- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00365794
Effects of Testosterone Gel on Carbohydrate and Lipid Metabolism In Elderly Obese Men
Investigator Initiated Study of the Effects of Androgen Therapy on Carbohydrate and Lipid Metabolism In Elderly Men
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.
- Supplemental testosterone will decrease abdominal adipose tissue and hepatic fat) and appendicular fat and intramyocellular lipid in peripheral muscles (IMCL).
Supplemental testosterone will improve insulin sensitivity by:
- Decreasing hepatic glucose output (HGO), a measure of central insulin resistance
- increasing peipheral glucose disposal (Rd), a measure of periperal insuln sensiivity
- . Improving peripheral glucose disposal (Rd) by reducing IMCL
- Increasing appendicular skeletal muscle mass
B. OBJECTIVES:
- 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).
- 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.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed 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.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
California
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Los Angeles, California, United States, 90033
- LAC-USC Medical Center GCRC
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
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
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Single arm
Open label treatment without masking with each participant serving as his own control.
Measurements are compared before and after treatment.
|
Testosterone gel therapy for 20 weeks
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Total Mass and Regional Adipose Adiposiy
Time Frame: Baseline to 20 weeks
|
Change in total body mass, total fat mass, trunk fat, and extremity fat
|
Baseline to 20 weeks
|
Change in Hepatic Lipid
Time Frame: Baseline to week 20
|
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
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Intramyocellular Lipid (IMCL)
Time Frame: Baseline to week 20
|
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 Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Percentage of Total Body Fat
Time Frame: Baseline and 20 weeks
|
Percentage of total body fat is quantified by DEXA scanning
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Baseline and 20 weeks
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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])
Time Frame: Baseline and 20 weeks
|
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.
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Baseline and 20 weeks
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Change in Skeletal Muscle Mass by DEXA
Time Frame: Baselne to 20 weeks
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Skeletal muscle mass was assesed by regional DEXA to quantify appendicular lean tissues which is primarily muscle.
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Baselne to 20 weeks
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Plasma Lipids
Time Frame: Baseline to week 20
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Baseline to week 20
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Change in HOMA-IR
Time Frame: Baseline to week 20
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HOMA-IR is a measure of insulin resistance
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Baseline to week 20
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Change in Basal FFAs in Plasma
Time Frame: Baseline to week 20
|
FFA (plasma free fatty acids) are measure of lipid metabolism
|
Baseline to week 20
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Change in Plasma Free Fatty Acids During Glucose Clamp
Time Frame: Baseline to 20 weeks
|
Baseline to 20 weeks
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Fred R Sattler, MD, University of Southern California
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Glucose Metabolism Disorders
- Metabolic Diseases
- Endocrine System Diseases
- Gonadal Disorders
- Overnutrition
- Nutrition Disorders
- Overweight
- Body Weight
- Hyperinsulinism
- Obesity
- Insulin Resistance
- Hypogonadism
- Physiological Effects of Drugs
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Androgens
- Testosterone
Other Study ID Numbers
- GCRC Protocol 1156
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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