Testosterone therapy not tied to additional metabolic benefits for older men with obesity
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Key takeaways:
- Changes in most cardiometabolic measures were similar for men receiving lifestyle intervention plus testosterone vs. placebo.
- The placebo group had larger improvements in HDL cholesterol and adiponectin levels.
Testosterone therapy did not improve cardiometabolic measures for older men with obesity and hypogonadism receiving lifestyle intervention, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“Testosterone therapy does not further improve metabolic outcomes if the older adults can follow a lifestyle modification program alone,” Dennis T. Villareal, MD, professor of medicine at Baylor College of Medicine and staff physician at the Michael E. DeBakey VA Medical Center in Houston, told Healio. “Our study population is unique, given the focus on older men who both have low testosterone, obesity and frailty. Most of these people are put on testosterone alone without the additional benefits of weight management program.”
Villareal and colleagues conducted a secondary analysis of a randomized controlled trial enrolling 83 men aged 65 years and older with obesity and a baseline testosterone level of less than 10.4 nmol/L who exercised less than 1 hour per week and had a stable body weight and medication regimen for at least 6 months prior to baseline. All men took part in a lifestyle therapy that included a weight management program, exercise training and a balanced diet. Participants were randomly assigned to lifestyle therapy plus testosterone therapy (AndroGel 1.62%, AbbVie) or lifestyle therapy plus placebo for 6 months. In the secondary analysis, researchers assessed the change in HbA1c, body composition measures, lipid profile, inflammatory markers, other glucometabolic measures and metabolic syndrome score from baseline to 6 months.
Men receiving testosterone therapy had a similar decline in HbA1c, glucose and insulin levels as the placebo group. Both groups had similar declines in waist circumference and adipose tissue. There was no difference between the two groups for change in liver fat.
Change in total cholesterol, LDL cholesterol and triglycerides did not differ between the two groups. Men in the placebo group had a greater increase in HDL cholesterol at 6 months than those in the testosterone group (mean difference, 5.3 mg/dL; 95% CI, 1.3-9.3; P = .01). There were no differences between the two groups for change in blood pressure and metabolic syndrome score.
Both groups had a similar change in liver enzymes at 6 months. Change in leptin was also similar between the two groups. The placebo group had a greater increase in adiponectin level than the testosterone group (mean difference, 2,281 ng/mL; 95% CI, 397-4,166; P = .02). No differences in change of inflammatory markers were observed between the two groups.
“Testosterone is known to lower HDL cholesterol and adiponectin while lifestyle change with weight loss and exercise is known to increase HDL cholesterol and adiponectin,” Villareal said. “What was somewhat surprising was the effect of testosterone on HDL cholesterol, and adiponectin was strong enough to negate the effect of lifestyle change.”
Villareal said a study that includes a testosterone-only group and a placebo-only group should be conducted to assess the effects of testosterone therapy and lifestyle intervention in isolation and in combination.
For more information:
Dennis T. Villareal, MD, can be reached at dennis.villareal@va.gov.
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