Muscle function following testosterone replacement in men on opioid therapy for chronic non‐cancer pain ‐ a randomized controlled trial

Background

: Chronic pain and opioid treatment are associated with increased risk of male hypogonadism and subsequently decreased muscle function. A diagnosis of hypogonadism is based on the presence of low total testosterone (TT) and associated symptoms. The effect of testosterone replacement therapy (TRT) on muscle function in men with chronic pain and low TT remains to be investigated.

Objectives

: To investigate effects of TRT on muscle function and gait performance in men treated with opioids for chronic non-cancer pain.

Materials and methods

: Double-blind, placebo-controlled study. 41 men (>18 years) with opioid-treated chronic pain and serum total testosterone <12 nmol/L were randomized to 24 weeks TRT (Testosterone undecanoate injection three times/6 months, n  = 20) or placebo injections (n  = 21). Muscle function was measured as leg press maximal voluntary contraction (LP-MVC), leg extension power using the Nottingham power rig and handgrip strength using a handheld dynameter. Gait performance was measured at usual and maximal gait speed on a 10-m track. Body composition (lean body mass and fat mass) was determined by Dual-energy X-ray Absorptiometry. Mann-Whitney tests were performed on ∆-values (24–0 weeks) between TRT and placebo.

Results

: At baseline, median (interquartile range) age was 55 ± 13 years and BMI was 30.7 ± 5.2 kg/m2. ∆-muscle function and ∆-gait performance were similar between TRT and placebo. Median ∆-LP-MVC was 174.2 ± 406.7 Newton following TRT and 7.6 ± 419.1 Newton after placebo, p = 0.091. ∆-lean body mass was significantly higher following TRT compared to placebo, 3.6 ± 2.7 vs 0.1 ± 3.5 kg, respectively (p <0.001).

Discussion

: TRT, compared to placebo, did not improve muscle function or gait performance despite increased lean body mass. Changes in body composition did not infer any changes in muscle function.

Conclusion

: 24 weeks TRT in opioid treated men with pain-related male hypogonadism did not improve muscle function.

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