Testosterone threshold levels and lean tissue mass targets needed to enhance skeletal muscle strength and function

Testosterone threshold levels and lean tissue mass targets needed to enhance skeletal muscle strength and function: the HORMA trial / Fred Sattler, Shalender Bhasin, Jiaxiu He, Chih-Ping Chou, Carmen Castaneda-Sceppa, Kevin Yarasheski, Ellen Binder, E. Todd Schroeder, Miwa Kawakubo, Anqi Zhang, Ronenn Roubenoff, Stanley Azen. - (Journals of Gerontology: Series A 66A (2011) 1 (January); p. 122-129)

  • PMID: 21059836
  • PMCID: PMC3032430
  • DOI: 10.1093/gerona/glq183


Background: In the HORMA (Hormonal Regulators of Muscle and Metabolism in Aging) Trial, supplemental testosterone and recombinant human growth hormone (rhGH) enhanced lean body mass, appendicular skeletal muscle mass, muscle performance, and physical function, but there was substantial interindividual variability in outcomes.

Methods: One hundred and twelve men aged 65-90 years received testosterone gel (5 g/d vs 10 g/d via Leydig cell clamp) and rhGH (0 vs 3 vs 5 μg/kg/d) in a double-masked 2 × 3 factorial design for 16 weeks. Outcomes included lean tissue mass by dual energy x-ray absorptiometry, one-repetition maximum strength, Margaria stair power, and activity questionnaires. We used pathway analysis to determine the relationship between changes in hormone levels, muscle mass, strength, and function.

Results: Increases in total testosterone of 1046 ng/dL (95% confidence interval = 1040-1051) and 898 ng/dL (95% confidence interval = 892-904) were necessary to achieve median increases in lean body mass of 1.5 kg and appendicular skeletal muscle mass of 0.8 kg, respectively, which were required to significantly enhance one-repetition maximum strength (≥ 30%). Co-treatment with rhGH lowered the testosterone levels (quantified using liquid chromatography-tandem mass spectrometry) necessary to reach these lean mass thresholds. Changes in one-repetition maximum strength were associated with increases in stair climbing power (r = .26, p = .01). Pathway analysis supported the model that changes in testosterone and insulin-like growth factor 1 levels are related to changes in lean body mass needed to enhance muscle performance and physical function. Testosterone's effects on physical activity were mediated through a different pathway because testosterone directly affected Physical Activity Score of the Elderly.

Conclusions: To enhance muscle strength and physical function, threshold improvements in lean body mass and appendicular skeletal muscle mass are necessary and these can be achieved by targeting changes in testosterone levels. rhGH augments the effects of testosterone. To maximize functional improvements, the doses of anabolic hormones should be titrated to achieve target blood levels.

Original document


Research / Study
8 November 2010
Azen, Stanley P.
Bhasin, Shalender
Binder, Ellen F.
Castaneda-Sceppa, Carmen
Chou, Chih-Ping
He, Jiaxiu
Kawakubo, Miwa
Roubenoff, Nonenn
Sattler, Fred R.
Schroeder, E. Todd
Yarasheski, Kevin E.
Zhang, Anqi
United States of America
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Boston University School of Public Health (BUSPH)
Tufts University
University of Southern California (USC)
Washington University in St. Louis (WUSTL)
Doping classes
S1. Anabolic Agents
S2. Peptide Hormones, Growth Factors
Growth hormone (GH)
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Legitimate Medical Treatment
Date generated
5 November 2020
Date of last modification
13 November 2020
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