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Pulmonary rehabilitation: the reference therapy for undernourished patients with chronic obstructive pulmonary disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:248420. [PMID: 24701566 PMCID: PMC3950477 DOI: 10.1155/2014/248420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.
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Borst SE, Yarrow JF, Conover CF, Nseyo U, Meuleman JR, Lipinska JA, Braith RW, Beck DT, Martin JS, Morrow M, Roessner S, Beggs LA, McCoy SC, Cannady DF, Shuster JJ. Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial. Am J Physiol Endocrinol Metab 2014; 306:E433-42. [PMID: 24326421 PMCID: PMC4073894 DOI: 10.1152/ajpendo.00592.2013] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Testosterone acts directly at androgen receptors and also exerts potent actions following 5α-reduction to dihydrotestosterone (DHT). Finasteride (type II 5α-reductase inhibitor) lowers DHT and is used to treat benign prostatic hyperplasia. However, it is unknown whether elevated DHT mediates either beneficial musculoskeletal effects or prostate enlargement resulting from higher-than-replacement doses of testosterone. Our purpose was to determine whether administration of testosterone plus finasteride to older hypogonadal men could produce musculoskeletal benefits without prostate enlargement. Sixty men aged ≥60 yr with a serum testosterone concentration of ≤300 ng/dl or bioavailable testosterone ≤70 ng/dl received 52 wk of treatment with testosterone enanthate (TE; 125 mg/wk) vs. vehicle, paired with finasteride (5 mg/day) vs. placebo using a 2 × 2 factorial design. Over the course of 12 mo, TE increased upper and lower body muscle strength by 8-14% (P = 0.015 to <0.001), fat-free mass 4.04 kg (P = 0.032), lumbar spine bone mineral density (BMD) 4.19% (P < 0.001), and total hip BMD 1.96% (P = 0.024) while reducing total body fat -3.87 kg (P < 0.001) and trunk fat -1.88 kg (P = 0.0051). In the first 3 mo, testosterone increased hematocrit 4.13% (P < 0.001). Coadministration of finasteride did not alter any of these effects. Over 12 mo, testosterone also increased prostate volume 11.4 cm(3) (P = 0.0051), an effect that was completely prevented by finasteride (P = 0.0027). We conclude that a higher-than-replacement TE combined with finasteride significantly increases muscle strength and BMD and reduces body fat without causing prostate enlargement. These results demonstrate that elevated DHT mediates testosterone-induced prostate enlargement but is not required for benefits in musculoskeletal or adipose tissue.
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Affiliation(s)
- Stephen E Borst
- Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida
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Clemmons DR, Molitch M, Hoffman AR, Klibanski A, Strasburger CJ, Kleinberg DL, Ho K, Webb SM, Bronstein MD, Bouillon R, Ben-Shlomo A, Hamrahian AH, Chanson P, Barkan AL, Merriam GR, Blackman MR, Salvatori R. Growth hormone should be used only for approved indications. J Clin Endocrinol Metab 2014; 99:409-11. [PMID: 24423315 PMCID: PMC5393472 DOI: 10.1210/jc.2013-4187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- David R Clemmons
- University of North Carolina School of Medicine (D.R.C.), Chapel Hill, North Carolina 27594; Northwestern University (M.M.), Chicago, Illinois 60611; VA Palo Alto Heath Care System (A.R.H.), Palo Alto, California 94304; Massachusetts General Hospital (A.K.), Boston, Massachusetts 02114; Charite Medical Faculty Berlin (C.J.S.), Germany D-10187; New York School of Medicine (D.L.K.), New York, New York 10016; Princess Alexandra Hospital (K.H.), Brisbane, Australia 4102; Autonomous University of Barcelona (S.M.W.), Barcelona, Spain; Hospital das Clinicas (M.D.B.), Sao Paula, Brazil; Gasthuisberg Campus; Katholieke Universitat (R.B.), Leuven, Belgium; Cedars Sinai Health Center (A.B.-S.), Los Angeles, California 96048; Cleveland Clinic Foundation (A.M.H.), Cleveland, Ohio 44195; Hôpitaux Universitaires Paris-Sud (P.C.), Le Kremlin Bicêtre F-94275, France; University of Michigan Medical Center (A.L.B.), Ann Arbor, Michigan 48109; University of Washington (G.R.M.), Seattle, Washington 98195; Veterans Administration Medical Center (M.R.B.), Washington, DC 20427; and Johns Hopkins School of Medicine (R.S.), Baltimore, Maryland 21287
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Yamada M, Moriguch Y, Mitani T, Aoyama T, Arai H. Age-dependent changes in skeletal muscle mass and visceral fat area in Japanese adults from 40 to 79 years-of-age. Geriatr Gerontol Int 2014; 14 Suppl 1:8-14. [DOI: 10.1111/ggi.12209] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Minoru Yamada
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | | | - Tomoki Aoyama
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Hidenori Arai
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
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Sato K, Iemitsu M, Matsutani K, Kurihara T, Hamaoka T, Fujita S. Resistance training restores muscle sex steroid hormone steroidogenesis in older men. FASEB J 2014; 28:1891-7. [DOI: 10.1096/fj.13-245480] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Koji Sato
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Kenji Matsutani
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Toshiyuki Kurihara
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Takafumi Hamaoka
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Satoshi Fujita
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
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Yulyaningsih E, Loh K, Lin S, Lau J, Zhang L, Shi Y, Berning BA, Enriquez R, Driessler F, Macia L, Khor EC, Qi Y, Baldock P, Sainsbury A, Herzog H. Pancreatic polypeptide controls energy homeostasis via Npy6r signaling in the suprachiasmatic nucleus in mice. Cell Metab 2014; 19:58-72. [PMID: 24411939 DOI: 10.1016/j.cmet.2013.11.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 10/04/2013] [Accepted: 11/15/2013] [Indexed: 12/29/2022]
Abstract
Y-receptors control energy homeostasis, but the role of Npy6 receptors (Npy6r) is largely unknown. Young Npy6r-deficient (Npy6r(-/-)) mice have reduced body weight, lean mass, and adiposity, while older and high-fat-fed Npy6r(-/-) mice have low lean mass with increased adiposity. Npy6r(-/-) mice showed reduced hypothalamic growth hormone releasing hormone (Ghrh) expression and serum insulin-like growth factor-1 (IGF-1) levels relative to WT. This is likely due to impaired vasoactive intestinal peptide (VIP) signaling in the suprachiasmatic nucleus (SCN), where we found Npy6r coexpressed in VIP neurons. Peripheral administration of pancreatic polypeptide (PP) increased Fos expression in the SCN, increased energy expenditure, and reduced food intake in WT, but not Npy6r(-/-), mice. Moreover, intraperitoneal (i.p.) PP injection increased hypothalamic Ghrh mRNA expression and serum IGF-1 levels in WT, but not Npy6r(-/-), mice, an effect blocked by intracerebroventricular (i.c.v.) Vasoactive Intestinal Peptide (VPAC) receptors antagonism. Thus, PP-initiated signaling through Npy6r in VIP neurons regulates the growth hormone axis and body composition.
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Affiliation(s)
- Ernie Yulyaningsih
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Kim Loh
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Shu Lin
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Jackie Lau
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Lei Zhang
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Yanchuan Shi
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Britt A Berning
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Ronaldo Enriquez
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Frank Driessler
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Laurence Macia
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Ee Cheng Khor
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Yue Qi
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Paul Baldock
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Amanda Sainsbury
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia; School of Medical Sciences, Wallace Wurth Building, University of NSW, Botany Street, Sydney 2052, Australia; The Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, Sydney Medical School, The University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown NSW 2006, Australia
| | - Herbert Herzog
- Neuroscience Program, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia; UNSW Medicine, ASGM Building, University of NSW, Botany Street, Sydney 2052, Australia.
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Abdel Rahman TT, Elkholy NM, Mortagy AK. Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/aar.2014.32019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sattler F, He J, Chukwuneke J, Kim H, Stewart Y, Colletti P, Yarasheski K, Buchanan T. Testosterone Supplementation Improves Carbohydrate and Lipid Metabolism in Some Older Men with Abdominal Obesity. ACTA ACUST UNITED AC 2014; 3:1000159. [PMID: 25392748 PMCID: PMC4225803 DOI: 10.4172/2167-7182.1000159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background/Objectives The effects of testosterone supplementation on carbohydrate and lipid metabolism in obese older men are uncertain. We conducted a single-arm open-label prospective pilot study to investigate the effects of testosterone supplementation on central and peripheral insulin sensitivity in older men with upper body obesity and insulin resistance. Subjects/Methods Twenty men (62–78 years-old) with morning testosterone levels <13.9 nmol/L (400 ng/dL), waist circumference ≥ 102 cm, and HOMA-IR ≥ 4.0 or HgbA1C 5.7–6.4% applied transdermal testosterone (10 mg) daily for 20 weeks. Insulin sensitivity (Si) was determined by a 2-stage glucose clamp, liver and intramyocellular lipid by 1H-MR spectroscopy and body composition by DEXA. Results Testosterone supplementation significantly reduced total fat (−.9 ± 2.4 kg, p=0.002), trunk fat (−1.3 ± 1.4 kg, p=0.0007) and extremity fat (−0.7 ± 1.1 kg, p=0.01), and increased extremity lean tissue (+1.3 ± 1.4 kg, p=0.0006). Whole body (WB) Si improved by 21% (0.76 ± 1.57 dL/min per µU/mL, p=0.04) and insulin-stimulated glucose uptake (Rd) by 24% (0.91 ± 1.74 dL/min per µU/mL, p=0.03). Improvements in glucose kinetics were limited to men with reductions in trunk and extremity fat greater than median declines for the entire group. Reductions in intramyocellular lipid were associated with improvements in WB Si (p=0.04) and Rd (p=0.03). Change in Rd accounted for 90% of the change in WB Si. Hepatic glucose output and liver lipid/H2O were unchanged (p>0.05). Multivariable analyses revealed that reductions in extremity fat, trunk fat, and FFA levels during the clamp accounted for 45% (p=0.004), 31% (p=0.002) and 8% (p=0.04) of respective changes in Rd. Triglycerides decreased by −0.40 ± 0.67mmol/L (p=0.02), LDL-C by-0.35 ± 0.57 mmol/L (p=0.02), and HDL-C by −0.14 ± 0.19 mmol/L (p=0.004). Conclusions Testosterone supplementation that resulted in greater reductions in regional adiposity was associated with improved insulin sensitivity, lower LDL-C and fasting triglycerides, but lower HDL-C. Placebo controlled trials need to further examine the potential cardiometabolic risks/benefits of androgen supplementation for older men with low testosterone levels, central obesity, and insulin resistance.
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Affiliation(s)
- Fr Sattler
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J He
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Chukwuneke
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - H Kim
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Y Stewart
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - P Colletti
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Ke Yarasheski
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Ta Buchanan
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
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Yamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H, Aoyama T, Arai H. Prevalence of Sarcopenia in Community-Dwelling Japanese Older Adults. J Am Med Dir Assoc 2013; 14:911-5. [DOI: 10.1016/j.jamda.2013.08.015] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 12/28/2022]
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[Androgenic treatment of male hypogonadism]. Presse Med 2013; 43:196-204. [PMID: 24268959 DOI: 10.1016/j.lpm.2013.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 05/02/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of male hypogonadism should be clearly established on a clinical and biological basis before considering the initiation of a substitutive treatment with androgens. A careful evaluation of advantages, constraints and limitations of the treatment should be done previously. The potential advantages of an androgenic substitution include an improvement of the symptoms of hypogonadism and the prevention of its bone and metabolic consequences. Absolute (namely prostatic) or relative contraindications should be detected before starting any substitution. The modalities of treatment will be adapted to both the patient's age and the goals to reach. The different available formulations do not induce a similar pattern of plasma testosterone levels. Patches, gel applications and long-acting intramuscular formulations [injected every 3 months] result in stable plasma levels in the physiologic range. The main limitation to their use is linked to a financial aspect as they are not the object of any refund. A careful survey (on clinical, biological and radiological basis) should be established after starting the substitutive treatment with androgens.
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Michalakis K, Goulis DG, Vazaiou A, Mintziori G, Polymeris A, Abrahamian-Michalakis A. Obesity in the ageing man. Metabolism 2013; 62:1341-9. [PMID: 23831443 DOI: 10.1016/j.metabol.2013.05.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/15/2013] [Accepted: 05/29/2013] [Indexed: 12/20/2022]
Abstract
As the population is ageing globally, both ageing and obesity are recognized as major public health challenges. The aim of this narrative review is to present and discuss the current evidence on the changes in body composition, energy balance and endocrine environment that occur in the ageing man. Obesity in the ageing man is related to changes in both body weight and composition due to alterations in energy intake and total energy expenditure. In addition, somatopenia (decreased GH secretion), late-onset hypogonadism (LOH), changes in thyroid and adrenal function, as well as changes in appetite-related peptides (leptin, ghrelin) and, most importantly, insulin action are related to obesity, abnormal energy balance, redistribution of the adipose tissue and sarcopenia (decreased muscle mass). A better understanding of the complex relationship of ageing-related endocrine changes and obesity could lead to more effective interventions for elderly men.
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Affiliation(s)
- K Michalakis
- First Department of Internal Medicine, National and Kapodestrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
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Hayes LD, Grace FM, Sculthorpe N, Herbert P, Kilduff LP, Baker JS. Does Chronic Exercise Attenuate Age-Related Physiological Decline in Males? Res Sports Med 2013; 21:343-54. [DOI: 10.1080/15438627.2013.825799] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lawrence D. Hayes
- a Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , United Kingdom
- b School of Human Sciences, London Metropolitan University , London , United Kingdom
| | - Fergal M. Grace
- a Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , United Kingdom
| | - Nick Sculthorpe
- a Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , United Kingdom
- c Department of Sport and Exercise Sciences, University of Bedfordshire , Bedford , United Kingdom
| | - Peter Herbert
- d School of Sport, Health and Outdoor Education, Trinity Saint David, University of Wales , Carmarthen , United Kingdom
| | - Liam P. Kilduff
- e Department of Sports Sciences, Swansea University , Swansea , United Kingdom
| | - Julien S. Baker
- a Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , United Kingdom
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Abstract
Secretion of growth hormone (GH) and IGF-1 levels decline during advancing years-of-life. These changes (somatopause) are associated with loss of vitality, muscle mass, physical function, together with the occurrence of frailty, central adiposity, cardiovascular complications, and deterioration of mental function. For GH treatment to be considered for anti-aging, improved longevity, organ-specific function, or quality of life should be demonstrable. A limited number of controlled studies suggest that GH supplementation in older men increases lean mass by ∼2 kg with similar reductions in fat mass. There is little evidence that GH treatment improves muscle strength and performance (e.g. walking speed or ability to climb stairs) or quality of life. The GHRH agonist (tesamorelin) restores normal GH pulsatility and amplitude, selectively reduces visceral fat, intima media thickness and triglycerides, and improves cognitive function in older persons. This report critically reviews the potential for GH augmentation during aging with emphasis on men since women appear more resistant to treatment.
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Affiliation(s)
- Fred R Sattler
- Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, IRD Building, Room 434, Los Angeles, CA 90033, USA.
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Spitzer M, Huang G, Basaria S, Travison TG, Bhasin S. Risks and benefits of testosterone therapy in older men. Nat Rev Endocrinol 2013; 9:414-24. [PMID: 23591366 DOI: 10.1038/nrendo.2013.73] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In young men (defined as age<50 years) with classic hypogonadism caused by known diseases of the hypothalamus, pituitary or testes, testosterone replacement therapy induces a number of beneficial effects, for example, the development of secondary sex characteristics, improvement and maintenance of sexual function, and increases in skeletal muscle mass and BMD. Moreover, testosterone treatment in this patient population is associated with a low frequency of adverse events. Circulating testosterone levels decline progressively with age, starting in the second and third decade of life, owing to defects at all levels of the hypothalamic-pituitary-testicular axis. In cohort studies, testosterone levels are associated weakly but consistently with muscle mass, strength, physical function, anaemia, BMD and bone quality, visceral adiposity, and with the risk of diabetes mellitus, coronary artery disease, falls, fractures and mortality. However, the clinical benefits and long-term risks of testosterone therapy--especially prostate-related and cardiovascular-related adverse events--have not been adequately assessed in large, randomized clinical trials involving older men (defined as age>65 years) with androgen deficiency. Therefore, a general policy of testosterone replacement in all older men with age-related decline in testosterone levels is not justified.
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Affiliation(s)
- Matthew Spitzer
- The Research Program in Men's Health: Ageing and Metabolism, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
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Morley JE. Scientific overview of hormone treatment used for rejuvenation. Fertil Steril 2013; 99:1807-13. [DOI: 10.1016/j.fertnstert.2013.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 01/08/2023]
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Lin E, Bredella MA, Gerweck AV, Landa M, Schoenfeld D, Utz AL, Miller KK. Effects of growth hormone withdrawal in obese premenopausal women. Clin Endocrinol (Oxf) 2013; 78:914-9. [PMID: 23146135 PMCID: PMC3586770 DOI: 10.1111/cen.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 10/14/2012] [Accepted: 11/07/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We previously reported improved body composition and cardiovascular risk markers plus a small decrease in glucose tolerance with GH administration vs placebo for 6 months to abdominally obese premenopausal women. The objective of this study was to determine whether the effects of GH treatment on cardiovascular risk markers, body composition and glucose tolerance in obese women persist 6 months after GH withdrawal. DESIGN AND PATIENTS Fifty abdominally obese premenopausal women completed a trial of rhGH vs placebo for 6 months; thirty-nine women completed a subsequent 6-month withdrawal observation period. MEASUREMENTS IGF-I, body composition by CT, (1) H-MRS and DXA, serum cardiovascular risk markers, oral glucose tolerance test (OGTT). RESULTS IGF-I standard deviation scores (SDS) within the GH group were -1.7 ± 0.1 (pretreatment),-0.1 ± 0.3 (after 6 months of GH) and -1.7 ± 0.1 (6 months post-GH withdrawal). Six months after GH withdrawal, total abdominal and subcutaneous adipose tissue, total fat, trunk fat, trunk/extremity fat, hsCRP, apoB, LDL, and tPA were higher than at the 6-month (GH discontinuation) timepoint (P ≤ 0.05). All body composition and cardiovascular risk markers that had improved with GH returned to baseline levels by 6 months after GH discontinuation, as did fasting and 2-h OGTT glucose levels. CONCLUSION The effects of GH administration to abdominally obese premenopausal women have a short time-course. The beneficial effects on body composition and cardiovascular risk markers, and the side effect of altered glucose tolerance returned to pretreatment levels after GH withdrawal. There was no suppression of endogenous IGF-I levels, which returned to baseline after GH withdrawal.
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Affiliation(s)
- E Lin
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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68
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Yeap BB, Paul Chubb SA, Lopez D, Ho KKY, Hankey GJ, Flicker L. Associations of insulin-like growth factor-I and its binding proteins and testosterone with frailty in older men. Clin Endocrinol (Oxf) 2013; 78:752-9. [PMID: 23009592 DOI: 10.1111/cen.12052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Ageing is associated with frailty and decreased anabolic hormones, insulin-like growth factor-I (IGF-I) and testosterone. We hypothesized that components of the IGF-I system, in conjunction with testosterone, modulate frailty risk in the elderly. We examined associations between IGF-I, its binding proteins IGFBP1 and IGFBP3 and testosterone with frailty in men. DESIGN Observational study of 3 447 community-dwelling men aged 70-89 years assessed in 2001-04, with 1 654 reassessed in 2008-09. METHODS Baseline total IGF-I, IGFBP1, IGFBP3 and testosterone were assayed. Frailty was assessed using the FRAIL scale, comprising 5 domains: fatigue; difficulty climbing stairs; difficulty walking >100 m; >5 illnesses; weight loss >5%. Men with ≥ 3 domains were considered frail. RESULTS At baseline, 527 men (15·3%) were frail. Frail men had lower IGFBP3 (3 630 ng/ml vs not frail: 3 800 ng/ml, P < 0·001) and comparable IGFBP1 (23·5 vs 21·5 ng/ml, P = 0·09). In multivariate analyses, higher IGFBP1 was associated with increased prevalence of frailty (highest vs lowest quartile Q4:Q1, adjusted odds ratio [OR] = 1·39, 95% CI = 1·03-1·88). New-onset frailty arose in 260 (17·5%) of 1 484 men. Lower baseline IGF-I predicted new-onset frailty (Q1:Q4 OR = 1·48, 95% CI = 1·00-2·20) as did higher IGFBP1 (Q4:Q1 OR = 1·59, 95% CI = 1·01-2·50). Men with both IGF-I and free testosterone in Q1 had greater odds of prevalent frailty (OR = 2·13, 95% CI = 1·54-2·95). CONCLUSIONS Older men with higher IGFBP1 level, or both lower IGF-I and testosterone, are more likely to be frail, while those with lower IGF-I and higher IGFBP1 are more likely to become frail. Components of the IGF-I system may be biomarkers or independent predictors of frailty.
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Affiliation(s)
- B B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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69
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He J, Bhasin S, Binder EF, Yarasheski KE, Castaneda-Sceppa C, Schroeder ET, Roubenoff R, Chou CP, Azen SP, Sattler FR. Cardiometabolic risks during anabolic hormone supplementation in older men. Obesity (Silver Spring) 2013; 21:968-75. [PMID: 23784898 PMCID: PMC3930448 DOI: 10.1002/oby.20081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the cardiometabolic risks of testosterone and growth hormone (GH) replacement therapy to youthful levels during aging. DESIGN AND METHODS A double-masked, partially placebo controlled study in 112 men 65-90 years-old was conducted. Transdermal testosterone (5 g vs. 10 g/day) using a Leydig Cell Clamp and subcutaneous recombinant GH (rhGH) (0 vs. 3 vs. 5 μg/kg/day) were administered for 16-weeks. Measurements included testosterone and IGF-1 levels, body composition by DEXA, and cardiometabolic risk factors (upper body fat, blood pressure, insulin sensitivity, fasting triglycerides, HDL-cholesterol, and serum adiponectin) at baseline and after 16 weeks of treatment. RESULTS Some cardiometabolic factors improved (total and trunk fat, triglycerides, HDL-cholesterol) and others worsened (systolic blood pressure, insulin sensitivity index [QUICKI], adiponectin). Cardiometabolic risk composite scores (CRCSs) improved (-0.69 ± 1.55, P < 0.001). In multivariate analyses, QUICKI, triglycerides, and HDL-cholesterol contributed 33%, 16%, and 14% of the variance in CRCS, respectively. Pathway analyses indicated that changes in fat and lean mass were related to individual cardiometabolic variables and CRCS in a complex manner. Changes in BMI, reflecting composite effects of changes in fat and lean mass, were more robustly associated with cardiometabolic risks than changes in fat mass or LBM individually. CONCLUSIONS Testosterone and rhGH administration was associated with diverse changes in individual cardiometabolic risk factors, but in aggregate appeared not to worsen cardiometabolic risk in healthy older men after 4-months. The long-term effects of these and similar anabolic therapies on cardiovascular events should be investigated in populations with greater functional limitations along with important health disabilities including upper body obesity and other cardiometabolic risks.
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Affiliation(s)
- J He
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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70
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Hildreth KL, Barry DW, Moreau KL, Vande Griend J, Meacham RB, Nakamura T, Wolfe P, Kohrt WM, Ruscin JM, Kittelson J, Cress ME, Ballard R, Schwartz RS. Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels. J Clin Endocrinol Metab 2013; 98:E1891-900. [PMID: 23533227 PMCID: PMC3644594 DOI: 10.1210/jc.2013-2227] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Aging in men is associated with reduced testosterone (T) levels and physiological changes leading to frailty, but the benefits of T supplementation are inconclusive. OBJECTIVE We studied the effects of T supplementation with and without progressive resistance training (PRT) on functional performance, strength, and body composition. DESIGN, SETTING, AND PARTICIPANTS We recruited 167 generally healthy community-dwelling older men (66 ± 5 years) with low-normal baseline total T levels (200-350 ng/dL). INTERVENTION Subjects were randomized to placebo or transdermal T gel [2 doses targeting either a lower (400-550 ng/dL) or higher (600-1000 ng/dL) T range] and to either PRT or no exercise for 12 months. MAIN OUTCOME MEASURE The primary outcome was functional performance, whereas secondary outcomes were strength and body composition. RESULTS A total of 143 men completed the study. At 12 months, total T was 528 ± 287 ng/dL in subjects receiving any T and 287 ± 65 ng/dL in the placebo group. In the PRT group, function and strength were not different between T- and placebo-treated subjects, despite greater improvements in fat mass (P = .04) and fat-free mass (P = .01) with T. In the non-PRT group, T did not improve function but improved fat mass (P = .005), fat-free mass (P = .03), and upper body strength (P = .03) compared with placebo. There were fewer cardiovascular events in the T-treated groups compared with placebo. CONCLUSIONS T supplementation was well tolerated and improved body composition but had no effect on functional performance. T supplementation improved upper body strength only in nonexercisers compared with placebo.
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Affiliation(s)
- Kerry L Hildreth
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
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71
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Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels. J Clin Endocrinol Metab 2013. [PMID: 23533227 DOI: 10.1210/jc.2012-3695] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Aging in men is associated with reduced testosterone (T) levels and physiological changes leading to frailty, but the benefits of T supplementation are inconclusive. OBJECTIVE We studied the effects of T supplementation with and without progressive resistance training (PRT) on functional performance, strength, and body composition. DESIGN, SETTING, AND PARTICIPANTS We recruited 167 generally healthy community-dwelling older men (66 ± 5 years) with low-normal baseline total T levels (200-350 ng/dL). INTERVENTION Subjects were randomized to placebo or transdermal T gel [2 doses targeting either a lower (400-550 ng/dL) or higher (600-1000 ng/dL) T range] and to either PRT or no exercise for 12 months. MAIN OUTCOME MEASURE The primary outcome was functional performance, whereas secondary outcomes were strength and body composition. RESULTS A total of 143 men completed the study. At 12 months, total T was 528 ± 287 ng/dL in subjects receiving any T and 287 ± 65 ng/dL in the placebo group. In the PRT group, function and strength were not different between T- and placebo-treated subjects, despite greater improvements in fat mass (P = .04) and fat-free mass (P = .01) with T. In the non-PRT group, T did not improve function but improved fat mass (P = .005), fat-free mass (P = .03), and upper body strength (P = .03) compared with placebo. There were fewer cardiovascular events in the T-treated groups compared with placebo. CONCLUSIONS T supplementation was well tolerated and improved body composition but had no effect on functional performance. T supplementation improved upper body strength only in nonexercisers compared with placebo.
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72
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Chiu CS, Peekhaus N, Weber H, Adamski S, Murray EM, Zhang HZ, Zhao JZ, Ernst R, Lineberger J, Huang L, Hampton R, Arnold BA, Vitelli S, Hamuro L, Wang WR, Wei N, Dillon GM, Miao J, Alves SE, Glantschnig H, Wang F, Wilkinson HA. Increased Muscle Force Production and Bone Mineral Density in ActRIIB-Fc-Treated Mature Rodents. J Gerontol A Biol Sci Med Sci 2013; 68:1181-92. [DOI: 10.1093/gerona/glt030] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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73
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Samaras N, Samaras D, Lang PO, Forster A, Pichard C, Frangos E, Meyer P. A view of geriatrics through hormones. What is the relation between andropause and well-known geriatric syndromes? Maturitas 2013; 74:213-9. [DOI: 10.1016/j.maturitas.2012.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/24/2012] [Accepted: 11/21/2012] [Indexed: 11/29/2022]
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Ragnarsson O, Burt MG, Ho KKY, Johannsson G. Effect of short-term GH and testosterone administration on body composition and glucose homoeostasis in men receiving chronic glucocorticoid therapy. Eur J Endocrinol 2013; 168:243-51. [PMID: 23169695 DOI: 10.1530/eje-12-0873] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Long-term pharmacological glucocorticoid (GC) therapy leads to skeletal muscle atrophy and weakness. The objective of this study was to investigate whether short-term treatment with GH and testosterone (T) can increase lean mass without major impairment of glucose homoeostasis in patients on GC therapy. DESIGN, MATERIALS AND METHODS This was a prospective, open-label, randomised, crossover study. Twelve men (age 74±6 years) on chronic GC treatment participated. The effects of 2 weeks' treatment with GH, testosterone and the combination of both on lean body mass (LBM), appendicular skeletal muscle mass (ASMM), extracellular water (ECW), body cell mass (BCM) and plasma glucose concentrations were investigated. RESULTS LBM increased significantly after GH (Δ1.7±1.4 kg; P=0.007) and GH+testosterone (Δ2.4±1.1 kg; P=0.003), but not testosterone alone. ASMM increased after all three treatment periods; by 1.0±0.8 kg after GH (P=0.005), 1.7±0.4 kg after GH+testosterone (P=0.002) and 0.8±1.0 kg after testosterone (P=0.018). The increase in ASMM was larger with combined treatment than either GH or testosterone alone (P<0.05). ECW increased significantly after GH+testosterone by 1.5±2.6 l (P=0.038) but not after GH or testosterone alone. BCM increased slightly after single and combined treatments, but the changes were not significant. Fasting glucose increased significantly after GH (Δ0.4±0.4 mmol/l, P=0.006) while both fasting (Δ0.2±0.3 mmol/l, P=0.045) and post glucose-load (Δ1.8±2.3 mmol/l, P=0.023) plasma glucose concentrations increased after GH+testosterone. CONCLUSIONS GH and testosterone induce favourable and additive body compositional changes in men on chronic, low-dose GC treatment. In the doses used, combination therapy increases fasting and postprandial glucose concentration.
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Affiliation(s)
- Oskar Ragnarsson
- Department of Endocrinology, Sahlgrenska University Hospital and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Göteborg, Sweden.
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75
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Hayes LD, Grace FM, Sculthorpe N, Herbert P, Ratcliffe JW, Kilduff LP, Baker JS. The effects of a formal exercise training programme on salivary hormone concentrations and body composition in previously sedentary aging men. SPRINGERPLUS 2013; 2:18. [PMID: 23396630 PMCID: PMC3566381 DOI: 10.1186/2193-1801-2-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/14/2013] [Indexed: 12/02/2022]
Abstract
Alteration in body composition, physical function, and substrate metabolism occur with advancing age. These changes may be attenuated by exercise. This study examined whether twenty eight, previously sedentary males (62.5 ± 5.3 years of age; body mass of 89.7 ± 16.4 kg) adhering to the ACSM minimum guidelines for aerobic exercise for six weeks would improve exercise capabilities, body composition and salivary hormone profiles. After six weeks of adhering to the guidelines, salivary testosterone and vo2max (absolute and relative) increased (p < 0.05), whilst body fat percentage and body mass decreased (p < 0.05). Peak power output, fat free mass and cortisol values were not significantly different. Interestingly, salivary testosterone correlated inversely with body fat percentage (R2 = .285, p = 0.011). These results suggest that despite previous inactivity, older males can achieve improvements in cardiorespiratory fitness, body composition and anabolism by adhering to simple lifestyle changes.
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Affiliation(s)
- Lawrence D Hayes
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Scotland ; School of Human Sciences, London Metropolitan University, 166-220 Holloway Road, London, N7 8DB UK
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76
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Dillon EL. Nutritionally essential amino acids and metabolic signaling in aging. Amino Acids 2012; 45:431-41. [PMID: 23239011 DOI: 10.1007/s00726-012-1438-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 11/28/2012] [Indexed: 02/07/2023]
Abstract
Aging is associated with a gradual decline in skeletal muscle mass and strength leading to increased risk for functional impairments. Although basal rates of protein synthesis and degradation are largely unaffected with age, the sensitivity of older muscle cells to the anabolic actions of essential amino acids appears to decline. The major pathway through which essential amino acids induce anabolic responses involves the mammalian target of rapamycin (mTOR) Complex 1, a signaling pathway that is especially sensitive to regulation by the branched chain amino acid leucine. Recent evidence suggests that muscle of older individuals require increasing concentrations of leucine to maintain robust anabolic responses through the mTOR pathway. While the exact mechanisms for the age-related alterations in nutritional signaling through the mTOR pathway remain elusive, there is increasing evidence that decreased sensitivity to insulin action, reductions in endothelial function, and increased oxidative stress may be underlying factors in this decrease in anabolic sensitivity. Ensuring adequate nutrition, including sources of high quality protein, and promoting regular physical activity will remain among the frontline defenses against the onset of sarcopenia in older individuals.
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Affiliation(s)
- E Lichar Dillon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
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77
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Yeap BB, Araujo AB, Wittert GA. Do low testosterone levels contribute to ill-health during male ageing? Crit Rev Clin Lab Sci 2012; 49:168-82. [PMID: 23094995 DOI: 10.3109/10408363.2012.725461] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Testosterone regulates male sexual development and body composition. In adult men, testosterone levels exhibit a gradual decline with increasing age. Whether it is age per se or health and behaviour related factors that are responsible for this decline, and the implications thereof for subsequent health remain controversial. Observational studies report associations of lower testosterone levels with poorer health outcomes in ageing men, including frailty, reduced sexual activity, insulin resistance and cardiovascular events and mortality. However, outcome data from randomised clinical trials of testosterone are limited, and are lacking for major endpoints such as cardiovascular events. The risks and benefits of testosterone intervention in older men require further clarification. This article will review the role of testosterone in men, discuss epidemiological and interventional data illuminating its potential role to preserve health during male ageing, consider the limitations of the evidence base and implications for clinical practice, and explore future directions for research in this topical area.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
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78
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Carrero JJ, Stenvinkel P. The vulnerable man: impact of testosterone deficiency on the uraemic phenotype. Nephrol Dial Transplant 2012; 27:4030-41. [PMID: 22962412 DOI: 10.1093/ndt/gfs383] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Testosterone deficiency or hypogonadism is a common finding in men undergoing dialysis, to a great extent a consequence of the failing kidney per se. Testosterone restoration in hypogonadism is common practice among endocrinologists. However, there is currently little awareness of this condition among both uremic patients and nephrologists, and in many cases, testosterone deficiency remains unscreened and untreated. This review article summarizes our current understanding of the role of testosterone deficiency at the crossroad of cardiometabolic complications of patients with chronic kidney disease. Pathways discussed include, among others, the plausible role of testosterone deficiency in the development of anaemia and ESA hyporesponsiveness, muscle catabolism, endothelial dysfunction, cognitive dysfunction, decreased libido, cardiovascular disease and mortality. As there are limited sources to guide decision-making, we also review existing testosterone replacement therapy studies in the context of CKD as well as considerations for side and adverse effects. This review makes a case for consideration of screening and better management of hypogonadism in men undergoing dialysis.
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Abstract
INTRODUCTION The Framingham risk score predicts a patient's 10-year risk of developing cardiovascular disease. Many risk factors included in its calculation influence or are influenced by circulating testosterone. To investigate the possible association between testosterone and cardiovascular risk, as defined by the Framingham score, a Veterans Affairs (VA) database was analyzed. METHODS A retrospective chart review was performed. Inclusion criteria were male sex and age ≥ 20 years. Exclusion criteria included pre-existing cardiovascular disease, stroke, and diabetes. Data were collected on veterans who had total plasma testosterone checked in the year 2008. RESULTS The study included 1,479 patients (mean age 61 years). Framingham score was negatively associated with both total testosterone (p < 0.0001) and free testosterone (p = 0.0003). There was a positive association between total testosterone and high-density lipoprotein and negative associations between total testosterone and body mass index (BMI), total cholesterol, triglycerides, and blood pressure medication use. Free testosterone was positively associated with total cholesterol, low-density lipoprotein, and current smoking status and negatively associated with age, BMI, and blood pressure medication use. The BMI was not associated with Framingham score. CONCLUSIONS Lower plasma testosterone may suggest the presence of cardiovascular risk factors and potentially increased risk for heart disease.
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Affiliation(s)
- Brandon Chock
- Veterans Affairs Northern California Health Care System (VANCHCS), Martinez, CA, USA.
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80
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Gielen E, Verschueren S, O'Neill TW, Pye SR, O'Connell MDL, Lee DM, Ravindrarajah R, Claessens F, Laurent M, Milisen K, Tournoy J, Dejaeger M, Wu FC, Vanderschueren D, Boonen S. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int 2012; 91:161-77. [PMID: 22797855 DOI: 10.1007/s00223-012-9622-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/27/2012] [Indexed: 12/19/2022]
Abstract
A progressive decline in physiologic reserves inevitably occurs with ageing. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, frail elderly experience an excess vulnerability to stressors and are at high risk for functional deficits and comorbid disorders, possibly leading to institutionalization, hospitalization and death. The phenotype of frailty is referred to as the frailty syndrome and is widely recognized in geriatric medical practice. Although frailty affects both musculoskeletal and nonmusculoskeletal systems, sarcopenia, which is defined as age-related loss of muscle mass and strength, constitutes one of the main determinants of fracture risk in older age and one of the main components of the clinical frailty syndrome. As a result, operational definitions of frailty and therapeutic strategies in older patients tend to focus on the consequences of sarcopenia.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, KU Leuven, Leuven, Belgium
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81
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Yarrow JF, McCoy SC, Borst SE. Intracrine and myotrophic roles of 5α-reductase and androgens: a review. Med Sci Sports Exerc 2012; 44:818-26. [PMID: 21988936 DOI: 10.1249/mss.0b013e31823bfcbf] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Historically, the circulation was thought to be the primary source of androgens influencing skeletal muscle. However, a growing body of research indicates that skeletal muscle expresses several androgen-synthesizing enzymes, including 5α-reductase. The intramuscular expression of these enzymes suggests that skeletal muscle is capable of synthesizing bioactive androgens, which could induce myotrophic effects via intracrine action. PURPOSE The aim of this brief review is to discuss recent research related to the intracrine and myotrophic roles of androgens, with particular focus on 5α-reductase as a myotrophic mediator. METHODS Included in the review are 17 reviews and 58 original studies that were identified by a systematic review from MEDLINE and deemed particularly relevant to our purpose. Results are summarized to provide an overview of 5α-reductase as a mediator of the myotrophic effects of androgens. In particular, discussions are included regarding androgen biosynthesis and androgen signaling within skeletal muscle, the effects of exercise on intramuscular androgen biosynthesis, and clinical applications of androgens and of a new class of myotrophic agonists termed selective androgen receptor modulator. RESULTS The ability of several peripheral tissues to synthesize bioactive androgens is well documented in the literature. Herein, we summarize newer studies that demonstrate that 1) skeletal muscle has the capability to synthesize both testosterone and dihydrotestosterone from dehydroepiandrosterone, which is present in abundance within the circulation, and 2) that exercise increases the expression of certain androgen-biosynthesizing enzymes within muscle. CONCLUSIONS Intramuscularly synthesized androgens have the potential to influence skeletal muscle via intracrine action; however, their exact role in skeletal muscle development and maintenance requires further elucidation.
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Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P. Hormone replacement therapy and physical function in healthy older men. Time to talk hormones? Endocr Rev 2012; 33:314-77. [PMID: 22433122 PMCID: PMC5393154 DOI: 10.1210/er.2012-1002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Improving physical function and mobility in a continuously expanding elderly population emerges as a high priority of medicine today. Muscle mass, strength/power, and maximal exercise capacity are major determinants of physical function, and all decline with aging. This contributes to the incidence of frailty and disability observed in older men. Furthermore, it facilitates the accumulation of body fat and development of insulin resistance. Muscle adaptation to exercise is strongly influenced by anabolic endocrine hormones and local load-sensitive autocrine/paracrine growth factors. GH, IGF-I, and testosterone (T) are directly involved in muscle adaptation to exercise because they promote muscle protein synthesis, whereas T and locally expressed IGF-I have been reported to activate muscle stem cells. Although exercise programs improve physical function, in the long-term most older men fail to comply. The GH/IGF-I axis and T levels decline markedly with aging, whereas accumulating evidence supports their indispensable role in maintaining physical function integrity. Several studies have reported that the administration of T improves lean body mass and maximal voluntary strength in healthy older men. On the other hand, most studies have shown that administration of GH alone failed to improve muscle strength despite amelioration of the detrimental somatic changes of aging. Both GH and T are anabolic agents that promote muscle protein synthesis and hypertrophy but work through separate mechanisms, and the combined administration of GH and T, albeit in only a few studies, has resulted in greater efficacy than either hormone alone. Although it is clear that this combined approach is effective, this review concludes that further studies are needed to assess the long-term efficacy and safety of combined hormone replacement therapy in older men before the medical rationale of prescribing hormone replacement therapy for combating the sarcopenia of aging can be established.
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Affiliation(s)
| | - Finbarr C. Martin
- Guy's and St. Thomas' National Health Service Foundation Trust (F.C.M.), and Institute of Gerontology (F.C.M.), King's College, London WC2R 2LS, United Kingdom
| | | | - A. Margot Umpleby
- Department of Human Metabolism, Diabetes, and Metabolic Medicine (A.M.U.), Postgraduate Medical School, University of Surrey, Guildford GU2 7WG, United Kingdom
| | - Peter Sonksen
- St. Thomas' Hospital and King's College (P.S.), London SE1 7EW, United Kingdom; and Southampton University (P.S.), SO17 1BJ, Southampton, United Kingdom
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Maggi M, Buvat J, Corona G, Guay A, Torres LO. Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA). J Sex Med 2012; 10:661-77. [PMID: 22524444 DOI: 10.1111/j.1743-6109.2012.02735.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Besides hypogonadism, other endocrine disorders have been associated with male sexual dysfunction (MSD). AIM To review the role of the pituitary hormone prolactin (PRL), growth hormone (GH), thyroid hormones, and adrenal androgens in MSD. METHODS A systematic search of published evidence was performed using Medline (1969 to September 2011). Oxford Centre for Evidence-Based Medicine-Levels of Evidence (March 2009) was applied when possible. MAIN OUTCOME MEASURES The most important evidence regarding the role played by PRL, GH, thyroid, and adrenal hormone was reviewed and discussed. RESULTS Only severe hyperprolactinemia (>35 ng/mL or 735 mU/L), often related to a pituitary tumor, has a negative impact on sexual function, impairing sexual desire, testosterone production, and, through the latter, erectile function due to a dual effect: mass effect and PRL-induced suppression on gonadotropin secretion. The latter is PRL-level dependent. Emerging evidence indicates that hyperthyroidism is associated with an increased risk of premature ejaculation and might also be associated with erectile dysfunction (ED), whereas hypothyroidism mainly affects sexual desire and impairs the ejaculatory reflex. However, the real incidence of thyroid dysfunction in subjects with sexual problems needs to be evaluated. Prevalence of ED and decreased libido increase in acromegalic patients; however, it is still a matter of debate whether GH excess (acromegaly) may create effects due to a direct overproduction of GH/insulin-like growth factor 1 or because of the pituitary mass effects on gonadotropic cells, resulting in hypogonadism. Finally, although dehydroepiandrosterone (DHEA) and its sulfate have been implicated in a broad range of biological derangements, controlled trials have shown that DHEA administration is not useful for improving male sexual function. CONCLUSIONS While the association between hyperprolactinemia and hypoactive sexual desire is well defined, more studies are needed to completely understand the role of other hormones in regulating male sexual functioning.
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Affiliation(s)
- Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
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Braga M, Bhasin S, Jasuja R, Pervin S, Singh R. Testosterone inhibits transforming growth factor-β signaling during myogenic differentiation and proliferation of mouse satellite cells: potential role of follistatin in mediating testosterone action. Mol Cell Endocrinol 2012; 350:39-52. [PMID: 22138414 PMCID: PMC3264813 DOI: 10.1016/j.mce.2011.11.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 01/07/2023]
Abstract
Testosterone (T) administration is associated with increased satellite cell number and skeletal muscle hypertrophy, although there is considerable heterogeneity in the response of different skeletal muscle groups to T in vivo. We investigated the effects of T on the growth and differentiation of satellite cells isolated from levator ani (LA) and gastrocnemius (gastroc) muscles. T up regulated follistatin (Fst) expression, but down regulated the mRNA and protein expression of a number of genes in the transforming growth factor-beta (TGF-β)-signaling pathway. Inhibition of Fst expression by small interfering RNA (siRNA) inhibited myogenic differentiation and blocked the pro-myogenic effects of T. Treatment of satellite cells with T or Fst up regulated the expression of Pax7 and PCNA, and increased their proliferation. T and Fst blocked TGF-β induced inhibition of growth and myogenic differentiation and down regulated TGF-β-dependent transcriptome in both LA and gastroc cells. We conclude that T stimulation of satellite cell proliferation and myogenic differentiation are associated with up regulation of Fst and inhibition of TGF-β-signaling.
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Affiliation(s)
- Melissa Braga
- Division of Endocrinology and Metabolism, Charles Drew University of Medicine and Science, Los Angeles, California 90059
| | - Shalender Bhasin
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Ravi Jasuja
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Shehla Pervin
- Division of Endocrinology and Metabolism, Charles Drew University of Medicine and Science, Los Angeles, California 90059
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Rajan Singh
- Division of Endocrinology and Metabolism, Charles Drew University of Medicine and Science, Los Angeles, California 90059
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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85
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Di Sante S, Conners WP, Morgentaler A. Influence of Baseline Serum Testosterone on Changes in Body Composition in Response to Testosterone Therapy. J Sex Med 2012; 9:585-93. [DOI: 10.1111/j.1743-6109.2011.02557.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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86
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Abstract
Background Established risk factors for prostate cancer have not translated to effective prevention or adjuvant care strategies. Several epidemiologic studies suggest greater body adiposity may be a modifiable risk factor for high-grade (Gleason 7, Gleason 8-10) prostate cancer and prostate cancer mortality. However, BMI only approximates body adiposity, and may be confounded by centralized fat deposition or lean body mass in older men. Our objective was to use bioelectric impedance analysis (BIA) to measure body composition and determine the association between prostate cancer and total body fat mass (FM) fat-free mass (FFM), and percent body fat (%BF), and which body composition measure mediated the association between BMI or waist circumference (WC) with prostate cancer. Methods The study used a multi-centered recruitment protocol targeting men scheduled for prostate biopsy. Men without prostate cancer at biopsy served as controls (n = 1057). Prostate cancer cases were classified as having Gleason 6 (n = 402), Gleason 7 (n = 272), or Gleason 8-10 (n = 135) cancer. BIA and body size measures were ascertained by trained staff prior to diagnosis, and clinical and comorbidity status were determined by chart review. Analyses utilized multivariable linear and logistic regression. Results Body size and composition measures were not significantly associated with low-grade (Gleason 6) prostate cancer. In contrast, BMI, WC, FM, and FFM were associated with an increased risk of Gleason 7 and Gleason 8-10 prostate cancer. Furthermore, BMI and WC were no longer associated with Gleason 8-10 (ORBMI = 1.039 (1.000, 1.081), ORWC = 1.016 (0.999, 1.033), continuous scales) with control for total body FFM (ORBMI = 0.998 (0.946, 1.052), ORWC = 0.995 (0.974, 1.017)). Furthermore, increasing FFM remained significantly associated with Gleason 7 (ORFFM = 1.030 (1.008, 1.052)) and Gleason 8-10 (ORFFM = 1.044 (1.014, 1.074)) after controlling for FM. Conclusions Our results suggest that associations between BMI and WC with high-grade prostate cancer are mediated through the measurement of total body FFM. It is unlikely that FFM causes prostate cancer, but instead provides a marker of testosterone or IGF1 activities involved with retaining lean mass as men age.
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87
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Sakuma K, Yamaguchi A. Sarcopenia and age-related endocrine function. Int J Endocrinol 2012; 2012:127362. [PMID: 22690213 PMCID: PMC3368374 DOI: 10.1155/2012/127362] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/22/2012] [Indexed: 02/06/2023] Open
Abstract
Sarcopenia, the age-related loss of skeletal muscle, is characterized by a deterioration of muscle quantity and quality leading to a gradual slowing of movement, a decline in strength and power, and an increased risk of fall-related injuries. Since sarcopenia is largely attributed to various molecular mediators affecting fiber size, mitochondrial homeostasis, and apoptosis, numerous targets exist for drug discovery. In this paper, we summarize the current understanding of the endocrine contribution to sarcopenia and provide an update on hormonal intervention to try to improve endocrine defects. Myostatin inhibition seems to be the most interesting strategy for attenuating sarcopenia other than resistance training with amino acid supplementation. Testosterone supplementation in large amounts and at low frequency improves muscle defects with aging but has several side effects. Although IGF-I is a potent regulator of muscle mass, its therapeutic use has not had a positive effect probably due to local IGF-I resistance. Treatment with ghrelin may ameliorate the muscle atrophy elicited by age-dependent decreases in growth hormone. Ghrelin is an interesting candidate because it is orally active, avoiding the need for injections. A more comprehensive knowledge of vitamin-D-related mechanisms is needed to utilize this nutrient to prevent sarcopenia.
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Affiliation(s)
- Kunihiro Sakuma
- Research Center for Physical Fitness, Sports and Health, Toyohashi University of Technology, 1-1 Hibarigaoka, Tenpaku-cho, Toyohashi 441-8580, Japan
- *Kunihiro Sakuma:
| | - Akihiko Yamaguchi
- School of Dentistry, Health Sciences University of Hokkaido, Kanazawa, Ishikari-Tobetsu, Hokkaido 061-0293, Japan
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88
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Carson III CC, Rosano G. Exogenous Testosterone, Cardiovascular Events, and Cardiovascular Risk Factors in Elderly Men: A Review of Trial Data. J Sex Med 2012; 9:54-67. [DOI: 10.1111/j.1743-6109.2011.02337.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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89
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LeBlanc ES, Wang PY, Lee CG, Barrett-Connor E, Cauley JA, Hoffman AR, Laughlin GA, Marshall LM, Orwoll ES. Higher testosterone levels are associated with less loss of lean body mass in older men. J Clin Endocrinol Metab 2011; 96:3855-63. [PMID: 21976718 PMCID: PMC3232620 DOI: 10.1210/jc.2011-0312] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Little information exists about longitudinal changes in body composition and physical function in relation to sex hormone levels in older men. OBJECTIVE The aim of the study was to determine associations of testosterone, estradiol, and SHBG with changes in body composition and physical function. DESIGN AND SETTING We conducted a prospective cohort study within the Osteoporotic Fractures in Men (MrOS) study at six U.S. clinical centers. PARTICIPANTS A total of 5994 ambulatory men aged 65 yr or older enrolled in the MrOS. We examined 1183 men with complete measures of sex steroid hormones, body composition, and some measure of physical function. INTERVENTION There were no interventions. MAIN OUTCOME MEASURE(S) Sex steroids were measured by mass spectrometry in serum collected at baseline. Measurements of body composition using dual-energy x-ray absorptiometry and physical performance (grip strength, leg power, timed chair stands, narrow walk, and 6-m walk) were performed at baseline and repeated 4.5 yr later. RESULTS Overall, men lost 1.3 kg (±4.4 sd) weight between study visits. Lean mass, especially appendicular, declined less at higher baseline testosterone levels (P < 0.05). These associations were most evident in the 40% of men who lost more than 2.0 kg during follow-up. In weight losers, higher testosterone was associated with less decline in timed chair stands. Estradiol was not related to body composition or physical function changes. Higher SHBG was associated with less loss of appendicular lean mass and grip strength. CONCLUSIONS Higher endogenous testosterone is associated with reduced loss of lean mass and lower extremity function in older men losing weight. Endogenous testosterone may contribute to healthy aging.
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Affiliation(s)
- Erin S LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
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90
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Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol 2011; 165:675-85. [PMID: 21753068 PMCID: PMC3188848 DOI: 10.1530/eje-11-0221] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are attained. DESIGN Literature data on testosterone replacement. RESULTS Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3-6 weeks with a maximum after 18-30 weeks. Effects on erythropoiesis are evident at 3 months, peaking at 9-12 months. Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase should be related to aging rather than therapy. Effects on lipids appear after 4 weeks, maximal after 6-12 months. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3-12 months. Changes in fat mass, lean body mass, and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but can marginally continue over years. Effects on inflammation occur within 3-12 weeks. Effects on bone are detectable already after 6 months while continuing at least for 3 years. CONCLUSION The time-course of the spectrum of effects of testosterone shows considerable variation, probably related to pharmacodynamics of the testosterone preparation. Genomic and non-genomic effects, androgen receptor polymorphism and intracellular steroid metabolism further contribute to such diversity.
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Affiliation(s)
- Farid Saad
- Scientific Affairs Men's Healthcare, BU General Medicine/Men's Healthcare, Bayer Pharma AG, D-13342 Berlin, Germany.
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91
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Nguyen CT, Aaronson A, Morrissey RP, Agarwal M, Willix RD, Schwarz ER. Myths and truths of growth hormone and testosterone therapy in heart failure. Expert Rev Cardiovasc Ther 2011; 9:711-20. [PMID: 21714602 DOI: 10.1586/erc.11.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Heart failure is a chronic clinical syndrome with very poor prognosis. Despite being on optimal medical therapy, many patients still experience debilitating symptoms and poor quality of life. In recent years, there has been a great interest in anabolic hormone replacement therapy - namely, growth hormone and testosterone - as an adjunctive therapy in patients with advanced heart failure. It has been observed that low levels of growth hormone and testosterone have been associated with increased mortality and morbidity in patients with heart failure. Animal studies and clinical trials have shown promising clinical improvement with hormonal supplementation. Growth hormone has been shown to increase ventricular wall mass, decrease wall stress, increase cardiac contractility, and reduce peripheral vascular resistance, all of which might help to enhance cardiac function, resulting in improvement in clinical symptoms. Likewise, testosterone has been shown to improve hemodynamic parameters via reduction in peripheral vascular resistance and increased coronary blood flow through vasodilation, thereby improving functional and symptomatic status. To date, growth hormone and testosterone therapy have shown some positive benefits, albeit with some concerns over adverse effects. However, large randomized controlled trials are still needed to assess the long-term safety and efficacy.
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Affiliation(s)
- Cam T Nguyen
- Advanced Heart Failure and Heart Transplantation, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 6215, Los Angeles, CA 90048, USA
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92
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Sheppard RL, Spangenburg EE, Chin ER, Roth SM. Androgen receptor polyglutamine repeat length affects receptor activity and C2C12 cell development. Physiol Genomics 2011; 43:1135-43. [PMID: 21828246 DOI: 10.1152/physiolgenomics.00049.2011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Testosterone (T) has an anabolic effect on skeletal muscle and is believed to exert its local effects via the androgen receptor (AR). The AR harbors a polymorphic stretch of glutamine repeats demonstrated to inversely affect receptor transcriptional activity in prostate and kidney cells. The effects of AR glutamine repeat length on skeletal muscle are unknown. In this study we examined the effect of AR CAG repeat length on AR function in C2C12 cells. AR expression vectors harboring 14, 24, and 33 CAG repeats were used to assess AR transcriptional activity. C2C12 cell proliferation, differentiation, gene expression, myotube formation, and myonuclear fusion index were assessed. Transcriptional activity increased with increasing repeat length and in response to testosterone (AR14 = 3.91 ± 0.26, AR24 = 25.21 ± 1.72, AR33 = 36.08 ± 3.22 relative light units; P < 0.001). Ligand activation was increased for AR33 (2.10 ± 0.04) compared with AR14 (1.54 ± 0.09) and AR24 (1.57 ± 0.05, P < 0.001). AR mRNA expression was elevated in each stably transfected line. AR33 cell proliferation (20,512.3 ± 1,024.0) was decreased vs. AR14 (27,604.17 ± 1,425.3; P < 0.001) after 72 h. Decreased CK activity in AR14 cells (54.9 ± 2.9 units/μg protein) in comparison to AR33 (70.8 ± 8.1) (P < 0.05) was noted. The myonuclear fusion index was lower for AR14 (15.21 ± 3.24%) and AR33 (9.97 ± 3.14%) in comparison to WT (35.07 ± 5.60%, P < 0.001). AR14 and AR33 cells also displayed atypical myotube morphology. RT-PCR revealed genotype differences in myostatin and myogenin expression. We conclude that AR polyglutamine repeat length is directly associated with transcriptional activity and alters the growth and development of C2C12 cells. This polymorphism may contribute to the heritability of muscle mass in humans.
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Affiliation(s)
- Ryan L Sheppard
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, Maryland 20742, USA
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93
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Abstract
The use of growth hormone (GH) as a performance enhancing substance was first promoted in lay publications, long before scientists fully acknowledged its benefits. It is thought athletes currently use GH to enhance their athletic performance and to accelerate the healing of sporting injuries. Over recent years, a number of high profile athletes have admitted to using GH. To date, there is only limited and weak evidence for its beneficial effects on performance. Nevertheless the “hype” around its effectiveness and the lack of a foolproof detection methodology that will detect its abuse longer than 24 hours after the last injection has encouraged its widespread use. This article reviews the current evidence of the ergogenic effects of GH along with the risks associated with its use. The review also examines methodologies, both currently available and in development for detecting its abuse.
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Affiliation(s)
- Ioulietta Erotokritou-Mulligan
- Developmental Origins of Health and Disease Division, University of Southampton School of Medicine, The Institute of Developmental Science, Southampton General Hospital, Southampton, UK
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94
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Leung DG, Germain-Lee EL, Denger BE, Wagner KR. Report on the Second Endocrine Aspects Of Duchenne Muscular Dystrophy Conference December 1-2, 2010, Baltimore, Maryland, USA. Neuromuscul Disord 2011; 21:594-601. [PMID: 21763136 DOI: 10.1016/j.nmd.2011.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/07/2011] [Accepted: 04/15/2011] [Indexed: 11/28/2022]
Affiliation(s)
- D G Leung
- Center for Genetic Muscle Disorders, The Kennedy Krieger Institute, USA
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95
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Ginzburg E, Klimas N, Parvus C, Life J, Willix R, Barber MJ, Lin A, Comite F. Long-term Safety of Testosterone and Growth Hormone Supplementation: A Retrospective Study of Metabolic, Cardiovascular, and Oncologic Outcomes. J Clin Med Res 2011; 2:159-66. [PMID: 21629532 PMCID: PMC3104655 DOI: 10.4021/jocmr428w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2010] [Indexed: 11/15/2022] Open
Abstract
Background Clinical research into the effects of hormonal supplementation has tended to focus on beneficial changes in anthropometric measures. There are fewer data on long-term safety with extended hormonal supplementation. Methods As part of a retrospective database survey, clinical outcomes were tabulated among patients who received at least 1 year of testosterone and/or growth hormone (GH) supplementation. In patients who were treated for at least 2 years, changes in markers of glucose and lipid metabolism were analyzed with and without concomitant use of oral hypoglycemics and statins. Results In 263 patients (mean age 56) treated for at least 2 years, the only statistically significant effect on markers of glucose metabolism was an increase in glycated hemoglobin (still within normal limits) in patients receiving GH alone or in combination with testosterone but without oral hypoglycemics; with or without hypoglycemics, insulin levels showed no significant change. The only significant effects on markers of lipid metabolism were decreases in total cholesterol and low-density lipoprotein (LDL) in patients receiving combined testosterone and GH without statins. Decreases in LDL were significant in both the statin and non-statin groups; decreases in triglycerides were significant only in the statin group. In 531 patients treated for at least 1 year (mean age 54), the overall incidence of adverse clinical outcomes (prostate disease, diabetes, cardiovascular disease, cancer) was 1.3%. Conclusions In this retrospective survey, extended testosterone and/or GH supplementation did not adversely affect metabolic markers or clinical outcomes. Keywords Safety; Testosterone; Growth hormone; Supplementation
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Affiliation(s)
- Enrique Ginzburg
- University of Miami Miller School of Medicine, Miami, Florida, USA
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96
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Value of measuring muscle performance to assess changes in lean mass with testosterone and growth hormone supplementation. Eur J Appl Physiol 2011; 112:1123-31. [PMID: 21748366 DOI: 10.1007/s00421-011-2077-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 07/05/2011] [Indexed: 10/18/2022]
Abstract
We hypothesized that treatment with testosterone (T) and recombinant human growth hormone (rhGH) would increase lean mass (LM) and muscle strength proportionally and an in a linear manner over 16 weeks. This was a multicenter, randomized, controlled, double-masked investigation of T and rhGH supplementation in older (71 ± 4 years) community-dwelling men. Participants received transdermal T at either 5 or 10 g/day as well as rhGH at 0, 3.0 or 5.0 μg/kg/day for 16 weeks. Body composition was determined by dual-energy X-ray absorptiometry (DEXA) and muscle performance by composite one-repetition maximum (1-RM) strength and strength per unit of lean mass (muscle quality, MQ) for five major muscle groups (upper and lower body) at baseline, week 8 and 17. The average change in total LM at study week 8 compared with baseline was 1.50 ± 1.54 kg (P < 0.0001) in the T only group and 2.64 ± 1.7 (P < 0.0001) in the T + rhGH group and at week 17 was 1.46 ± 1.48 kg (P < 0.0001) in the T only group and 2.14 ± 1.96 kg (P < 0.0001) in the T + rhGH group. 1-RM strength improved modestly in both groups combined (12.0 ± 23.9%, P < 0.0001) at week 8 but at week 17 these changes were twofold greater (24.7 ± 31.0%, P < 0.0001). MQ did not significantly change from baseline to week 8 but increased for the entire cohort, T only, and T + rhGH groups by week 17 (P < 0.001). Despite sizeable increases in LM measurements at week 8, tests of muscle performance did not show substantive improvements at this time point.
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97
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Sattler FR, Bhasin S, He J, Yarasheski KE, Binder EF, Schroeder ET, Castaneda-Sceppa C, Kawakubo M, Roubenoff R, Dunn M, Hahn C, Stewart Y, Martinez C, Azen SP. Durability of the effects of testosterone and growth hormone supplementation in older community-dwelling men: the HORMA Trial. Clin Endocrinol (Oxf) 2011; 75:103-11. [PMID: 21521283 PMCID: PMC3529980 DOI: 10.1111/j.1365-2265.2011.04014.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the durability of anabolic effects and adverse events (AEs) after stopping testosterone and growth hormone supplementation in older men. DESIGN Secondary analysis of a double-masked, randomized controlled trial of testosterone gel (5 or 10 g/daily) plus rhGH (0, 3 or 5 μg/kg/day) with follow-up of outcomes 3 months later. PARTICIPANTS A total of 108 community-dwelling 65- to 90-year-old men. MEASUREMENTS Testosterone and IGF-1 levels, body composition (DEXA), 1-repetition maximum (1-RM) strength, stair-climbing power, quality-of-life (QOL) and activity questionnaires, AEs. RESULTS Despite improvements in body composition during treatment, residual benefits 3 months later (week 28) were variable. For participants with improvements exceeding their week-17 median changes, benefits were sustained at week 28 for lean body mass (1·45 ± 1·63 kg, 45% of week-17 values, P < 0·0001 vs baseline), appendicular skeletal muscle mass (ASMM, 0·71 ± 1·01 kg, 42%, P < 0·0001), total fat (-1·06 ± 2·18 kg, 40%, P < 0·0001) and trunk fat (-0·89 ± 1·42 kg, 50%, P < 0·0001); retention of ASMM was associated with greater week-16 protein intake (P = 0·01). For 1-RM strength, 39%-43% of week-17 improvements (P ≤ 0·05) were retained and associated with better week-17 strength (P < 0·0001), change in testosterone from week 17-to 28 (P = 0·004) and baseline PASE (P = 0·04). Framingham 10-year cardiovascular risks were low (~14%), did not worsen and improved by week 28 (P = 0·0002). The hypothalamic-pituitary-gonadal axis recovered completely. CONCLUSIONS Durable improvements in muscle mass, strength and fat mass were retained 3 months after discontinuing hormone supplementation in participants with greater than median body composition changes during treatment, but not in others with smaller gains. AEs largely resolved after intervention discontinuation. Additional strategies may be needed to sustain or augment muscle mass and strength gains achieved during short-term hormone therapy.
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Affiliation(s)
- Fred R Sattler
- Department of Medicine, University of Southern CaliforniaDivision of Biokinesiology, University of Southern California, Los Angeles, CASection of Endocrinology, Diabetes, and Nutrition, Boston University, Boston, MADepartment of Preventive Medicine, University of Southern California, Los Angeles, CADepartment of Medicine, Washington University, St Louis, MOJean Mayer USDA Human Nutrition Research Center on Aging of Tufts University, Boston, MADepartment of Urology, University of Southern California, Los Angeles, CA, USA
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98
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Yarasheski KE, Castaneda-Sceppa C, He J, Kawakubo M, Bhasin S, Binder EF, Schroeder ET, Roubenoff R, Azen SP, Sattler FR. Whole-body and muscle protein metabolism are not affected by acute deviations from habitual protein intake in older men: the Hormonal Regulators of Muscle and Metabolism in Aging (HORMA) Study. Am J Clin Nutr 2011; 94:172-81. [PMID: 21543538 PMCID: PMC3127526 DOI: 10.3945/ajcn.110.010959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute deviations in protein intake before the quantification of protein kinetics in older humans may explain the controversy over the effects of older age on muscle protein synthesis and proteolysis rates. OBJECTIVE We hypothesized that an acute decrease in protein intake from the habitual intake is associated with lower muscle protein synthesis and higher proteolysis rates, whereas an acute increase in protein intake from the habitual intake is associated with higher muscle protein synthesis and lower proteolysis rates. DESIGN In 112 community-dwelling healthy men aged 65-90 y, we quantified resting whole-body [1,2-(13)C(2)]leucine kinetics, muscle mixed protein fractional synthesis rates (FSRs), and muscle proteasome proteolytic enzyme activities after participants consumed for 3 d controlled research meals (0.9-1.1 g protein · kg(-1) · d(-1)) that contained more or less protein than that habitually consumed and that induced alterations in nitrogen balance. RESULTS Protein kinetic parameters were not significantly different between the groups, despite controlled research protein intakes that were lower (-0.2 to -0.3 g · kg(-1) · d(-1)) or higher (+0.2 g · kg(-1) · d(-1)) than habitual intakes and that induced negative (-22 to -25 mg · kg(-1) · d(-1)) or positive (22-25 mg · kg(-1) · d(-1)) nitrogen balance. Within these acutely altered protein intake and nitrogen balance boundaries, a reduction in protein intake from habitual intake and induction of negative nitrogen balance were not associated with higher proteolysis or lower muscle FSR, and an acute increase in protein intake from habitual intake and induction of positive nitrogen balance were not associated with lower proteolysis or higher muscle FSR. A higher quantitative insulin sensitivity check index was associated with lower whole-body proteolysis rates. CONCLUSIONS The practice of acutely controlling protein intake, even at intakes lower than habitual intakes that induce negative nitrogen balance, before quantifying human protein kinetics does not significantly reduce muscle protein synthesis or increase proteolysis. Factors other than protein intake explain lower muscle protein synthesis rates with advanced age. This trial is registered at clinicaltrials.gov as NCT00183040.
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99
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Detecting growth hormone abuse in athletes. Anal Bioanal Chem 2011; 401:449-62. [DOI: 10.1007/s00216-011-5068-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/25/2011] [Accepted: 04/25/2011] [Indexed: 01/21/2023]
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100
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Rolland Y, Onder G, Morley JE, Gillette-Guyonet S, Abellan van Kan G, Vellas B. Current and future pharmacologic treatment of sarcopenia. Clin Geriatr Med 2011; 27:423-47. [PMID: 21824556 DOI: 10.1016/j.cger.2011.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcopenia is a complex multifactorial condition that can by treated with multimodal approaches. No pharmacologic agent to prevent or treat sarcopenia has been as efficacious as exercise (mainly resistance training) in combination with nutritional intervention (adequate protein and energy intake). However, performing resistance training sessions and following nutritional advice can be challenging, especially for frail, sarcopenic, elderly patients, and results remain only partial. Therefore, new pharmacologic agents may substantially reduce the functional decline in older people. This article reviews the new pharmacologic agents currently being assessed for treating sarcopenia.
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Affiliation(s)
- Yves Rolland
- Inserm U1027, University of Toulouse III, Avenue Jules Guesdes, France.
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