Systemic testosterone therapy may lead to a delayed reduction in the need for inhaled steroid medications among male patients.
RT’s Three Key Takeaways:
- Delayed Steroid Reduction: Men receiving systemic testosterone therapy showed a statistically significant decrease in inhaled corticosteroid use starting 18 to 24 months after treatment initiation.
- COPD Patient Impact: The reduction in steroid requirements was primarily observed in patients with COPD rather than those with asthma.
- Increased Reliever Use: Despite lower steroid needs, older adults experienced an increase in short-acting beta-agonist (SABA) use, suggesting a need for careful monitoring.
Systemic testosterone treatment is associated with a delayed reduction in inhaled corticosteroid (ICS) use among males, according to a nationwide population-based cohort study published in Respiratory Medicine. Results suggest a complex relationship between androgen therapy and airway management in patients with obstructive airway diseases.
The study included 858 male individuals treated with ICS who initiated systemic testosterone therapy between 1995 and 2022. Participants had a mean age of 51 years, and researchers assessed outcomes using national Danish healthcare and prescription registry data. Investigators compared medication patterns and exacerbation rates before and after testosterone initiation using a within-subject design.
According to the study, ICS exposure remained stable during the first 18 months after testosterone treatment began. A statistically significant reduction emerged between 18 and 24 months, with a mean decrease of 54 μg in budesonide-equivalent dose. Subgroup analyses suggested that this reduction was mainly seen among participants with chronic obstructive pulmonary disease (COPD), rather than those with asthma or asthma and COPD overlap.
Despite the reduction in ICS use, short-acting beta-agonist (SABA) use increased after testosterone treatment initiation. While the overall increase was not statistically significant, SABA use rose by a mean of 111 doses per half year among participants older than 45 years.
Exacerbation rates did not change significantly after androgen therapy was initiated. However, the authors noted numerical trends toward higher annualized exacerbation rates, which means the clinical implications remain uncertain.
The delayed reduction in ICS requirements may reflect a gradual immunomodulatory effect of testosterone, although the study cannot establish causality, the authors said. They also highlighted that prescription fill data may not reflect actual adherence, disease control, or the precise indication for testosterone treatment in all participants.
These findings suggest that testosterone treatment may influence long-term respiratory medication patterns in selected patients. Still, the concurrent rise in reliever medication use, particularly in older adults, supports careful monitoring when systemic androgens are prescribed to people with obstructive airway disease.
Reference
Hansen ESH et al. Testosterone treatment and respiratory medications and exacerbations in people prescribed inhaled corticosteroids: a nationwide cohort study. Respiratory Medicine. 2026;260:108910. https://www.resmedjournal.com/article/S0954-6111(26)00278-7/fulltext
This article was originally published by AMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
