Effects of Testosterone Gel on Carbohydrate and Lipid Metabolism In Elderly Obese Men

Obesity Clinical Trial

Official title:

Investigator Initiated Study of the Effects of Androgen Therapy on Carbohydrate and Lipid Metabolism In Elderly Men

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00365794
• Other study ID #: GCRC Protocol 1156
• Status: Completed
• Phase: Phase 2
• Start date: August 2006
• Est. completion date: December 2014

Study information

• Verified date: August 2019
• Source: University of Southern California
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A. HYPOTHESES: In older men low testosterone levels, abdominal obesity and elevated fasting insulin who are at risk for the cardiovascular complications such as heart attack and stroke.

1. Supplemental testosterone will decrease abdominal adipose tissue and hepatic fat) and appendicular fat and intramyocellular lipid in peripheral muscles (IMCL).

2. Supplemental testosterone will improve insulin sensitivity by:

1. Decreasing hepatic glucose output (HGO), a measure of central insulin resistance

2. increasing peipheral glucose disposal (Rd), a measure of periperal insuln sensiivity

3. . Improving peripheral glucose disposal (Rd) by reducing IMCL

4. Increasing appendicular skeletal muscle mass

B. OBJECTIVES:

1. Primary Objective: To determine the effects of supplemental testosterone to achieve testosterone levels in the upper normal physiologic range on central adipose tissue (abdominal and hepatic fat) and peripheral skeletal muscle fat (appendicular fat and IMCL).

2. Secondary Objectives: To determine the effects of supplemental testosterone to achieve testosterone levels in the upper normal physiologic range:on central insulin sensitivity ( hepatic glucose output ([HGO]) and peripheral insulin sensitivity (glucose disposal (Rd)

Results of this study will provide greater understanding whether androgen therapy enhances insulin sensitivity by decreasing HGO, improving peripheral Rd and if these desired effects are achieved, whether they are due to reductions in abdominal fat or liver lipid, IMCL or effects of augmenting muscle mass per se.

Results will generate hypotheses to investigate cellular and molecular mechanisms of androgen effects in persons at risk for the Metabolic Syndrome.

Description:

Study Design: This is an investigator-initiated open label, study to investigate the effects of supplemental testosterone (gel formulation) to increase testosterone levels to the upper normal range in 12 older hypogonadal (testosterone levels less than 300 ng/dL) men with abdominal obesity and elevated fasting insulin levels. Subjects will be assigned to receive 10 g of transdermal testosterone (Androgel) every morning to achieve levels in the upper normal physiologic range (similar to men in the 3rd and 4th decades) for 20 weeks.

• For the primary objective, regional adipose tissue, namely DEXA measures of abdominal and appendicular fat mass and hepatic fat, and IMCL will be quantified by 1H-spectroscopy at baseline (study week 0) and at study week 20 (completion of study therapy).

• For the secondary objective, insulin sensitivity (peripheral Rd, hepatic glucose output [HGO]) and hepatic gluconeogenesis will be measured directly during a two stage hyperinsulinemic euglycemic clamp at baseline and study week 20.

• Indirect markers of lipid (adiponectin, ApoB 100) and carbohydrate metabolism (Fasting blood sugar, HOMA-IR) at study week 10, and study week 20.

All components of the study will be conducted in the USC NIH-funded (NCRR), General Clinical Research Center.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 22
• Est. completion date: December 2014
• Est. primary completion date: December 2013
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Male
• Age group: 60 Years to 90 Years

Eligibility

Inclusion Criteria:

• Entry Criteria:

• Men > 60 years of age

• Total testosterone < 300 ng/dL

• Waist circumference >102 cm

• Fasting insulin level > 18 U/L

Exclusion Criteria:

• PSA > 4.1, symptoms of obstructive uropathy (AUA score > 14), unexplained prostate nodule or gland firmness

• Hematocrit > 50%

• Malignancy other than cutaneous cancers

• Sleep apnea requiring CPAP

• History of myocardial infarction, angina or stroke within the previous 6 months

• Clinical diagnosis of diabetes or FPG > 126 mg/dL

• Hypothyroidism not controlled to euthyroid levels with medication for at least 3 months

• LDL-C >160 mg/dL

• Transaminases > 1.5X ULN

• Systemic anticoagulation with warfarin

• Active progressive resistance training

• Dieting for weight loss

• Active inflammatory condition (e.g. rheumatoid arthritis)

• Use of any anabolic agent (e.g. growth hormone, testosterone precursor, anabolic steroid)or cytokine therapy in the proceeding 12 months

Related Conditions & MeSH terms

• Aging
• Hypogonadism
• Insulin Resistance
• Obesity

Intervention

Drug:
• Topical testosterone gel 10 g/day
Testosterone gel therapy for 20 weeks

Locations

Country	Name	City	State
United States	LAC-USC Medical Center GCRC	Los Angeles	California

Sponsors (2)

Lead Sponsor	Collaborator
University of Southern California	Solvay Pharmaceuticals

Country where clinical trial is conducted

United States, 

References & Publications (1)

Sattler F, He J, Chukwuneke J, Kim H, Stewart Y, Colletti P, Yarasheski K, Buchanan T. Testosterone Supplementation Improves Carbohydrate and Lipid Metabolism in Some Older Men with Abdominal Obesity. J Gerontol Geriatr Res. 2014 Jun 7;3(3):1000159. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Total Mass and Regional Adipose Adiposiy	Change in total body mass, total fat mass, trunk fat, and extremity fat	Baseline to 20 weeks
Primary	Change in Hepatic Lipid	Amount of liver fat is highly predictive of insulin resistance. Hepatic fat is measured by MR spectroscopy and adjusted for H2O and results are reported as ratio of these two.	Baseline to week 20
Primary	Intramyocellular Lipid (IMCL)	IMCL is quantified by MR spectroscopy of the anterior tibialis muscle of the leg. The value is adjusted for creatine and reported as a ratio	Baseline to week 20
Secondary	Change in Percentage of Total Body Fat	Percentage of total body fat is quantified by DEXA scanning	Baseline and 20 weeks
Secondary	Change in Total and Regional Carbohydrate Metabolism During a 2-hr Hyperinsulinemic Euglycemic Clamp and [6,6-2H2] Glucose Studies (Peripheral Glucose Disposal [Rd],Hepatic Glucose Output [HGO])	In the final analysis, total and regional carbohydrate metabolism during a 2-hr hyperinsulinemic euglycemic clamp (peripheral glucose disposal [Rd],hepatic glucose output [HGO]) were analyzed by mass transfer of glucose during both stages of the clamp relative to insulin levels.	Baseline and 20 weeks
Secondary	Change in Skeletal Muscle Mass by DEXA	Skeletal muscle mass was assesed by regional DEXA to quantify appendicular lean tissues which is primarily muscle.	Baselne to 20 weeks
Secondary	Plasma Lipids		Baseline to week 20
Secondary	Change in HOMA-IR	HOMA-IR is a measure of insulin resistance	Baseline to week 20
Secondary	Change in Basal FFAs in Plasma	FFA (plasma free fatty acids) are measure of lipid metabolism	Baseline to week 20
Secondary	Change in Plasma Free Fatty Acids During Glucose Clamp		Baseline to 20 weeks