Testosterone boost no lasting help to frail elderly, study says

NEW YORK (Reuters Health) - Testosterone gels may offer frail, old men a chance to regain some of their youthful vigor, but the effects fade away as soon as they stop treatment, British researchers report.

While hardly surprising, the findings slash hopes that a short hormone boost would break the vicious circle of muscle loss, fatigue and disability that blunts the quality of life for some seniors.

The exact medical definition of frailty is still up in the air, so it's hard to say how many elderly are affected, although it's likely to be a minority.

But for those men and women, the consequences can be quite severe, making them unable to carry out daily activities like climbing stairs and landing many in nursing homes or hospitals.

"A lot of people prescribe physical exercise, but not everybody can undergo the kind of training that is required," said Dr. Frederick Wu, a hormone expert at the University of Manchester who led the new study.

Testosterone is not approved for treating frailty, but a handful of studies, including Wu's own research, suggest short-term treatment increases muscle mass, strength and quality of life in older men.

Other work has hinted that treating middle-aged and older men with the hormone might increase their risk of heart disease and prostate problems, however, making short treatments all the more attractive.

But the idea that a brief treatment would provide long-term benefits appears to be wishful thinking, according to the new study, published in the Journal of Clinical Endocrinology & Metabolism.

Following 274 older men who had been randomly assigned to treatment with a testosterone gel or a placebo, Wu and colleagues found that all of the benefits gained over six months of therapy -- including increased muscle mass, leg strength and improved sexual function -- had vanished another six months later.

"That means that in order to maintain the improvement you need to continue on treatment," Wu told Reuters Health.

Wu estimates that about six percent of men aged 70 and older suffer from frailty. For now, he added, it appears they are stuck with the same onerous treatment option as their female counterparts: exercise and good nutrition.

"A lot of elderly don't have a very good diet," he said, adding that they don't get enough proteins and carbohydrates.

In contrast to the British, American doctors are increasingly prescribing testosterone to older patients, according to Dr. Martin Miner, who co-directs the Men's Health Center at The Miriam Hospital in Providence, Rhode Island.

He said the practice is still controversial, but that the medical literature supports testosterone use

"As long as the men don't have congestive heart failure or prostate cancer, testosterone can be quite safe," he said. "Dr. Wu is rather conservative."

The new findings show men would probably have to remain on hormone treatment - available as a gel to be applied to the skin -- for the rest of their lives, according to Miner. He added that the gels can cost as much as $250 per month, but that injections are cheaper.

Wu countered that in the absence of good long-term data on testosterone safety and effectiveness in the aging population, maintaining overall health is the way to go.

"I think prevention is probably better treatment," he said.

SOURCE: link.reuters.com/wyz48q Journal of Clinical Endocrinology and Metabolism, online November 17, 2010.