Low Testosterone Levels and Decline in Physical Performance and Muscle Strength in Older Men: Findings From Two

Prospective Cohort Studies Laura A. Schaap; Saskia M. F. Pluijm; Dorly J. H. Deeg; Brenda W. Penninx; Barbara J. Nicklas; Paul Lips; Tamara B. Harris; Anne B. Newman; Steve B. Kritchevsky; Jane A. Cauley; Bret H. Goodpaster; Frances A. Tylavsky; Kristine Yaffe and Marjolein Visser; for the Health ABC study
Aim: To establish a direct relationship between decreasing muscle strength and physical performance in ageing men with a fall in serum testosterone levels. Introduction: Testosterone is a steroid hormone which falls into the androgen category. It is the primary sex hormone of men and its levels progressively decrease with age. In the past multiple studies have been conducted to establish a link between testosterone level and muscle performance. These observational studies collectively suggest that a decrease in testosterone corresponds with a decrease in muscular strength. Another study showed a similar relationship between the two variables but only until a threshold point had been reached. Temporal links between testosterone level and physical performance are still inconclusive and are an important topic for scientists as the establishment of these links could mean testosterone supplementation in ageing men to compensate for the loss of hormone in the body. Thus a loss of physical performance with age would be prevented. Method: This study comprises of two separate, self governing cohort studies (LASA and ABC) investigating the association between low total testosterone (tt) and free testosterone (ft), and progressive loss of physical performance and strength. n both studies performance tests were carried out at baseline and at a 3-year follow-up visit and included a timed walk test, a repeated chair stands test and a tandem stand using modified protocols. The scores of the three performance items were summed to a final score (range 012), where a lower score indicated a poorer physical performance. Change in physical performance was calculated as physical performance at 3-year follow-up minus baseline physical performance score. In both studies handgrip strength (kg)

was measured using a hand-held dynamometer. All dynamometers were regularly calibrated and checked for any abnormalities. The dynamometer was individually adjusted for hand size, and two trials were performed on each hand. The maximum values of the right and the left hand were summed. This is the first examination that
links both TT and FT to physical performance and strength using a prospective design. From the results obtained it can be evaluated that low baseline serum levels of TT and FT in older men are not associated with a degenerating physical performance and muscle strength. These results were consistent with two independent studies of older men. Results: The average (mean) displacement in physical performance was -1.19 ( SD 2.7, -13.6 %) as presented by LASA and -0.3 (SD 1.5, -2.9%) (Fig.1). The mean change in grip strength after a period of 3 years was -9.7 (sd12.2, -13.2%) in LASA and -4.4 kg( SD 11.4, -5.8 %) in health ABC(fig 2). Decreased hormonal levels of TT did not show much/any correlation with a decline in physical performance or strength.

Discussion: Low levels of TT and FT were neither associated with 3-year decline in physical performance nor with 3-year decline in muscle strength in two independent samples of older men.