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Effect of testosterone and a nutritional supplement, alone and in combination, on hospital admissions in undernourished older men and women

¹ From the Division of Medicine, University of Adelaide Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia (IMC, AJH, JBFF, KT, DPB, RYTC, and MH); Aged and Extended Care Service, Division of Medicine, University of Adelaide, Queen Elizabeth Hospital, Adelaide, Australia (RV); and the Department of Geriatrics, St Louis University, St Louis, MO (JEM).

² Supported by a grant from Organon, Netherlands. Robert Penhall, Director, Eastern Domiciliary Care Services, Adelaide, Australia, generously arranged for the use of a car from that service for home visits.

³ Reprints not available. Address correspondence to IM Chapman, the Division of Medicine, University of Adelaide Department of Medicine, Level 6, Eleanor Harrald Building, Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia. E-mail: ian.chapman{at}adelaide.edu.au.

Background: In older people, undernutrition is associated with increased hospitalization rates and mortality. Because weight loss in older people often reflects a disproportionate reduction of skeletal muscle, anabolic treatments may be beneficial.

Objective: Our aim was to evaluate the hypothesis that testosterone treatment and a nutritional supplement have additive benefits.

Design: Oral testosterone undecanoate (40 mg daily for women, 80 mg twice daily for men) and an oral nutritional supplement (475 kcal/d) were administered, alone or combined, for 1 y to 49 community-dwelling, undernourished people [Mini Nutritional Assessment score <24 and low body weight (body mass index, in kg/m²: <22) or recent weight loss (>7.5% over 3 mo)] aged >65 y (mean age: 77 y; 26 women and 23 men). Hospital admissions and other variables were assessed.

Results: In subjects receiving combined testosterone and nutritional supplements (n = 11), there were no hospital admissions, whereas there were 9 admissions (2 elective) in 13 subjects in the no-treatment group, 4 in the testosterone-treated group (n = 12), and 5 in the supplement-treated group (n = 13); P = 0.06 with no-treatment compared with combined treatment. When compared with the no-treatment group, the combined-treatment group had significantly fewer subjects admitted to hospital (0 compared with 5, P = 0.03), fewer days in hospital (0 compared with 74, P = 0.041), and a longer time to hospital admission (P = 0.017).

Conclusions: In undernourished older people, combined treatment with testosterone and nutritional supplementation reduced the number of people hospitalized and the duration of hospital admissions, which are important endpoints in this group. Larger, confirmatory studies are now needed. This trial was registered before commencement at clinical trials.gov as NCT00117000.

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