Testosterone vs. aromatase inhibitor in older men with low testosterone: effects on cardiometabolic parameters

Jenny Pena Dias, M. D. Shardell, O. D. Carlson, D. Melvin, G. Caturegli, L. Ferrucci, C. W. Chia, J. M. Egan, S. Basaria

Research output: Contribution to journalArticle

Abstract

Testosterone (T) replacement is being increasingly offered to older men with age-related decline in testosterone levels. The effects of long-term testosterone replacement and aromatase inhibition (AI) on glucose homeostasis and cardiometabolic markers were determine in older non-diabetic men with low testosterone levels. Men ≥65 years, mean age 71 ± 3 years with serum total T < 350 ng/dL were randomized in a double-blind, placebo-controlled, parallel-group, proof-of-concept trial evaluating the effects of 5 g transdermal testosterone gel (TT) (n = 10), 1 mg anastrozole (n = 10) or placebo (n = 9) daily for 12 months. Homeostatic Model Assessment of insulin resistance (HOMAIR) was the primary outcome. Secondary outcomes included OGIS in response to OGTT, fasting lipids, C-reactive protein (CRP), adipokines, and abdominal and mid-thigh fat by computed tomography. All outcomes were assessed at baseline and 12 months. After 12 months, absolute changes in HOMAIR in both treatment arms (TT group: −0.05 ± 0.21); (AI group: 0.15 ± 0.10) were similar to placebo (−0.11 ± 0.26), as were CRP and fasting lipid levels. Adiponectin levels significantly decreased in the TT group (−1.8 ± 0.9 mg/L, p = 0.02) and abdominal subcutaneous fat (−60.34 ± 3.19 cm2, p = 0.003) and leptin levels (−1.5 ± 1.2 ng/mL, p = 0.04) were significantly lower with AI. Mid-thigh subcutaneous fat was reduced in both treatment arms (TT group: −4.88 ± 1.24 cm2, p = 0.008); (AI group: −6.05 ± 0.87 cm2, p = 0.0002). In summary, in this proof-of-concept trial, changes in HOMAIR AI were similar in all three groups while the effects of intervention on subcutaneous fat distribution and adipokines were variable. Larger efficacy and safety trials are needed before AI pharmacotherapy can be considered as a treatment option for low T levels in older men.

Original languageEnglish (US)
Pages (from-to)31-40
Number of pages10
JournalAndrology
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Aromatase Inhibitors
Aromatase
Testosterone
Gels
Insulin Resistance
Adipokines
Placebos
Thigh
C-Reactive Protein
Fasting
Arm
Abdominal Subcutaneous Fat
Lipids
Subcutaneous Fat
Adiponectin
Glucose Tolerance Test
Leptin
Inhibition (Psychology)
Homeostasis
Therapeutics

Keywords

  • aromatase inhibition
  • inflammation
  • insulin sensitivity
  • lipids
  • testosterone

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Reproductive Medicine
  • Endocrinology
  • Urology

Cite this

Pena Dias, J., Shardell, M. D., Carlson, O. D., Melvin, D., Caturegli, G., Ferrucci, L., ... Basaria, S. (2017). Testosterone vs. aromatase inhibitor in older men with low testosterone: effects on cardiometabolic parameters. Andrology, 5(1), 31-40. https://doi.org/10.1111/andr.12284

Testosterone vs. aromatase inhibitor in older men with low testosterone : effects on cardiometabolic parameters. / Pena Dias, Jenny; Shardell, M. D.; Carlson, O. D.; Melvin, D.; Caturegli, G.; Ferrucci, L.; Chia, C. W.; Egan, J. M.; Basaria, S.

In: Andrology, Vol. 5, No. 1, 01.01.2017, p. 31-40.

Research output: Contribution to journalArticle

Pena Dias, J, Shardell, MD, Carlson, OD, Melvin, D, Caturegli, G, Ferrucci, L, Chia, CW, Egan, JM & Basaria, S 2017, 'Testosterone vs. aromatase inhibitor in older men with low testosterone: effects on cardiometabolic parameters', Andrology, vol. 5, no. 1, pp. 31-40. https://doi.org/10.1111/andr.12284
Pena Dias, Jenny ; Shardell, M. D. ; Carlson, O. D. ; Melvin, D. ; Caturegli, G. ; Ferrucci, L. ; Chia, C. W. ; Egan, J. M. ; Basaria, S. / Testosterone vs. aromatase inhibitor in older men with low testosterone : effects on cardiometabolic parameters. In: Andrology. 2017 ; Vol. 5, No. 1. pp. 31-40.
@article{b4a45aaae1fe42338650624d7e705d7d,
title = "Testosterone vs. aromatase inhibitor in older men with low testosterone: effects on cardiometabolic parameters",
abstract = "Testosterone (T) replacement is being increasingly offered to older men with age-related decline in testosterone levels. The effects of long-term testosterone replacement and aromatase inhibition (AI) on glucose homeostasis and cardiometabolic markers were determine in older non-diabetic men with low testosterone levels. Men ≥65 years, mean age 71 ± 3 years with serum total T < 350 ng/dL were randomized in a double-blind, placebo-controlled, parallel-group, proof-of-concept trial evaluating the effects of 5 g transdermal testosterone gel (TT) (n = 10), 1 mg anastrozole (n = 10) or placebo (n = 9) daily for 12 months. Homeostatic Model Assessment of insulin resistance (HOMAIR) was the primary outcome. Secondary outcomes included OGIS in response to OGTT, fasting lipids, C-reactive protein (CRP), adipokines, and abdominal and mid-thigh fat by computed tomography. All outcomes were assessed at baseline and 12 months. After 12 months, absolute changes in HOMAIR in both treatment arms (TT group: −0.05 ± 0.21); (AI group: 0.15 ± 0.10) were similar to placebo (−0.11 ± 0.26), as were CRP and fasting lipid levels. Adiponectin levels significantly decreased in the TT group (−1.8 ± 0.9 mg/L, p = 0.02) and abdominal subcutaneous fat (−60.34 ± 3.19 cm2, p = 0.003) and leptin levels (−1.5 ± 1.2 ng/mL, p = 0.04) were significantly lower with AI. Mid-thigh subcutaneous fat was reduced in both treatment arms (TT group: −4.88 ± 1.24 cm2, p = 0.008); (AI group: −6.05 ± 0.87 cm2, p = 0.0002). In summary, in this proof-of-concept trial, changes in HOMAIR AI were similar in all three groups while the effects of intervention on subcutaneous fat distribution and adipokines were variable. Larger efficacy and safety trials are needed before AI pharmacotherapy can be considered as a treatment option for low T levels in older men.",
keywords = "aromatase inhibition, inflammation, insulin sensitivity, lipids, testosterone",
author = "{Pena Dias}, Jenny and Shardell, {M. D.} and Carlson, {O. D.} and D. Melvin and G. Caturegli and L. Ferrucci and Chia, {C. W.} and Egan, {J. M.} and S. Basaria",
year = "2017",
month = "1",
day = "1",
doi = "10.1111/andr.12284",
language = "English (US)",
volume = "5",
pages = "31--40",
journal = "Andrology",
issn = "2047-2919",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

TY - JOUR

T1 - Testosterone vs. aromatase inhibitor in older men with low testosterone

T2 - effects on cardiometabolic parameters

AU - Pena Dias, Jenny

AU - Shardell, M. D.

AU - Carlson, O. D.

AU - Melvin, D.

AU - Caturegli, G.

AU - Ferrucci, L.

AU - Chia, C. W.

AU - Egan, J. M.

AU - Basaria, S.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Testosterone (T) replacement is being increasingly offered to older men with age-related decline in testosterone levels. The effects of long-term testosterone replacement and aromatase inhibition (AI) on glucose homeostasis and cardiometabolic markers were determine in older non-diabetic men with low testosterone levels. Men ≥65 years, mean age 71 ± 3 years with serum total T < 350 ng/dL were randomized in a double-blind, placebo-controlled, parallel-group, proof-of-concept trial evaluating the effects of 5 g transdermal testosterone gel (TT) (n = 10), 1 mg anastrozole (n = 10) or placebo (n = 9) daily for 12 months. Homeostatic Model Assessment of insulin resistance (HOMAIR) was the primary outcome. Secondary outcomes included OGIS in response to OGTT, fasting lipids, C-reactive protein (CRP), adipokines, and abdominal and mid-thigh fat by computed tomography. All outcomes were assessed at baseline and 12 months. After 12 months, absolute changes in HOMAIR in both treatment arms (TT group: −0.05 ± 0.21); (AI group: 0.15 ± 0.10) were similar to placebo (−0.11 ± 0.26), as were CRP and fasting lipid levels. Adiponectin levels significantly decreased in the TT group (−1.8 ± 0.9 mg/L, p = 0.02) and abdominal subcutaneous fat (−60.34 ± 3.19 cm2, p = 0.003) and leptin levels (−1.5 ± 1.2 ng/mL, p = 0.04) were significantly lower with AI. Mid-thigh subcutaneous fat was reduced in both treatment arms (TT group: −4.88 ± 1.24 cm2, p = 0.008); (AI group: −6.05 ± 0.87 cm2, p = 0.0002). In summary, in this proof-of-concept trial, changes in HOMAIR AI were similar in all three groups while the effects of intervention on subcutaneous fat distribution and adipokines were variable. Larger efficacy and safety trials are needed before AI pharmacotherapy can be considered as a treatment option for low T levels in older men.

AB - Testosterone (T) replacement is being increasingly offered to older men with age-related decline in testosterone levels. The effects of long-term testosterone replacement and aromatase inhibition (AI) on glucose homeostasis and cardiometabolic markers were determine in older non-diabetic men with low testosterone levels. Men ≥65 years, mean age 71 ± 3 years with serum total T < 350 ng/dL were randomized in a double-blind, placebo-controlled, parallel-group, proof-of-concept trial evaluating the effects of 5 g transdermal testosterone gel (TT) (n = 10), 1 mg anastrozole (n = 10) or placebo (n = 9) daily for 12 months. Homeostatic Model Assessment of insulin resistance (HOMAIR) was the primary outcome. Secondary outcomes included OGIS in response to OGTT, fasting lipids, C-reactive protein (CRP), adipokines, and abdominal and mid-thigh fat by computed tomography. All outcomes were assessed at baseline and 12 months. After 12 months, absolute changes in HOMAIR in both treatment arms (TT group: −0.05 ± 0.21); (AI group: 0.15 ± 0.10) were similar to placebo (−0.11 ± 0.26), as were CRP and fasting lipid levels. Adiponectin levels significantly decreased in the TT group (−1.8 ± 0.9 mg/L, p = 0.02) and abdominal subcutaneous fat (−60.34 ± 3.19 cm2, p = 0.003) and leptin levels (−1.5 ± 1.2 ng/mL, p = 0.04) were significantly lower with AI. Mid-thigh subcutaneous fat was reduced in both treatment arms (TT group: −4.88 ± 1.24 cm2, p = 0.008); (AI group: −6.05 ± 0.87 cm2, p = 0.0002). In summary, in this proof-of-concept trial, changes in HOMAIR AI were similar in all three groups while the effects of intervention on subcutaneous fat distribution and adipokines were variable. Larger efficacy and safety trials are needed before AI pharmacotherapy can be considered as a treatment option for low T levels in older men.

KW - aromatase inhibition

KW - inflammation

KW - insulin sensitivity

KW - lipids

KW - testosterone

UR - http://www.scopus.com/inward/record.url?scp=85000632544&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85000632544&partnerID=8YFLogxK

U2 - 10.1111/andr.12284

DO - 10.1111/andr.12284

M3 - Article

C2 - 27792869

AN - SCOPUS:85000632544

VL - 5

SP - 31

EP - 40

JO - Andrology

JF - Andrology

SN - 2047-2919

IS - 1

ER -