Review of trials shows testosterone increases lean body mass, and is most effective when given intramuscularly

A review of randomised, placebo-controlled trials concludes that testosterone therapy increases lean body mass more than placebo in HIV-positive patients with wasting. And the researchers at St Bartholomew’s Hospital in London also conclude that the increase is even greater if the therapy is given intramuscularly.

Anthony Kong and colleagues report that eight trials met the inclusion criteria and 417 randomised patients were included. Only six trials used lean body mass, fat-free mass, or body cell mass as outcome measures and meta-analysis of these showed a difference in lean body mass between the testosterone group and the placebo group of 1.22kg for the random effect model and 0.51kg for fixed effect.

The researchers draw attention to the fact that the difference was much greater in three trials that used the intramuscular route: 3.34kg in the post hoc analysis.

All eight trials included total body weight as an outcome measure, the meta-analysis of which showed a difference of 1.04kg by random effect and 0.63kg for fixed effect models. The incidence of adverse effects was similar in both groups.

The researchers warn that the study is limited by the small numbers and heterogeneity of the population, but nonetheless they write: “Testosterone therapy may be considered in patients with HIV wasting syndrome to reverse muscular loss, but there is a concern about the adverse metabolic effects of long-term testosterone administration and long-term follow-up for these patients is needed.”