Testosterone therapy in glucocorticoid-treated men

Background: Treatment with glucocorticoid drugs is a valuable therapy, but the use of these drugs is associated with major side effects, including osteoporosis, muscle wasting, and obesity. In men who take glucocorticoids, circulating testosterone concentrations are reduced, and this might contribute to the changes in bone and soft-tissue mass. Objective: To assess the effect of testosterone replacement on these above-mentioned parameters in glucocorticoid-treated men. Methods: Fifteen asthmatic men who were receiving long-term glucocorticoid treatment were randomly allocated to receive therapy with testosterone esters (30 mg of proprionate, 60 mg of phenylprionate, 60 mg of isocaproate, and 100 mg of decanoate [Sustanon]) (250-mg/mo intramuscular depot injection) or to act as control subjects during 12 months. After a washout period for those men who were receiving testosterone, the groups were then crossed over and studied for a further 12 months. Bone density and body composition were assessed by dual-energy, x-ray absorptiometry. Paired or unpaired 2-tailed t tested were calculated. Unless otherwise stated, all values are given as mean+/-SEM. Results: Bone density in the lumbar spine increased 5.0%+/-1.4% (mean+/-SEM) (P=.005) during testosterone supplementation, but it did not change during the control period (between-groups difference, P=.05). These changes were accompanied by a decrease in the indexes of bone turnover. There was a gain in body far mass (2.1+/-0.06 kg, P=.01) and a loss of lean body mass (1.4+/-0.5 kg, P=.02) during the control period, with both changes being reversed by testosterone treatment (P<.03). Conclusion: Testosterone treatment reverses the deleterious effects of glucocorticoid drugs on skeletal and soft tissues in men.