Effects of Testosterone Replacement with a Nongenital, Transd...

Effects of Testosterone Replacement with a Nongenital, Transdermal System, Androderm, in Human Immunodeficiency Virus-Infected Men with Low Testosterone Levels¹

Shalender Bhasin, Thomas W. Storer, Nancy Asbel-Sethi, Amy Kilbourne, Ron Hays, Indrani Sinha-Hikim, Ruoquing Shen, Stefan Arver and Gildon Beall

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science (S.B., T.W.S., I.S.-H. R.S.), Los Angeles, California 90059; the Laboratory of Exercise Science, El Camino College (T.W.S.), Torrance, California 90504; Harbor-University of California-Los Angeles Medical Center (G.B.), Torrance, California 90502; SmithKline Beecham Pharmaceutical Co., Collegeville, PA 19426 (N.A.-S.); Center for Health Sciences, University of California School of Medicine (A.K., R.H.), Los Angeles, California 90024; and Karolinska Institute (S.A.), Stockholm, Sweden

Address all correspondence and requests for reprints to: Shalender Bhasin, M.D., Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California 90059.

Although weight loss associated with human immunodeficiency virus (HIV) infection is multifactorial in its pathogenesis, it has been speculated that hypogonadism, a common occurrence in HIV disease, contributes to depletion of lean tissue and muscle dysfunction. We, therefore, examined the effects of testosterone replacement by means of Androderm, a permeation-enhanced, nongenital transdermal system, on lean body mass, body weight, muscle strength, health-related quality of life, and HIV-disease markers.

We randomly assigned 41 HIV-infected, ambulatory men, 18&endash;60 yr of age, with serum testosterone levels below 400 ng/dL, to 1 of 2 treatment groups: group I, two placebo patches (n = 21); or group II, two testosterone patches designed to release 5 mg testosterone over 24 h. Eighteen men in the placebo group and 14 men in the testosterone group completed the 12-week treatment.

Serum total and free testosterone and dihydrotestosterone levels increased, and LH and FSH levels decreased in the testosterone-treated, but not in the placebo-treated, men. Lean body mass and fat-free mass, measured by dual energy x-ray absorptiometry, increased significantly in men receiving testosterone patches [change in lean body mass, 1.345 ± 0.533 kg (P = 0.02 compared to no change); change in fat-free mass, 1.364 ± 0.525 kg (P = 0.02 compared to no change)], but did not change in the placebo group [change in lean body mass, 0.189 ± 0.470 kg (P = NS compared to no change); change in fat-free mass, 0.186 ± 0.470 kg (P = NS compared to no change)]. However, there was no significant difference between the 2 treatment groups in the change in lean body mass. The change in lean body mass during treatment was moderately correlated with the increment in serum testosterone levels (r = 0.41; P = 0.02). The testosterone-treated men experienced a greater decrease in fat mass than those receiving placebo patches (P = 0.04). There was no significant change in body weight in either treatment group. Changes in overall quality of life scores did not correlate with testosterone treatment; however, in the subcategory of role limitation due to emotional problems, the men in the testosterone group improved an average of 43 points of a 0&endash;100 possible score, whereas those in the placebo group did not change. Red cell count increased in the testosterone group (change in red cell count, 0.1 ± 0.1 1012/L) but decreased in the placebo group (change in red cell count, -0.2 ± 0.1 1012/L). CD4 and CD8 T cell counts and plasma HIV copy number did not significantly change during treatment. Serum prostate-specific antigen and plasma lipid levels did not change in either treatment group.

Testosterone replacement in HIV-infected men with low testosterone levels is safe and is associated with a 1.35-kg gain in lean body mass, a significantly greater reduction in fat mass than that achieved with placebo treatment, an increased red cell count, and an improvement in role limitation due to emotional problems. Further studies are needed to assess whether testosterone supplementation can produce clinically meaningful changes in muscle function and disease outcome in HIV-infected men.