Use of testosterone replacement therapy in the rehabilitation of patients with intensive care unit-associated weakness and hospital-associated deconditioning: the Singapore General Hospital rehabilitation experience.

Mean grip strength improved by 4.2 kg (+24.9%) over the 2-week trial period in patients receiving adjunctive androgen therapy alongside standard rehabilitation.

• Five patients with ICU-associated weakness (ICU-AW) or hospital-associated deconditioning (HAD) were treated
• Grip strength was used as the primary outcome measure
• The mean improvement was 4.2 kg, representing a 24.9% increase
• The trial period was 2 weeks, described as an 'encouraging' timeframe for this magnitude of improvement

Four out of five subjects were found to be biochemically hypogonadal prior to initiation of testosterone replacement therapy.

• Sex hormone analysis was performed before initiation of TRT for all five subjects
• Four of the five patients (80%) met biochemical criteria for hypogonadism
• This finding suggests that hypogonadism may be prevalent in critically ill or deconditioned inpatients
• The retrospective analysis covered the period from April to November 2020

Functional recovery in terms of ambulation distance and level of assistance needed for ambulation improved during the 2-week treatment period.

• Improvements in distance ambulated were observed across subjects
• Subjects required less assistance for ambulation following treatment
• These functional gains were described as matching the grip strength improvements
• All subjects underwent standard rehabilitation therapy concurrently during the 2-week trial period

No subjects dropped out and no significant adverse events were reported during the 2-week androgen therapy trial.

• The sample consisted of five patients treated with either testosterone replacement therapy (TRT) or oxandrolone
• Treatment duration was 2 weeks
• Zero dropouts occurred over the trial period
• No significant adverse events were documented in any of the five subjects

All subjects except one improved to full independence at 3 months post-discharge.

• Four out of five subjects (80%) achieved full independence by 3-month follow-up
• One subject did not achieve full independence at 3 months post-discharge
• This outcome was assessed after the 2-week in-hospital androgen therapy trial and subsequent discharge
• The 3-month functional outcome was used as a longer-term measure beyond the primary grip strength endpoint

ICU-associated weakness and hospital-associated deconditioning contribute to poor long-term functional outcomes and increased mortality.

• These conditions were identified as a major focus of rehabilitation medicine in a tertiary care hospital setting
• The paper describes these conditions as motivating exploration of adjunctive androgen therapy to improve rehabilitative outcomes
• A multidisciplinary approach including optimal nutrition, rehabilitation, and testosterone therapy was recommended