Cycled Testosterone Therapy to Improve Physical Function in Frail Nursing Home Residents

Overview

Frailty is a recognized cause for disability, hospitalization, and mortality in nursing home residents. Testosterone treatment is among the potentially beneficial treatments in addition to resistance exercise for improving muscle strength and mass in frail adults. The investigators have demonstrated that cycled administration of testosterone improves muscle mass and strength in healthy adults. It is proposed that cycled testosterone administration may be an effective adjuvant therapy for frail older men and women during rehabilitation programs. The hypothesis is that testosterone treatment in addition to standard-of-care (SOC) rehabilitation will result in improved muscle mass and physical function when compared to patients receiving SOC only. Therefore, in a randomized, double-blind, placebo controlled study, the investigators will test the effects of cycled testosterone administration (2 week on treatment, 2 weeks off treatment) on body composition and physical function in male and female nursing home residents undergoing rehabilitative care. Primary outcomes will be assessed before and after 10 weeks of treatment using bioelectric impedance, handgrip dynamometers, short physical performance battery (SPPB), and quality of life (QOL) questionnaires. Data from this pilot project will become the foundation for the development of a larger long-term project solicitation to the NIH aimed at elucidating the efficacy of testosterone treatment on physical function and independence in frail older adults.

Frailty with aging is a serious debilitating condition that can further contribute to a downward spiraling of health and physical function. Many long term nursing home patients enter into rehabilitative care programs with the intent to increase strength and physical independence. However, many patients have lasting functional limitations despite rehabilitation programs intended to improve their physical function and sarcopenia and frailty is common among nursing home residents. Aging in general, and frailty in particular, has been associated with decreases in sex hormones, and testosterone treatment has known anabolic effects to muscle of hypogonadal as well has eugonadal males. Effective adjuvant treatments that can be safely employed in conjunction with existing therapies such as rehabilitative care intended to improve function can have profound benefits to the long-term outcome of male and female patients. The investigators have demonstrated that administration of testosterone (100 mg/wk) starts showing improvements in lean body mass (LBM) as early as 4 weeks and muscle strength by 8 weeks in healthy older community dwelling males (Sheffield-Moore et al., 2011). In this study, both continuous weekly treatment as well as intermittent treatment (4 weeks on testosterone, 4 weeks off testosterone, etc) resulted in similar benefits after 20 weeks. In addition, the investigators recently completed a 10-week study where the investigators showed both the safety and efficacy of cycled testosterone treatment (100 mg/wk for 2 weeks, alternated by 2 weeks of no treatment) in combination with regular exercise in healthy eugonadal adult men confined to continuous bed rest (see preliminary data). In that study, testosterone robustly increased LBM in as little as 2 weeks of bed rest and improvements in LBM were associated with better protection of physical function upon reambulation. It is proposed that a cycled testosterone paradigm may be a safe and effective adjuvant therapy for frail older nursing home patients undergoing physical rehabilitation. The investigators hypothesize that testosterone treatment in addition to standard-of-care (SOC) physical therapy or rehabilitation will result in improved muscle mass and physical function when compared to patients receiving SOC only. The long term goal is to develop effective treatments against the functional declines in muscle mass and strength that contribute to the development and progression of frailty. Therefore, the investigators will test the specific aims outlined below in older male and female residents engaging in rehabilitation care at health care centers in Texas City and Galveston. Men and women (age 60-up) will be recruited as they enroll into rehabilitative care programs, screened upon informed consent, and if eligible, block-randomized (double-blinded) to receive either testosterone enanthate (100 mg/wk for males and 25 mg/wk for females) or placebo (saline) treatment for 10 weeks. The treatment will follow a 2-week cycle (2 weeks on-treatment, 2 weeks off, etc). Primary outcomes will be assessed using non-invasive methods at baseline and at completion of the study after 10 weeks. These outcomes will include body composition as determined with bioelectric impedance analysis (BIA), muscle strength and fatigue by handgrip dynamometry, physical function by a short physical performance battery (SPPB), and quality of life (QOL) by a short battery of questionnaires. Blood samples will be collected at screening for safety and will be repeated at completion of the study for secondary outcome measures (hormones, lipid profiles and blood chemistries). Specific Aim 1. Determine the effects of cycled testosterone treatment on body composition in male and female nursing home residents undergoing rehabilitative care. Specific Aim 2. Determine the effects of cycled testosterone treatment on physical function in male and female nursing home residents undergoing rehabilitative care. Data from this pilot/feasibility project will become the foundation for the development of a larger long-term project solicitation to the NIH aimed at elucidating the efficacy of testosterone treatment on physical function and independence in frail older adults.