like oneself as well as within society in general, the Pearlin Mastery Scale questionnaire assessed whether people felt they were in control of forces affecting their life and the Sense of Coherence Scale questionnaire measured how people used resistance resources to maintain and develop their health. Those four questionnaires were completed at baseline, 30, 54, 78 and 104 weeks. The Center for Epidemiological Studies – Depression questionnaire was administered to measure depression symptoms and was completed at baseline, 54 and 104 weeks.
Few differences in psychosocial measures
Of the T4DM participants, 648 completed all of the assessments at baseline and 104 weeks. For the MacArthur Scale of Subjective Social Status questionnaire, men receiving testosterone had a higher score for social status relative to people like themselves at 78 weeks than those receiving placebo (P = .04). The testosterone group also had a higher score on the Sense of Coherence Scale questionnaire at 54 and 78 weeks than the placebo group (P = .03). No differences for any other psychosocial or quality of life outcomes were observed between the two treatment groups.
Researchers found fasting plasma glucose and 2-hour glucose did not interact between any psychosocial measures and the study treatment. However, a 1 U increase in baseline score for the SF-12 and Sense of Coherence Scale questionnaires were associated with a mean 0.05 kg decrease in body weight. A 1 U increase in Center for Epidemiological Studies – Depression score at baseline was associated with a mean 0.11 kg increase in body weight.
Weight loss improves mental health
When weight change was assessed across the study period, larger decreases in weight as early as 6 months were associated with greater improvements in SF-12 mental score, whereas larger changes in weight at 2 years were associated with lower improvements on that same score. Researchers observed larger decreases in body weight with higher scores on the Pearlin Mastery Scale questionnaire at 6 months and 2 years.
At 2 years, 28% of men were attending WW (formerly Weight Watchers) as part of lifestyle intervention in the study. Each 1 U increase in baseline SF-12 mental score was associated with a higher likelihood for attending WW (OR = 1.03; 95% CI, 1.01-1.05). Lifestyle adherence did not impact most questionnaire scores during the study. However, men who attended WW had higher SF-12 mental scores and lower scores for the Center for Epidemiological Studies – Depression questionnaire, indicating fewer depression symptoms.
“Collectively, the data support the importance of a holistic treatment approach to men at high risk of diabetes, including the optimization of physical and mental health function and extending to the identification and treatment of depressive symptomatology,” the researchers wrote. “Conversely, the data also suggests that exposure to lifestyle intervention, including weight loss in [men with overweight and obesity], is important to optimize health-related quality of life and psychosocial function.”
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