The Effects of Testosterone and Nutritional Supplementation in the Undernourished Elderly

Inclusion Criteria: * Men and women aged 65 years or older who are under-nourished, as defined by a Mini Nutritional Assessment (MNA) score \<24 AND 1 or more of the following: \*a body mass index (BMI) of less than 22 kg/m2; \*weight loss of \> 7.5% in the 3 months before enrolling in the study * Living independently in the community (not in a hospital, nursing home or hostel) * Understand and sign informed consent document, able to communicate with the investigator, and understand and comply with the requirements of the study. * Women who are taking oestrogen or other hormone replacement therapy (HRT) may take part (see exclusion criteria for exceptions), as may women who are not taking HRT. If a woman is taking HRT she must have been on a stable dose for at least 3 months before enrolment in the study. If not on HRT, she must not have been taking it for at least 3 months before enrolment. Exclusion Criteria: * Dementia as indicated by a Folstein's Mini Mental State Examination (MMSE) score of \< 23 * Elevated haematocrit (HCT) levels (\>50%) * Past or present history of prostatic cancer in men (Prostate Specific Antigen (PSA) levels \[\> age-related normal range and/or irregular prostate on prostate examination\]) or breast cancer. * Pre-existing androgenic signs or symptoms in women of concern to either subject or investigator (deep voice, hirsutism, acne, androgenic hair loss). * Depression (Yesavage Geriatric Depression Scale (GDS) Score \> 11) * Inability to attend DEXA scan or complete other requirements of the study * Significant cardiac failure (NYHA Class III and above) * Significantly abnormal liver function tests (ALT, GGT, bilirubin or ALP more than 2 times the upper limit of normal) * Nephrotic syndrome; 24h urine protein excretion \> 3 grams (if baseline urinalysis reveals \> 1+ proteinuria, quantification will be performed) AND/OR calculated creatinine clearance (by the equation of Baracskay and Jarjoura for ambulatory elderly subjects \[Cr clearance = 4.4/serum creatinine (mmol/L) + (88-age)\](63) \< 30 ml/min) AND/OR serum creatinine concentration \> 0.2mmol/l. * Amputee (body mass index, creatinine clearance and body composition estimations inaccurate). * Any disease, which in the opinion of the investigator is likely to lead to death within one year * Testosterone or other androgen therapy (including DHEA and tibolone) in the four months before starting the study. * Medication with cyclosporin or barbiturates