Anabolic Therapies

Androgens

Serum testosterone levels decline with advancing age; however, the benefits of increasing serum levels by androgen supplementation are controversial. Testosterone has been shown to increase muscle mass in older men, but adverse effects on the prostate are greater and hematocrit levels are higher than in [Page 38]younger individuals. Oxandrolone is a chemical derivative of testosterone that increases muscle mass but has decreased toxicity. In the elderly, oxandrolone administered daily for 3-month intervals over a year resulted in improved appetite and mental improvement. More recently, the metabolic effects of oxandrolone were thoroughly evaluated in healthy, overweight elderly men. Highly significant reductions in abdominal fat were noted, and insulin sensitivity was improved. Positive effects were most pronounced in men with low testosterone levels, and the benefits were sustained for at least 12 weeks after discontinuation of therapy. Taken together, these preliminary studies suggest that oxandrolone significantly increases lean body mass and reduces body fat in healthy elderly men.

Dronabinol (Tetrahydrocannabinol)

Dronabinol, the active ingredient in marijuana, has been used as an antiemetic and appetite stimulant primarily in cancer and AIDS patients with mixed results. Little is known about the use of dronabinol in the elderly. Dronabinol, megestrol acetate (MA), and a combination of the two were compared in a randomized study of 469 cancer patients with a mean age of approximately 65 years. MA was superior to dronabinol in terms of appetite (75% vs. 49%) and in the number of participants who gained more than 10% of their body weight (11% vs. 3%). Combination therapy showed no advantage over MA alone. However, in one intriguing study of 15 Alzheimer's disease patients hospitalized on a dementia study unit, dronabinol increased body weight and improved resident behavior. No serious adverse reactions were noted. Taken together, these studies indicate that dronabinol is a weak orexigenic (appetite-stimulating) agent and is less potent than MA. There may be a role for its use in treating patients with dementia, but convincing evidence is lacking at the current time.

Megestrol Acetate

A review of 26 studies involving MA was published recently. The vast majority of these studies involved cancer (86%) and AIDS (11%) patients. MA increased appetite, led to weight gain, and improved quality of life. In the elderly, MA also has been shown to increase appetite and well-being. MA is well tolerated, although it is associated with an increased incidence of blood clots in the legs. MA also has been shown to cause muscle wasting and suppression of the adrenal glands.

...