From the Guidelines
Testosterone therapy is associated with a less-than-small improvement in objective physical function as measured by gait, and may be considered for patients with gait impairment and low testosterone levels. When evaluating the efficacy of testosterone treatment on gait impairment, it is essential to consider the results of high-quality studies, such as the one published in the Annals of Internal Medicine 1. This study found that testosterone treatment was associated with a small improvement in gait speed, as measured by the 6-minute walk test, with a standardized mean difference (SMD) of 0.14 [CI, 0.02 to 0.27]. Some key points to consider when prescribing testosterone therapy for gait impairment include:
- The patient's baseline testosterone level, as treatment is most effective in those with confirmed low testosterone levels
- The use of intramuscular or transdermal testosterone formulations, with typical regimens including testosterone cypionate 50-100mg intramuscularly every 1-2 weeks, or testosterone gel 50-100mg applied daily to the shoulders, upper arms, or abdomen
- Regular monitoring of testosterone levels, aiming for mid-normal range levels (400-700 ng/dL), and assessment of gait parameters and muscle strength
- Baseline prostate-specific antigen (PSA) testing and hematocrit measurement, as well as regular follow-up evaluations to monitor for side effects such as fluid retention, sleep apnea, or polycythemia
- The potential benefits of combining testosterone replacement with physical therapy to yield better results than hormone therapy alone.
From the Research
Testosterone Therapy and Gait Impairment
- There is limited direct evidence on the relationship between testosterone therapy and gait impairment.
- However, a study published in 2013 2 found that the addition of physiotherapy to testosterone replacement therapy improved functional capacity of the motor system in men with hypogonadism, which may have a positive impact on gait.
- The study measured physical activity and body composition, and applied the vertical jump test, finding significant increases in maximum and relative power of jump in the group receiving testosterone replacement therapy with physiotherapy.
- Other studies have focused on the benefits and risks of testosterone therapy in general, without specifically addressing gait impairment 3, 4, 5, 6.
- These studies suggest that testosterone therapy may improve muscle mass and bone density, which could potentially have a positive impact on gait, but more research is needed to fully understand this relationship.