Men aged 65 years and older with unexplained anemia may benefit from measurement and treatment of testosterone levels, according to data published in JAMA Internal Medicine.
“The prevalence of anemia is approximately 10% in older adults and tends to be higher in men than in women,” Cindy N. Roy, PhD, of the divisions of geriatric medicine and gerontology and hematology at Johns Hopkins University, and colleagues wrote. “Several causes of anemia in the elderly are recognized, including iron and vitamin B12 deficiencies, chronic inflammation and disease, chronic renal insufficiency, and the myelodysplastic syndromes. In approximately one-third of older adults with anemia, however, no recognized cause can be found. No treatment has been shown to improve this unexplained anemia.”
Roy and colleagues evaluated if testosterone treatment corrects anemia and increases hemoglobin concentration in older men. Between June 2010 and June 2014, they performed a multicenter, double-blinded, placebo-controlled trial of 788 men aged 65 years or older (mean age, 74.8 years; 84.9% white) with average testosterone levels of less than 275 ng/dL. A total of 126 were anemic with hemoglobin levels of 12.7 g/dL or less, of whom 62 had no known cause. The researchers allocated participants to treatment by minimization. For 12 months, men received either a dose of testosterone gel, adjusted to maintain testosterone levels normal for young men, or placebo gel.
Significantly more men with unexplained anemia treated with testosterone therapy had an increase of hemoglobin levels by 1 g/dL or more over baseline at 12 months than those treated with placebo (54% vs. 15%; adjusted OR = 31.5; 95% CI, 3.7-277.8; P = .002). Men who underwent testosterone treatment were also more likely to no longer be anemic at 12 months than those treated with placebo (58.3% vs. 22.2%; adjusted OR = 17; 95% CI, 2.8-104; P = .002). In addition, testosterone treatment significantly increased hemoglobin levels by 1 g/dL or more in men with anemia of known cause at 12 months compared with placebo (52% vs. 19%; adjusted OR = 8.2; 95% CI, 2.1-31.9; P = .003). As a result of testosterone treatment, six men who had not been anemic at baseline had hemoglobin levels of more than 17.5 g/dL.
“Among older men with low testosterone, testosterone treatment significantly increased hemoglobin levels in those with unexplained anemia and those with anemia associated with known causes,” Roy and colleagues concluded. “These increases may be of clinical significance, as suggested by the magnitude of the increases and the correction of anemia in the majority of men. The overall health benefits, however, remain to be determined. These results also suggest that measurement of serum testosterone levels might be considered in men 65 years or older who have unexplained anemia and symptoms of hypogonadism.” – by Alaina Tedesco
Disclosure: The researchers report receiving support from the National Institute on Aging, supplemented by funds from the National Heart, Lung, and Blood Institute; National Institute of Neurological Diseases and Stroke and National Institute of Child Health and Human Development. Please see full study for complete list of all other relevant financial disclosures.