title: Effects of testosterone supplementation on clinical and rehabilitative outcomes in older men undergoing on-pump CABG.
abstract: Testosterone levels decrease with age. This decline is steeper during "critical illnesses". Cardiac surgery is a particular representative model of major clinical condition producing stress responses similar to those observed during severe nonsurgical illness. Cardiac revascularization with extracorporeal circulation is characterized by marked postoperative complications such as insulin resistance, a pro-inflammatory state, acute anemia and renal dysfunction. These phenomena are more evident in older subjects, who are particularly vulnerable in the post-operative state, a condition that has been recently termed as "acute postoperative frailty". We recently showed that in older men with low ejection fraction undergoing cardiac revascularization with extracorporeal circulation, there is a profound decline in anabolic hormones, including testosterone. After surgery testosterone concentration frequently declines to less than 200 ng/dl, a situation suggestive of overt hypogonadism. Since men with low testosterone levels have a high probability of developing mobility limitations, we considered this a rationale for the perioperative use of testosterone treatment in older men undergoing cardiac revasularization surgery. We hypothesized that testosterone supplementation at this time might attenuate the impressive post-surgical catabolic hormonal milieu. The aim of this manuscript is to elucidate an ongoing randomized clinical trial in older men (70+ years old) undergoing elective cardiovascular revascularization with extracorporeal circulation. This randomized clinical trial will evaluate the effects of intramuscular testosterone administration on clinical and functional outcomes in this population. The study will also address potential mechanisms underlying the expected beneficial effects of testosterone supplementation including improvement of insulin sensitivity, markers of inflammatory status and improved hemoglobin levels.
authors.affiliation: Department of Internal and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattabiani
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schwartz
authors.forename: Giorgio
authors.initials: G
authors.lastname: Valenti
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
mesh_terms: D000339:Affect / Q000187:drug effects; D000368:Aged; D000369:Aged, 80 and over; D000728:Androgens / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D002315:Cardiopulmonary Bypass / Q000534:rehabilitation; D001026:Coronary Artery Bypass / Q000379:methods* / Q000534:rehabilitation; D004334:Drug Administration Schedule; D005080:Exercise Test; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D007273:Injections, Intramuscular; D035002:Lower Extremity; D008297:Male; D053580:Muscle Strength / Q000187:drug effects; D018908:Muscle Weakness / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011788:Quality of Life; D020127:Recovery of Function; D016037:Single-Blind Method; D013739:Testosterone / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000728:Androgens; D015415:Biomarkers; D013739:Testosterone