Neil Osterweil

May 27, 2014

ORLANDO, Florida — Men with late-onset hypogonadism who exercise regularly benefit more from testosterone replacement therapy than those who remain sedentary, according to a new study.

Testosterone levels were significantly higher in the exercise group than in the sedentary group, and the resolution of hypogonadism symptoms was better in the exercise group, said Min Gu Park, MD, from the Department of Urology at Inje University in Seoul, South Korea. In addition, the benefits of exercise remained after replacement therapy was stopped.

In a separate study looking at predictors of poor response to testosterone therapy, investigators found that nonobese men are much more likely to achieve normal testosterone levels than obese men.

"Weight loss may be as important as prescribing testosterone in the management of low T," said Ashley Winter, MD, a urology resident at Weill Cornell Medical College in New York City.

"What this means to us as practitioners is that there is a profound loss of healthcare dollars in treatment of low testosterone because of the epidemic of obesity," she said. "Annually, at least $400 million are spent on men who don't achieve normal levels of T despite treatment."

Both studies were presented here at the American Urological Association 2014 Annual Scientific Meeting.

A Supervised Exercise Program

Dr. Park's team evaluated men with erectile dysfunction and total serum testosterone levels below 350 ng/dL. They randomly assigned 25 men to 12 weeks of testosterone therapy alone and 25 men to 12 weeks of testosterone therapy plus 20 weeks of a supervised program of physical activity at least 3 times per week.

The exercise program consisted of 20 minutes of aerobic exercise, followed by 10 minutes of whole-body stretching, 30 minutes of strength exercises, and another 20 minutes of aerobic exercise.

The men were all in their late 50s or early 60s. At baseline, total testosterone levels were similar in the exercise and sedentary groups (281.9 vs 277.1 ng/dL), as were hemoglobin, hematocrit, glucose, and cholesterol levels.

Total serum testosterone was significantly better in the exercise group than in the sedentary group at 12 weeks (= .019) and at 20 weeks (< .001).

Although the results are positive, Dr. Park acknowledged that the study was small and did not include a control group treated with exercise only.

Obesity and Prediabetes Don't Help

Dr. Winter's team set out to determine why 16% to 22% of men with low testosterone do not achieve normal testosterone levels with treatment.

They followed 58 patients who presented with metabolic syndrome, low serum testosterone, and associated symptoms, such as low sex drive and erectile dysfunction. After a physical exam and lab workup, the men were treated with 1 of 3 commercially available transdermal testosterone replacements for 18 to 24 months.

The men were categorized as obese (body mass index, >30 kg/m²) or nonobese (<30 kg/m²).

At baseline, the groups were similar in age and had similar levels of total testosterone and cholesterol.

Nonobese men were more likely to achieve a normal testosterone level than obese men (81% vs 54%; P = .03). In addition, an elevated level of glycated hemoglobin (indicating either prediabetes or diabetes) decreased the odds of achieving a normal testosterone level by 33%. These findings were independent of age.

"What do we need to do to fix this? Clearly the answer is that patients have to eat more nutritious food and less garbage, exercise more, and take better care of themselves," said briefing moderator Tobias Köhler, MD, MPH, associate professor of urology at Southern Illinois University School of Medicine in Springfield, who was not involved in either study.

"There is a clear benefit from testosterone replacement for men who have biochemically low levels," he told Medscape Medical News. "If they get the right treatment, they're going to lose weight, they're going to improve metabolic parameters, and do better overall."

"I think that a lot controversy around testosterone is about guys who use it for the wrong reasons," he explained. "They're not trying to restore a normal physiologic state, they're trying to achieve a super-physiologic state. There, we clearly have to be cautious, to make sure that it's in the right hands."

Both studies were internally funded. Dr. Winter and Dr. Park have disclosed no relevant financial relationships. Dr. Köhler reports being on the speaker's bureaus of Eli Lilly and Auxilium, both makers of testosterone replacements.

American Urological Association (AUA) 2014 Annual Scientific Meeting: Abstracts MP48-02 (Park et al) and MP48-04 (Winter et al). Presented May 19, 2014.


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