Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study

Abstract

Aim: The goal of this study was to determine if long-term testosterone (T) therapy in men with hypogonadism, henceforth referred to as testosterone deficiency (TD), ameliorates or improves metabolic syndrome (MetS) components.

Methods: We performed a cumulative registry study of 255 men, aged between 33 and 69 years (mean 58.02 ± 6.30) with subnormal plasma total T levels (mean: 9.93 ± 1.38; range: 5.89-12.13 nmol/l) as well as at least mild symptoms of TD assessed by the Aging Males' symptoms scale. All men received treatment with parenteral T undecanoate 1000 mg (Nebido(®) , Bayer Pharma, Berlin, Germany), administered at baseline and 6 weeks and thereafter every 12 weeks for up to 60 months. Lipids, glucose, liver enzymes and haemoglobin A1c analyses were carried out in a commercial laboratory. Anthropometric measurements were also made throughout the study period.

Results: Testosterone therapy restored physiological T levels and resulted in reductions in total cholesterol (TC) [7.29 ± 1.03 to 4.87 ± 0.29 mmol/l (281.58 ± 39.8 to 188.12 ± 11.31 mg/dl)], low-density lipoprotein cholesterol [4.24 ± 1.07 to 2.84 ± 0.92 mmol/l (163.79 ± 41.44 to 109.84 ± 35.41 mg/dl)], triglycerides [3.14 ± 0.58 to 2.16 ± 0.13 mmol/l (276.16 ± 51.32 to 189.78 ± 11.33 mg/dl)] and increased high-density lipoprotein levels [1.45 ± 0.46 to 1.52 ± 0.45 mmol/l (56.17 ± 17.79 to 58.85 ± 17.51 mg/dl)] (p < 0.0001 for all). There were marked reductions in systolic and diastolic blood pressure, blood glucose, haemoglobin A1c , C-reactive protein (6.29 ± 7.96 to 1.03 ± 1.87 U/l), alanine aminotransferase and aspartate aminotransferase (p < 0.0001 for all).

Conclusions: Long-term T therapy, at physiological levels, ameliorates MetS components. These findings strongly suggest that T therapy in hypogonadal men may prove useful in reducing the risk of cardiometabolic diseases.

Figure 1

Mean total plasma testosterone levels in men with TD undergoing T therapy for a period of 5 years

Figure 2

Total cholesterol (A) and LDL cholesterol levels (B) in men with TD undergoing T therapy for 5 years

Figure 3

HDL cholesterol (A) and total cholesterol/HDL-C ratio (B) in men with TD undergoing therapy for 5 years

Figure 4

Triglyceride levels in men with TD undergoing T therapy for 5 years

Figure 5

Systolic blood pressure (A) and diastolic blood pressure (B) in men with TD undergoing T therapy for 5 years

Figure 6

Glucose concentration (Panel A) and HbA1c levels (Panel B) in men with TD undergoing T therapy for 5 years

Figure 7

C-reactive protein (CRP) levels in men with TD undergoing T therapy for 5 years

Figure 8

Alanine aminotransferase (A) and aspartate aminotransferase (B) in men with TD undergoing T therapy for 5 years