Testosterone Replacement in Metabolic Syndrome and Inflammation

Study Overview
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Brief Summary
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Hypogonadism (HG) frequently complicates the Metabolic Syndrome (MetS), whether testosterone replacement (TRT) is beneficial has not been clearly ascertained. This study was designed to address the effects of TRT on insulin resistance, body composition and pro-inflammatory status in naïve patients with MetS and HG.

Detailed Description
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The features of Metabolic Syndrome (MetS) include abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance or glucose intolerance. These symptoms are also frequently found in hypogonadal men. Adipose tissue and androgens in male obesity are reciprocally linked. Total and free testosterone (T) are decreased in proportion to the degree of body fatness while T regulates insulin sensitivity and body composition. As a consequence, hypoandrogenism carries an additional independent risk for cardiovascular and metabolic disorders. Men with type 2 diabetes mellitus (T2D) exhibit lowered T levels that are inversely correlated to HbA1c. In addition, abdominal adiposity causes an impairment of testicular steroidogenesis that is directly linked to circulating adipokines; enhanced cytokine release from macrophage-infiltrated adipose tissue is pivotal to the pathogenesis of insulin resistance and atherosclerosis. Both MetS and T2D share with hypogonadism such a proinflammatory state. For this reason we performed a randomized controlled trial on the effects of TRT on insulin resistance and circulating inflammatory markers in a cohort of middle-aged men with mild hypogonadism and MetS at first diagnosis, that were not taking medications known to influence the investigated outcomes. We established strict criteria for enrollment and used a physiological replacing therapy. Given that testosterone replacement therapy (TRT) determines a reduction of body fat mass paralleled by an increase in fat free mass (6), and that TRT exerts an anti-inflammatory role inhibiting interleukins (IL), in particular the IL-6 gene (14), it remains to be established whether these independent effects also reflect in an improvement in insulin resistance.

Official Title
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Testosterone Replacement in Metabolic Syndrome and Inflammation of Fat Tissue

Conditions
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Hypogonadism, Metabolic Syndrome, Obesity, Erectile Dysfunction

Intervention / Treatment
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* Drug: Testosterone
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with Metabolic Syndrome according to ATPIII patients with mild hypogonadism (both testosterone evaluations between 6 and 11 nmol/L) patients naïve to hypoglycemic therapies Exclusion Criteria: patients on hypoglycemic medications patients with severe hypogonadism (<5 nmol/L) patients with borderline T values hypogonadism (>11 nmol/L) patients with contraindication to testosterone therapy: prostate cancer, PSA>4 ng/ml, severe hepatic or renal insufficiency, Hb>17, Htc>52%, severe urinary retention

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Testosterone gel<br>Testosterone transdermal gel 50 mg/day | Drug: Testosterone<br>* Testosterone transdermal gel 50 mg/day (5 gr)<br>* Other names: Testogel;|
| Placebo Comparator: Placebo gel<br>Placebo gel | Drug: Placebo<br>* Placebo transdermal gel (5 gr)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fat-Free Mass (kg) | Estimate of within subject absolute change in fat-free mass measured by DEXA (dual energy x-ray absorptiometry) at 3 months (90 days) interval during active or placebo treatment. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fat Mass (kg) | Estimate of within subject absolute change (Kg) in fat mass measured by DEXA at 3 months (90 days) interval during active or placebo treatment. | 3 months | 
| HOMA-IR (homeostasis model assessment)- (insulin resistance) | Estimate of within subject absolute change in measure of insulin resistance homeostatic model HOMA-IR. | 3 months | 
| CRP (C reactive protein) | C reactive protein (High sensitivity). | 3 months | 
| Interleukins | Within subject absolute and percentage change in serum: IL-1, IL-6, IL-10, IL-12, IL-2, IL-8, TNFa (tumor necrosis factor alpha) | 3 months | 
| Adipokines | Estimate of within subject absolute change in serum: ADIPONECTIN, LEPTIN, RESISTIN. | 3 months | 
| Waist circumference | Waist circumference (cm) | 3 months | 
| IIEF | International Index of Erectile Dysfunction | 3 months | 
| Penile CDU (color Doppler ultrasound) | Penile Color-Doppler Ultrasonography of cavernosal arteries before and after active or placebo treatment. | 3 months | 
| PSA (prostatic specific antigen) | PSA | 3 months | 
| Hb, Htc | haemoglobin and haematocrit | 3 months | 
| Fat-free mass |  | 6 months | 
| Fat Mass |  | 6 months | 
| HOMA-IR |  | 6 months | 
| CRP |  | 6 months | 
| Interleukins | Serum IL-1, IL-6, IL-10, IL-12, IL-2, IL-8, TNFa | 6 months | 
| Adipokines | Serum ADIPONECTIN, LEPTIN, RESISTIN. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adiponectin, Resistin, Adipocytes, Testosterone, Aging, HOMA-IR, Insulin, Hypogonadism, Metabolic Syndrome, Obesity, Erectile Dysfunction