Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772314Y.0000000206 · Published: January 1, 2015

Spinal Cord Injury Endocrinology Rehabilitation

Simple Explanation

This study investigates whether the positive effects of testosterone replacement therapy (TRT) on muscle mass and energy expenditure in men with spinal cord injury (SCI) persist after stopping treatment. Hypogonadal men with SCI received TRT for 12 months, and their muscle mass and energy expenditure were measured before, during, and after treatment. A control group of eugonadal men with SCI was also evaluated. The study found that the increase in muscle mass and energy expenditure observed during TRT persisted for at least 6 months after stopping treatment, suggesting lasting benefits of TRT in this population.

Study Duration

24 Months

Participants

24 healthy non-ambulatory men with SCI

Evidence Level

Prospective, open-label, controlled drug intervention trial

Key Findings

1
Significant increase in LTM was observed from baseline to TRT-12M (50.2 ± 7.4 vs. 52.9 ± 6.8 kg, P < 0.01), which persisted Post-TRT compared to BL (52.2 ± 7.8 kg, P < 0.05).
2
The increase in REE from BL to TRT-12M (1283 ± 246 vs. 1410 ± 250 kcal/day) was also retained at Post-TRT (1393 ± 220 kcal/day).
3
Serum HDL-C level increased at month 12 (P < 0.05) and remained at a similarly higher concentration at Post-TRT.

Research Summary

This study investigated the retention of favorable changes in lean tissue mass (LTM) and resting energy expenditure (REE) after discontinuation of testosterone replacement therapy (TRT) in hypogonadal men with spinal cord injury (SCI). The results showed that the significant increase in LTM and REE observed during TRT persisted 6 months after discontinuation of TRT, suggesting potential long-term benefits of TRT in this population. The study suggests that appropriately monitored TRT offers a logical and efficacious approach to treat clinically low T and improve body composition in men with chronic SCI.

Practical Implications

Improved Body Composition

TRT can lead to sustained increases in lean tissue mass and resting energy expenditure in hypogonadal men with SCI, even after discontinuation of treatment.

Potential for Long-Term Health Benefits

The sustained improvements in LTM and REE may be associated with persistent beneficial effects on health and physical function of hypogonadal men with chronic SCI.

Consideration for Clinical Practice

Clinicians should consider screening for low serum T levels in men with chronic SCI and consider TRT as a potential intervention to improve body composition and metabolic outcomes.

Study Limitations

1
The study had a relatively small sample size, which limited the ability to address other endpoints of interest.
2
The study design was unbalanced, with some subjects terminating participation prior to the final study time point.
3
The translation and/or relevance of these findings as they may relate to functional gain, mood, strength, and sexual function could not be addressed with any degree of certainty in this report.

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