Effects of Testosterone Treatment in Older Men

“Hormone replacement has many benefits. As an orthopedic surgery specialty hormone deprivation is a concern for commonly causing a loss of bone mass and density. In women, it is established that 25% of the total bone mass is lost from menopause to age 60 years. The same occurs in men with hyperandrogenism, low testosterone; I do not have the frequency (incidence rate) nor the average amount of bone loss in men. There are many other benefits besides increased sexual function. The effects of the various methods of replacing testosterone are not addressed here. In addition to testosterone gels, there is injectable testosterone cypionate and an implantable deposit of testosterone showing promising early results. My point with this post is there are more medical reasons to consider hormone replacement in addition to changing sexual activity. A simple Internet search can lead you to the right data; especially look for statements from a specialty society such as the American Academy of Orthopaedic Surgeons.” Bill Chesnut, MD.

Effects of Testosterone Treatment in Older Men

Peter J. Snyder, M.D., Shalender Bhasin, M.D., Glenn R. Cunningham, M.D., Alvin M. Matsumoto, M.D., Alisa J. Stephens-Shields, Ph.D., Jane A. Cauley, Dr.P.H., Thomas M. Gill, M.D., Elizabeth Barrett-Connor, M.D., Ronald S. Swerdloff, M.D., Christina Wang, M.D., Kristine E. Ensrud, M.D., M.P.H., Cora E. Lewis, M.D., M.S.P.H., John T. Farrar, M.D., Ph.D., David Cella, Ph.D., Raymond C. Rosen, Ph.D., Marco Pahor, M.D., Jill P. Crandall, M.D., Mark E. Molitch, M.D., Denise Cifelli, M.S., Darlene Dougar, M.P.H., Laura Fluharty, M.P.H., Susan M. Resnick, Ph.D., Thomas W. Storer, Ph.D., Stephen Anton, Ph.D., Shehzad Basaria, M.D., Susan J. Diem, M.D., M.P.H., Xiaoling Hou, M.S., Emile R. Mohler, III, M.D., J. Kellogg Parsons, M.D., M.H.S., Nanette K. Wenger, M.D., Bret Zeldow, M.S., J. Richard Landis, Ph.D., and Susan S. Ellenberg, Ph.D. for the Testosterone Trials Investigators

N Engl J Med 2016; 374:611-624February 18, 2016DOI: 10.1056/NEJMoa1506119

BACKGROUND

Serum testosterone concentrations decrease as men age, but benefits of raising testosterone levels in older men have not been established.

METHODS

We assigned 790 men 65 years of age or older with a serum testosterone concentration of less than 275 ng per deciliter and symptoms suggesting hypoandrogenism to receive either testosterone gel or placebo gel for 1 year. Each man participated in one or more of three trials — the Sexual Function Trial, the Physical Function Trial, and the Vitality Trial. The primary outcome of each of the individual trials was also evaluated in all participants.

RESULTS

Testosterone treatment increased serum testosterone levels to the mid-normal range for men 19 to 40 years of age. The increase in testosterone levels was associated with significantly increased sexual activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased sexual desire and erectile function. The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003). Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo. The rates of adverse events were similar in the two groups.

CONCLUSIONS

In symptomatic men 65 years of age or older, raising testosterone concentrations for 1 year from moderately low to the mid-normal range for men 19 to 40 years of age had a moderate benefit with respect to sexual function and some benefit with respect to mood and depressive symptoms but no benefit with respect to vitality or walking distance. The number of participants was too few to draw conclusions about the risks of testosterone treatment. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00799617.)