Body composition changes with testosterone replacement therapy following spinal cord injury and aging: A mini review

Abstract

Context Hypogonadism is a male clinical condition in which the body does not produce enough testosterone. Testosterone plays a key role in maintaining body composition, bone mineral density, sexual function, mood, erythropoiesis, cognition and quality of life. Hypogonadism can occur due to several underlying pathologies during aging and in men with physical disabilities, such as spinal cord injury (SCI). This condition is often under diagnosed and as a result, symptoms undertreated. Methods In this mini-review, we propose that testosterone replacement therapy (TRT) may be a viable strategy to improve lean body mass (LBM) and fat mass (FM) in men with SCI. Evidence Synthesis Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled aging men, we present evidence that, relative to placebo, transdermal TRT can increase LBM and reduce FM over 3-36 months. The impact of TRT on bone mineral density and metabolism is also discussed, with particular relevance for persons with SCI. Moreover, the risks of TRT remain controversial and pertinent safety considerations related to transdermal administration are outlined. Conclusion Further research is necessary to help develop clinical guidelines for the specific dose and duration of TRT in persons with SCI. Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, which experiences an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury.

Associations of the trunk skeletal musculature and dietary intake to biomarkers of cardiometabolic health after spinal cord injury

“…Testosterone was also shown to reduce fatty acid synthesis and promote lipolysis, primarily in VAT (De Pergola, ). Testosterone replacement therapy (TRT) has been used in numerous populations to help increase LM while decreasing adipose tissue (Nightingale et al ., ). Bauman et al .…”

The Effects of Androgens on Cardiometabolic Syndrome: Current Therapeutic Concepts

“…63 Therefore, high-quality randomized controlled studies are required to investigate the efficacy and safety of TRT in this population with an increased risk of cardiometabolic diseases. 64 Long-term T therapy reduces the risk of CVD with improvement in cardiometabolic function in men with hypogonadism. 54 In addition, mortality associated with CVD was remarkably reduced in the T-group.…”

A secondary analysis of testosterone and electrically evoked resistance training versus testosterone only (TEREX-SCI) on untrained muscles after spinal cord injury: a pilot randomized clinical trial

“…Bauman et al used a dose of 5-10 mg per day in hypogonadal men SCI and showed increase in both lean mass and basal metabolic rate following 12 months [22]. Nightingale et al recommended an optimum dose of 6-8 mg per day to increase lean mass in men with SCI [21].…”

“…Persons with SCI suffer an average 43% decline in serum testosterone levels. Low serum testosterone (< 325ng/dL) has been observed in 40-60% of men with SCI [19][20][21]. Recently, strong associations were noted between serum testosterone and cardio-metabolic risk factors in persons with SCI [20].…”

“…In fact, those with low-levels of circulating testosterone have 72% greater visceral adiposity than those with normal testosterone [20]. TRT has been shown to be a safe and effective strategy in improving lean tissue mass and basal metabolic rate in men with SCI [21,22]. Therefore, the addition of low-dose TRT may maximize the effects of NMES-RT on the proximal (trunk and glutei) and distal (lower leg) untrained muscles during training of the knee extensor muscle group.…”