When a person suffers from loss of muscle and fat tissue due to chronic illness, this condition is called cachexia.  The general loss of weight and muscle mass that naturally occurs with advancing age is called sarcopenia.  The term “catabolic wasting” encompasses both of these medical conditions.
Testosterone plays a critical role in muscle building and maintaining muscle mass, and many muscle-wasted patients are deficient in testosterone.  A study by Hager et al. even reported that testosterone levels were deficient in over 70% of men with cancer cachexia. The researchers observed that total testosterone levels were lower in cancer patients with cachexia compared to cancer patients without cachexia.
Another study by Yuki et al. demonstrated a significant relationship between baseline testosterone and muscle mass changes in Japanese men.  Data were collected from community-dwelling 957 adult men who participated in the study from 1997-2010. Interestingly, the researchers concluded that low free testosterone may be a predictor of risk for muscle loss in Japanese men.
Hypogonadism is common in patients undergoing hemodialysis and is associated with higher doses of medications, reduced muscle mass and lower physical activity. In a study conducted by Cobo et al., a strong link between low testosterone levels and physical inactivity was found which is believed to conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis. 
Since testosterone is known to boost muscle protein synthesis, muscle mass and strength, several researchers concluded that the decrease in testosterone may ultimately result in loss of muscle mass, especially in the older population where testosterone decline is a normal part of the aging process. With this in mind, several studies have investigated the effect of testosterone replacement therapy in older men with abnormally low testosterone concentrations.
For instance, a study by Tenover et al. found that intramuscular testosterone enanthate injections at a dose of 100 mg weekly for 3 months among healthy men, 57-76 years old, who had low or borderline blood testosterone levels, resulted in an increase in lean body mass.  This result suggests that testosterone supplementation may have a beneficial effect on age-related loss of muscle mass.
In another study assessing the effects of testosterone replacement therapy on older hypogonadal men (mean age 76 years), Morley et al. found that subjects who received testosterone enanthate injections at a dose of 200 mg/ml every 2 weeks for 3 months, had a significant increase in testosterone and bioavailable testosterone concentration, as well as right hand muscle strength, suggesting that testosterone treatment doesn’t only improve muscle mass but also muscle strength. 
In a similar study by Katznelson et al., testosterone enanthate injections at a dose of 100 mg/week for 18 months among 29 hypogonadal men significantly decreased body fat percentage and increased lean muscle mass without any adverse side effects.  These beneficial effects of testosterone provide additional indications for testosterone therapy in hypogonadal men.
Other studies also provide stronger evidence that other route of testosterone administration may also be beneficial in preventing age-related muscle loss. For instance, Ly et al. reported that daily skin application (transdermal) of 70 mg testosterone gel in older men with testosterone deficiency was able to improve lower limb muscle strength without any adverse effects. 
In a similar study, Kenny et al. found that transdermal testosterone at a dose of 5 mg/day decreased body fat and increased lean body mass in a group of healthy men over age 65 with low bioavailable testosterone levels. 
Not only does testosterone helps treat age-related loss of muscle mass and strength, it can also help build muscle and prevent further muscle loss caused by specific medical conditions. Gullet et al. reported that testosterone replacement therapy has been useful in promoting lean weight gain for patients with HIV/AIDS- or COPD-related cachexia.  Because loss of body weight, lean body mass, and fat tissue significantly increases these patients’ risk of dying from complications, testosterone supplementation can therefore prevent this from happening.
Studies even show that the oral testosterone derivative oxandrolone has been used for several years as a therapeutic intervention against unintentional weight loss associated with HIV/AIDS-related muscle wasting.  In a double-blind, randomized study, oxandrolone at doses of either 5 mg or 15 mg daily was effective in improving body weight and well-being in 63 HIV-positive men with weight loss of more than 10% of initial body weight. 
An overwhelming body of clinical research even found that testosterone may help improve muscle mass, strength and function in older persons with sarcopenia related to various health conditions. [389-394] Specifically, studies show that testosterone supplementation can prevent muscle wasting and improve functional capacity in patients with heart failure as well as testosterone deficiency.  In patients with chronic kidney disease, testosterone can also help improve handgrip strength and increase fat-free mass, suggesting that testosterone supplementation has a holistic positive effect on muscle mass, strength and function. 
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