Musculoskeletal and body composition response to high-dose testosterone with finasteride after chronic incomplete spinal cord injury—a randomized, double-blind, and placebo-controlled pilot study

Frontiers in Neurology, 2024 · DOI: 10.3389/fneur.2024.1479264 · Published: December 11, 2024

Simple Explanation

This study investigates the effects of high-dose testosterone replacement therapy (TRT) combined with finasteride on men with spinal cord injury (SCI). Men with SCI often experience muscle atrophy, bone loss, and increased fat, along with low testosterone levels. The study aimed to determine if TRT with finasteride could improve body composition and musculoskeletal health in men with SCI. Finasteride was used to prevent prostate enlargement, a common side effect of TRT. The results showed that TRT with finasteride increased muscle mass, reduced fat, and improved bone density in men with SCI. The treatment was well-tolerated, with similar adverse events in both the TRT and placebo groups.

Study Duration

12 Months

Participants

12 men with low to low–normal testosterone and gait impairments after chronic motor-incomplete SCI

Evidence Level

Level 1: Randomized, double-blind, and placebo-controlled pilot study

Key Findings

1
TRT + finasteride consistently increased testosterone and estradiol, while concomitantly reducing dihydrotestosterone.
2
TRT + finasteride increased whole-body fat-free (lean) mass (+3–4% vs. baseline) and knee extensor (KE) whole-muscle cross-sectional area (+8–11% vs. baseline) more than vehicle+placebo.
3
TRT + finasteride also produced small effect sizes favoring lesser prostate growth than vehicle+placebo.

Research Summary

This pilot study provides proof-of-concept for the use of TRT + finasteride in men with SCI. The treatment showed promise in improving body composition and musculoskeletal health. The results suggest that TRT + finasteride can increase muscle mass, reduce fat, and improve bone density in this population. Further research is needed to confirm these findings. The study also provides effect sizes and variance of responses to assist in planning subsequent trials. This information is crucial for designing larger and more comprehensive clinical trials.

Practical Implications

Clinical Practice

TRT with finasteride may be a viable treatment option for men with SCI who experience low testosterone, muscle atrophy, and bone loss. Monitoring of testosterone levels and prostate health is recommended.

Future Research

Larger RCTs are needed to confirm the findings of this pilot study and to determine the long-term effects of TRT with finasteride on body composition, musculoskeletal health, and physical function in men with SCI.

Pharmaceutical Development

The study provides a rationale for further investigation into the use of TRT with finasteride in the SCI population. Pharmaceutical companies may consider developing targeted therapies for this specific group.

Study Limitations

1
Small sample size
2
Participants were men with low to low-normal testosterone and ambulatory dysfunction after chronic motor-incomplete SCI.
3
Study was terminated prior to achieving a priori enrollment target.

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