Effect of Testosterone Replacement on Insulin Resistance

Study Overview
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Brief Summary
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This study aims to determine whether testosterone replacement improves insulin sensitivity in non-obese men with low testosterone and the metabolic syndrome. The metabolic syndrome includes three of the following five conditions, 1) an elevated blood pressure (greater than 130/85), 2) a triglyceride level greater than 150 mg/dl, 3) an HDL-cholesterol less than 40 mg/dl, 4) glucose levels greater than 100 mg/dl, and 5) a waist measurement greater than 40 inches.

Detailed Description
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In this proposal, we will examine the relationship between hypogonadism and insulin sensitivity. The strongest relationship between hypogonadism and insulin resistance appears to reside in men with the metabolic syndrome who have a normal BMI. The causal relationship between these two conditions is unknown. Therefore, we propose to determine if testosterone replacement in hypogonadal non-obese men with metabolic syndrome will improve insulin sensitivity. Data obtained from this preliminary investigation, will hopefully result in a hypothesis that can be tested in a larger, more rigorous trial in the future.

Official Title
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Effect of Testosterone Replacement on Insulin Resistance in Hypogonadal, Non-obese Men With Metabolic Syndrome

Conditions
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Metabolic Syndrome, Hypogonadism

Intervention / Treatment
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* Radiation: Testosterone gel
* Drug: Placebo for testosterone gel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: (subjects must meet both criteria) Metabolic syndrome (have 3 out of the following 4 criteria): BP > 130/85 or on antihypertensive therapy Fasting glucose > 100 mg/dl Fasting TG > 150 mg/dl or on a triglyceride lowering agent (fenofibrate, gemfibrozil, niacin in doses of >= 500 mg/day, or fish oils in doses of >=2000mg DHA+EPA) Fasting HDL-C < 40 mg/dl Note that the waist circumference will not be used as one of the criteria for the metabolic syndrome for this study because we are studying non-obese subjects. Total Testosterone less than 300 ng/dl Exclusion Criteria: Women. Men less than 20 years of age. BMI > or = to 30 kg/M2. Use of testosterone preparations within 1 year of the screening visit Use of hypoglycemic medications within the previous 3 months. Fasting blood glucose > 126 mg/dl. The following men will be excluded because of the potential safety issues in the placebo treated group: Creatinine greater than 1.4 mg/dl Triglyceride levels greater than 500 mg/dl HDL-C levels less than 20 mg/dl Blood pressure greater than 160/90 The following men will be excluded because of the potential side effects of testosterone therapy: Men greater than 65 years of age International prostate symptom score >19 PSA greater than 2.5 History of benign prostatic hypertrophy History of prostate cancer Abnormal digital rectal exam Hg greater than 16 mg/dl or Hct greater than 48% peripheral edema

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 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: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Subjects in this arm will receive testosterone gel | Radiation: Testosterone gel<br>* testosterone gel, applied daily. Dosed to achieve testosterone level <500 ng/dL. Possible doses include 2.5g, 5g, 7.5g or 10g gel packets.<br>* Other names: Androgel;|
| Placebo Comparator: 2<br> | Drug: Placebo for testosterone gel<br>* Placebo gel, 2.5g for each gel packet<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in insulin sensitivity as measured by HOMA-IR |  | 18 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in parameters of the Metabolic Syndrome |  | 18 weeks | 
| Changes in body composition |  | 18 weeks | 
| Changes in total and high MW adiponectin levels |  | 18 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Metabolic Syndrome, Hypogonadism, Insulin Resistance