Low-Dose Testosterone and Evoked Resistance Exercise after Spinal Cord Injury on Cardio-Metabolic Risk Factors: An Open-Label Randomized Clinical Trial

Locomotor training with adjuvant testosterone preserves cancellous bone and promotes muscle plasticity in male rats after severe spinal cord injury

“…Moreover, the logistics of performing 200 min/week of individualized one‐on‐one TM training for 7 continuous weeks would have made inclusion of another experimental group unfeasible in our main experiment. In this regard, it should be noted that our study design matched that of a recent clinical trial that evaluated whether TRT, when administered alone or in combination with lower‐extremity NMES resistance training, improved muscular outcomes in men with complete SCI, demonstrating our study design is relevant to the clinical literature (Gorgey et al, ; Holman & Gorgey, ). Nevertheless, future studies comparing bone and muscle adaptations to TM and TE when administered alone and in combination are necessary to determine the degree to which each individual therapy contributed to the musculoskeletal benefits of this multimodal strategy.…”

“…A small study and a separate case series also reported that TRT increased lower‐extremity lean body mass (Bauman et al, ) and muscle CSA (Moore et al, ), respectively, in men with motor‐complete SCI. However, a recent open‐label trial reported no improvements in lean mass or knee extensor CSA in men with low‐normal testosterone who received low‐dose TRT for 16 weeks after chronic motor‐complete SCI (Gorgey et al, ). Similarly, our group has not detected significant improvement in soleus mass or soleus fCSA in skeletally mature male rodents receiving TE for 21 days after SCI (Phillips et al, ).…”

“…From a pragmatic standpoint, we also did not include a stand‐alone TM group in our main study because findings from our two preliminary studies (discussed below) indicated that TM did not improve and, in some cases, worsened cancellous bone loss after severe SCI and because TM did not improve plantar flexor mass nor enhance locomotor recovery. However, it is important to note that our study design directly matched that of a recent clinical trial that evaluated whether TRT improved muscular outcomes in men with complete SCI, when administered alone or in combination with lower‐extremity NMES resistance training (Gorgey et al, ; Holman & Gorgey, ), providing rationale for our design.…”

“…Similarly, serum testosterone has been positively associated with whole thigh muscle cross‐sectional area (CSA) in persons with SCI (Abilmona, Sumrell, Gill, Adler, & Gorgey, ), and a small clinical study and case series have reported that TRT increased lower‐extremity fat‐free mass (Bauman et al, ) and knee extensor CSA (Moore et al, ), respectively, in men with motor‐complete SCI. However, a recent open‐label trial reported that low‐dose TRT did not increase fat‐free mass, lower‐extremity muscle CSA, or neuromuscular electrical stimulation (NMES)–elicited muscle contractile properties in paralyzed men with motor‐complete SCI, while these measures were improved in men undergoing lower‐extremity NMES resistance training with TRT (Gorgey et al, ; Holman & Gorgey, ). Given these findings, research is needed to determine the individual and combined effects of testosterone treatment and activity‐based physical rehabilitation on bone and muscle preservation after SCI.…”

Skeletal muscle hypertrophy and attenuation of cardio-metabolic risk factors (SHARC) using functional electrical stimulation-lower extremity cycling in persons with spinal cord injury: study protocol for a randomized clinical trial

“…Neuromuscular electrical stimulation (NMES) has been used to evoke exercise-induced resistance training (RT) using regular ankle weights in individuals with chronic SCI [20][21][22][23][24]. Several research groups demonstrated the efficacy of this approach in evoking robust muscle hypertrophy [21,24,25]. Dudley et al showed that eight weeks of twice-weekly NMES RT reverted knee extensor muscle size to 75% of original size at six weeks after SCI [21].…”