ClinicalTrials.gg
CompletedNCT03490513Updated Oct 19, 2026Results posted

Aromatase Inhibitors and Weight Loss in Severely Obese Men With Hypogonadism

A Phase 4 interventional study of anastrozole (1 mg/day) and Placebo in Hypogonadism, Hypogonadotropic and Obesity, sponsored by Baylor College of Medicine. Completed at 1 site in United States. Open to male participants aged 40 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-10-19.

Sponsored by Baylor College of Medicine · Phase 4, Interventional, and Treatment

Updated Oct 19, 2026Results postedStudy documents posted+5 moreGo to Updates ↓
Phase
Phase 4
Study type
Interventional
Enrollment
121
Allocation
Randomized
Ages
40 Years to 65 Years
Sex
Male
01

Study summary

The investigators have preliminary data suggesting that obese patients with hypogonadotropic hypogonadism (HHG) have minimal benefit from testosterone therapy likely because of its conversion to estradiol by the abundant aromatase enzyme in the adipocytes. The increased conversion of androgens into estrogens in obese men results in a negative feedback of high estradiol levels on hypothalamus and pituitary, inhibiting the production of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and follicle stimulating hormone (FSH) and, as a consequence, of testosterone by the testis. Testosterone administration could increase estradiol production, further promoting the inhibitory feedback to the hypothalamic-pituitary-gonadal axis. Although weight loss from lifestyle modification has been shown to reduce estradiol and increase testosterone levels, the effect is at best modest and weight regain results in recurrence of hypogonadism. The use of aromatase inhibitors, in combination with weight loss, could be an effective alternative strategy due to its action at the pathophysiology of the disease.

Intervention Subjects (body mass index of ≥35, testosterone \<300 ng/dl) will be randomized to the active (anastrozole) or control (placebo) group. Anastrozole 1 mg tablet / day will be self-administered with or without food, at around the same time every day (active group); placebo 1 tablet/day with or without food to take at around the same time every day (control group). The study duration will be 12 months.

Both groups will undergo lifestyle intervention consisting of diet and supervised exercise program. Target weight loss will be at least 10% of baseline body weight during the intervention. Subjects will attend weekly group behavior modification sessions which will last \~75-90 min for the first 3 months and decreased to every two weeks from 3 to 12 months. Subjects will attend supervised research center-based exercise sessions during the first 6 months followed by community fitness center-based sessions during the next 6 months for at least 2 d/wk, with recording of home-based exercises for the other 2-4 days/week.

Although the above original protocol requires the participants to come to our center for dietary and exercise training, since the Covid19 pandemic, study participants were given the following options for lifestyle intervention: 1) in-person visits at our facility for dietary classes and exercise training, 2) to enlist in the gym of their choice with membership paid for by the study, or 3) virtual method of lifestyle intervention. These amendments were put in place due to Covid 19 restrictions; however, we decided to keep these methods because most of our subjects prefer them over coming for in-person visits at our lab even after COVID restrictions were lifted. Since the study had just the first 25 subjects enrolled prior to COVID outbreak, majority of the subject's lifestyle interventions were done by virtual dietary classes every week for the first 3 months and then every 2 weeks thereafter either as a group or by one-on-one sessions. Exercise program was also supervised by exercise physiologist virtually or by phone for subjects who want to exercise at a community gym

Read the detailed description

After age of 40, testosterone (T) production in men gradually decreases at a rate of 1.6% per year for total and to 2-3% per year for bioavailable T. This reduction in T production in men parallels the age-associated loss of muscle mass that leads to sarcopenia and impairment of function and the age-associated loss of bone mass that leads to osteopenia and fracture risk.

Hypogonadism is a condition associated with multiple symptom complex including fatigue, depressed mood, osteoporosis, gain of fat mass, loss of libido and reduced muscle strength, all of which deeply affect patient quality of life. The prevalence of hypogonadism among obese men was estimated to be as much as 40% and could as much as 50% if they are also diabetic, with levels of androgens decreasing proportionately to the degree of obesity.

In obese men, the age-related decline in T is exacerbated by the suppression of the hypothalamic-pituitary-gonadal axis by hyperestrogenemia. The high expression of aromatase enzyme in the adipose tissue enhances the conversion of androgens into estrogens which in turn exerts a negative feedback on hypothalamus and pituitary, inhibiting the production of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and follicle stimulating hormone (FSH) and, as a consequence, of T by the testis resulting in hypogonadotropic hypogonadism (HH). Considering the high aromatase expression in the adipose tissue, the administration of T among obese men with HHG could increase the conversion of the substrate T to estradiol (E2) and fuels the negative feedback on hypothalamus and pituitary, producing a greater suppression of GnRH and gonadotropins. Thus, men with obesity induced HHG may benefit from other treatment strategies that target the pathophysiology of the disease.

Although weight loss intervention improves hormonal and metabolic abnormalities related to obesity, the increase in T levels induced by weight loss are often lost due to weight regain, which is very frequent among patients undergoing massive weight loss. One possible approach is the use of aromatase inhibitors (AI) to stop the conversion of T to E2 thereby interrupting the vicious cycle of E2 inhibition of the hypothalamic-pituitary-gonadal axis and restoring T production to normal levels. Since weight loss remains the standard of care for obese patients, the investigators propose the following OBJECTIVES:

  1. To evaluate the effect of an AI plus WL (AI+WL) compared to WL alone on the changes in hormonal profile in severely obese men with HHG.
  2. To evaluate the effect of an AI+WL compared to WL alone on the changes in muscle strength and muscle mass, and symptoms of hypogonadism in severely obese men with HHG.
  3. To evaluate the effect of an AI+WL compared to WL alone on the changes in body composition and metabolic risk factors in severely obese men with HHG.
  4. To evaluate the effect of an AI+WL compared to WL alone on the changes in bone mineral density (BMD), bone markers, and bone quality in severely obese men with HHG.

As secondary aim, the investigators will elucidate the mechanism for the anticipated positive effects of AI+WL on obesity-associated HHG.

This is a randomized double-blind placebo-controlled study comparing the effect of weight loss + anastrozole to weight loss + placebo for 12 months on the hormonal profile and symptoms associated with hypogonadism in severely obese men with a body mass index (BMI) of more or equal to 35 kg/m2.

02

Conditions studied

  • Hypogonadism, Hypogonadotropic
  • Obesity

Keywords

  • obesity, hypogonadism, testosterone, aromatase inhibitors, weight loss
03

In context

Hypogonadism

320 studies on the registry are indexed under Hypogonadism; 39 are open to participants now.

This study's enrollment of 121 is above the median of 50 across 243 interventional studies indexed under Hypogonadism.

Browse Hypogonadism studies →

Lead sponsor

Baylor College of Medicine is the lead sponsor of 747 studies on the registry; 110 are open to participants now.

Of its 84 completed or terminated interventional studies of FDA-regulated products, 45 (54%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
40 Years to 65 Years
Sexes eligible
Male
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • obese men with (BMI) of ≥35 kg/m2
  • age between 40 to 65 years old
  • average fasting testosterone level from 2 measurements taken between 8 to 10 AM on 2 separate days of \<300 ng/dl
  • Luteinizing Hormone (LH) of \<9.0 mIU/L
  • Estradiol of ≥17 pg/ml
  • Symptoms consistent with androgen deficiency as assessed by Androgen Deficiency in Aging Male (ADAM) questionnaire

Exclusion criteria

Exclusion criteria:

  • pituitary or hypothalamic disease,
  • drugs affecting gonadal hormone levels, production and action or bone metabolism (bisphosphonates, teriparatide, denosumab, , phenytoin)
  • diseases affecting bone metabolism (e.g. hyperparathyroidism, untreated hyperthyroidism, osteomalacia, chronic liver disease, significant renal failure, hypercortisolism, malabsorption, immobilization, Paget's disease),
  • prostate carcinoma or elevated serum prostate specific antigen (PSA)> 4 ng/ml,
  • Hematocrit > 50%,
  • untreated severe obstructive sleep apnea,
  • Cardiopulmonary disease (e.g. recent myocardial infarction, unstable angina, stroke) or unstable disease (e.g., Class III or IV congestive heart failure
  • severe pulmonary disease requiring steroid pills or the use of supplemental oxygen (that would contraindicate exercise or dietary restriction)
  • History of deep vein thrombosis or pulmonary embolism
  • severe lower urinary tract or prostate symptoms with International Prostate Symptom Score (IPSS) above 19
  • excessive alcohol or substance abuse
  • unstable weight (i.e. >±2 kg) in the last 3 months
  • condition that could prevent from completing the study
  • screening bone mineral density (BMD) T-score of \<-2.0 at the spine, femoral neck or total femur
  • history of osteoporosis or fragility fracture
  • Diabetes mellitus with a fasting blood glucose of >140 mg/dl, and/or (A1C) >8.5%.
Terms in these criteria, in plain language(4)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

BMI (body mass index)

Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.

What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

HbA1c

A blood test of average blood sugar over the past two to three months, given as a percentage or in mmol/mol. 6.5% (48 mmol/mol) or more is the usual threshold for diabetes, normally confirmed by a second test.

05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
121 participants (actual)

Study arms

  • Placebo comparator
    placebo

    Participants will take a placebo every day

    Drug: Placebo

  • Experimental
    anastrozole

    Participants will take Anastrozole 1mg per day

    Drug: anastrozole (1 mg/day)

Interventions

  • Druganastrozole (1 mg/day)

    Drug page: Anastrozole

    Participants will take Anastrozole 1mg per day, attend behavioral classes conducted by a dietitian, receive instruction on how to loss 10% of their body weight and participate in a supervised exercise training program.

    Also known as: Weight loss

  • DrugPlacebo

    Participants will take a placebo tablet every day, attend behavioral classes conducted by a dietitian, receive instruction on how to loss 10% of their body weight and participate in a supervised exercise training program.

    Also known as: Weight loss

06

What researchers measure

Primary outcomes

  1. Change in Serum Testosterone From Baseline to 12 Months

    Change in serum testosterone levels from baseline to 12 months. An increase in testosterone levels suggests in improvement in hormonal profile in men with hypogonadism or low testosterone.

    Time frame: 12 months

  2. Percent Change in Muscle Strength From Baseline to 12 Months

    Percent change in muscle strength (in Newton-meters) as assessed by knee extension strength using a Biodex machine from baseline to 12 months. An increase in knee extension indicates an improvement in muscle strength of the lower extremity.

    Time frame: 12 months

  3. Percent Change in Total Lean Mass From Baseline to 12 Months.

    Percent change in total lean mass (in kilograms) as measured by dual energy x-ray absorptiometry from baseline to 12 months. An increase in lean mass suggests an increase in muscle mass while a reduction implies the opposite.

    Time frame: 12 months

  4. Percent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.

    Precent change in total hip areal bone mineral density (aBMD) in g/cm2 as assessed by dual energy absorptiometry of the proximal left femur (right if left had surgery) from baseline to 12 months. An increase in hip aBMD indicates improvement in hip bone mass while a reduction suggests the opposite.

    Time frame: 12 months

Secondary outcomes

  1. Change in Estradiol From Baseline to 12 Months.

    Change in serum estradiol levels from baseline to 12 months. Men with obesity have high estradiol levels due to increase conversion of testosterone to estradiol in the abundant fat tissues. A reduction in estradiol in men with obesity from weight loss, with or without anastrozole, suggests an improvement in hormonal profile.

    Time frame: 12 months

  2. Change in Luteinizing Hormone Levels From Baseline to 12 Months.

    Change in serum luteinizing hormone (LH) levels from baseline to 12 months. In men with obesity, LH level is suppressed due to high estradiol level. An increase in LH from weight loss, with or without anastrozole, indicates improvement in hormonal profile.

    Time frame: 12 months

  3. Change in Follicle Stimulating Hormone Levels From Baseline to 12 Months

    Change in serum follicle stimulating hormone (FSH) from baseline to 12 months. In men with obesity, FSH level is suppressed due to high estradiol level. An increase in FSH from weight loss, with or without anastrozole, indicates improvement in hormonal profile.

    Time frame: 12 months

  4. Changes in Thigh Muscle Volume

    Assessed magnetic resonance imaging of both thighs.

    Time frame: 12 months

  5. Percent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.

    Percent change in symptoms of hypogonadism from baseline to 12 months as assessed by the quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire; higher scores indicate better outcome. Minimum score is 10 (poorest, i.e. most symptomatic) and the highest score is 50 (excellent, i.e. least symptomatic). Percent changes in scores from baseline to 12 months were calculated. An increase in scores from baseline indicates improvement in symptoms of low testosterone or hypogonadism.

    Time frame: 12 months

  6. Changes in Symptoms of Hypogonadism Using International Index of Erectile Function (IIEF) Questionnaire

    Assessed by the International Index of Erectile Function (IIEF) questionnaire; higher scores indicating better outcome. Minimum score is 0 (poorest or most symptomatic) and maximum score is 75 (excellent or least symptomatic). Percent change in scores from baseline to 12 months were calculated. An increase in scores from baseline indicates an improvement in erectile symptoms.

    Time frame: 12 months

  7. Changes in Symptoms of Hypogonadism and Obesity

    Evaluated by the Impact of Weight on Quality of Life questionnaire which assesses weight-related quality of life and include 5 domains as: Physical Function (11 items), Self-Esteem (7 items), Sexual Life (4 items), Public Distress (5 items), Work (4 items)

    Time frame: 12 months

  8. Percent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.

    Percent change in visceral adipose tissue (VAT) volume (in cubic centimeter) measured by dual energy X-ray absorptiometry from baseline to 12 months. High VAT volume is associated with increased metabolic dysfunction and inflammation. A reduction in VAT from weight loss is usually associated with improvement in metabolic and inflammatory profile.

    Time frame: 12 months

  9. Percent Change in Hemoglobin A1C From Baseline to 12 Months.

    Percent change in hemoglobin A1C (A1C, unit in %)) in the blood from baseline to 12 months. A reduction in A1C indicates an improvement in glucometabolic homeostasis.

    Time frame: 12 months

  10. Percent Change in Low Density Cholesterol Levels From Baseline to 12 Months.

    Percent change in serum low density cholesterol (LDL, unit in mg/dl) levels from baseline to 12 months. A reduction in LDL cholesterol indicates in improvement lipid metabolism.

    Time frame: 12 months

  11. Percent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.

    Percent change in serum homeostatic model assessment for insulin resistance (HOMA-IR, unitless as it is an index) calculated as (insulin \[microU/L\] x glucose \[mg/dl\])/405, from baseline to 12 months. A reduction in HOMA-IR indicates improvement in insulin resistance.

    Time frame: 12 months

  12. Percent Change in Total Volumetric Bone Density of the Radius

    Percent change in total volumetric bone mineral density (vBMD, unit in milligrams per cubic centimeter) of the radius by high-resolution peripheral quantitative computer tomography from baseline to 12 months. An increase in vBMD indicates bone gain while a reduction suggests bone loss.

    Time frame: 12 months

  13. Percent Change in Failure Load at the Radius From Baseline to 12 Months,

    Percent change in failure load (unit in kilo-Newtons or Kn), a measure of bone strength, assessed by high-resolution peripheral quantitative computer tomography of the radius from baseline to 12 months. An increase in failure load indicates increase in bone strength while the reduction suggests the opposite

    Time frame: 12 months

  14. Percent Change in C-terminal Telopeptide of Type I Collagen (CTX)

    Percent change in serum C-terminal telopeptide of type I collagen (CTX) (unit in ng/ml), a marker of bone resorption, from baseline to 12 months. An increase in CTX indicates increased bone resorption which contributes to bone loss, while a reduction suggests decreased bone resorption.

    Time frame: 12 months

  15. Percent Change in Osteocalcin From Baseline to 12 Months.

    Percent change in serum osteocalcin (unit in ng/ml), a marker of bone formation, from baseline to 12 months. An increase in osteocalcin suggests an increase in bone formation.

    Time frame: 12 months

  16. Percent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 Months

    Percent change in serum N-terminal propeptide (P1NP) (unit in ng/ml), a marker of bone formation, from baseline to 12 months. An increase in P1NP suggests an increase in bone formation.

    Time frame: 12 months

07

Results

Posted Oct 19, 2026

Participant flow

Participants were recruited by letters, and flyers, and from referrals from the different clinics (mainly Primary Care, and Endocrine Clinics) at the Michael E. DeBakey VA Medical Center from May 1, 2018 to June 30, 2024.

Participant flow — Overall Study
MilestonePlacebo N=60Anastrozole N=61
Started6061
Completed3948
Not completed2113

Outcome measures

PrimaryChange in Serum Testosterone From Baseline to 12 Months

Change in serum testosterone levels from baseline to 12 months. An increase in testosterone levels suggests in improvement in hormonal profile in men with hypogonadism or low testosterone.

Time frame:
12 months
Reported as:
Mean · change in ng/dl from baseline
Change in Serum Testosterone From Baseline to 12 Months
change in ng/dl from baselineAnastrozolePlacebo
Change in Serum Testosterone From Baseline to 12 Months137.7 ± 120.038.6 ± 85.2
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = <0.001
PrimaryPercent Change in Muscle Strength From Baseline to 12 Months

Percent change in muscle strength (in Newton-meters) as assessed by knee extension strength using a Biodex machine from baseline to 12 months. An increase in knee extension indicates an improvement in muscle strength of the lower extremity.

Time frame:
12 months
Reported as:
Mean · % change from baseline to 12 months
Percent Change in Muscle Strength From Baseline to 12 Months
% change from baseline to 12 monthsAnastrozolePlacebo
Percent Change in Muscle Strength From Baseline to 12 Months9.14 ± 23.915.1 ± 43.8
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.91
PrimaryPercent Change in Total Lean Mass From Baseline to 12 Months.

Percent change in total lean mass (in kilograms) as measured by dual energy x-ray absorptiometry from baseline to 12 months. An increase in lean mass suggests an increase in muscle mass while a reduction implies the opposite.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Total Lean Mass From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Total Lean Mass From Baseline to 12 Months.-1.0 ± 3.7-2.1 ± 4.4
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.31
PrimaryPercent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.

Precent change in total hip areal bone mineral density (aBMD) in g/cm2 as assessed by dual energy absorptiometry of the proximal left femur (right if left had surgery) from baseline to 12 months. An increase in hip aBMD indicates improvement in hip bone mass while a reduction suggests the opposite.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.-0.08 ± 4.60.98 ± 4.9
Statistical analysis
  • Anastrozole · Kruskal-Wallis · p = 0.23
SecondaryChange in Estradiol From Baseline to 12 Months.

Change in serum estradiol levels from baseline to 12 months. Men with obesity have high estradiol levels due to increase conversion of testosterone to estradiol in the abundant fat tissues. A reduction in estradiol in men with obesity from weight loss, with or without anastrozole, suggests an improvement in hormonal profile.

Time frame:
12 months
Reported as:
Mean · change in pg/ml from baseline
Change in Estradiol From Baseline to 12 Months.
change in pg/ml from baselineAnastrozolePlacebo
Change in Estradiol From Baseline to 12 Months.-13.1 ± 13.7-1.43 ± 8.22
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = <0.001
SecondaryChange in Luteinizing Hormone Levels From Baseline to 12 Months.

Change in serum luteinizing hormone (LH) levels from baseline to 12 months. In men with obesity, LH level is suppressed due to high estradiol level. An increase in LH from weight loss, with or without anastrozole, indicates improvement in hormonal profile.

Time frame:
12 months
Reported as:
Mean · Change in mIU/ml from baseline
Change in Luteinizing Hormone Levels From Baseline to 12 Months.
Change in mIU/ml from baselineAnastrozolePlacebo
Change in Luteinizing Hormone Levels From Baseline to 12 Months.2.06 ± 4.670.39 ± 1.78
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = <0.009
SecondaryChange in Follicle Stimulating Hormone Levels From Baseline to 12 Months

Change in serum follicle stimulating hormone (FSH) from baseline to 12 months. In men with obesity, FSH level is suppressed due to high estradiol level. An increase in FSH from weight loss, with or without anastrozole, indicates improvement in hormonal profile.

Time frame:
12 months
Reported as:
Mean · Change in mIU/ml from baseline
Change in Follicle Stimulating Hormone Levels From Baseline to 12 Months
Change in mIU/ml from baselineAnastrozolePlacebo
Change in Follicle Stimulating Hormone Levels From Baseline to 12 Months5.42 ± 6.810.44 ± 3.12
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = <0.001
SecondaryChanges in Thigh Muscle Volume

Assessed magnetic resonance imaging of both thighs.

Time frame:
12 months

Results for this outcome have not been posted.

SecondaryPercent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.

Percent change in symptoms of hypogonadism from baseline to 12 months as assessed by the quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire; higher scores indicate better outcome. Minimum score is 10 (poorest, i.e. most symptomatic) and the highest score is 50 (excellent, i.e. least symptomatic). Percent changes in scores from baseline to 12 months were calculated. An increase in scores from baseline indicates improvement in symptoms of low testosterone or hypogonadism.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.3.8 ± 22.121.5 ± 30.9
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.008
SecondaryChanges in Symptoms of Hypogonadism Using International Index of Erectile Function (IIEF) Questionnaire

Assessed by the International Index of Erectile Function (IIEF) questionnaire; higher scores indicating better outcome. Minimum score is 0 (poorest or most symptomatic) and maximum score is 75 (excellent or least symptomatic). Percent change in scores from baseline to 12 months were calculated. An increase in scores from baseline indicates an improvement in erectile symptoms.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Changes in Symptoms of Hypogonadism Using International Index of Erectile Function (IIEF) Questionnaire
% change from baselineAnastrozolePlacebo
Changes in Symptoms of Hypogonadism Using International Index of Erectile Function (IIEF) Questionnaire2.1 ± 31.431.5 ± 85.1
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = <0.05
SecondaryChanges in Symptoms of Hypogonadism and Obesity

Evaluated by the Impact of Weight on Quality of Life questionnaire which assesses weight-related quality of life and include 5 domains as: Physical Function (11 items), Self-Esteem (7 items), Sexual Life (4 items), Public Distress (5 items), Work (4 items)

Time frame:
12 months

Results for this outcome have not been posted.

SecondaryPercent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.

Percent change in visceral adipose tissue (VAT) volume (in cubic centimeter) measured by dual energy X-ray absorptiometry from baseline to 12 months. High VAT volume is associated with increased metabolic dysfunction and inflammation. A reduction in VAT from weight loss is usually associated with improvement in metabolic and inflammatory profile.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.-3.8 ± 27.7-6.1 ± 33.1
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.63
SecondaryPercent Change in Hemoglobin A1C From Baseline to 12 Months.

Percent change in hemoglobin A1C (A1C, unit in %)) in the blood from baseline to 12 months. A reduction in A1C indicates an improvement in glucometabolic homeostasis.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Hemoglobin A1C From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Hemoglobin A1C From Baseline to 12 Months.1.67 ± 14.5-2.58 ± 23.4
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.02
SecondaryPercent Change in Low Density Cholesterol Levels From Baseline to 12 Months.

Percent change in serum low density cholesterol (LDL, unit in mg/dl) levels from baseline to 12 months. A reduction in LDL cholesterol indicates in improvement lipid metabolism.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Low Density Cholesterol Levels From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Low Density Cholesterol Levels From Baseline to 12 Months.-2.77 ± 21.710.87 ± 56.60
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.27
SecondaryPercent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.

Percent change in serum homeostatic model assessment for insulin resistance (HOMA-IR, unitless as it is an index) calculated as (insulin \[microU/L\] x glucose \[mg/dl\])/405, from baseline to 12 months. A reduction in HOMA-IR indicates improvement in insulin resistance.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.28.3 ± 137.423.9 ± 93.7
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.61
SecondaryPercent Change in Total Volumetric Bone Density of the Radius

Percent change in total volumetric bone mineral density (vBMD, unit in milligrams per cubic centimeter) of the radius by high-resolution peripheral quantitative computer tomography from baseline to 12 months. An increase in vBMD indicates bone gain while a reduction suggests bone loss.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Total Volumetric Bone Density of the Radius
% change from baselineAnastrozolePlacebo
Percent Change in Total Volumetric Bone Density of the Radius1.40 ± 9.50.03 ± 9.0
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.90
SecondaryPercent Change in Failure Load at the Radius From Baseline to 12 Months,

Percent change in failure load (unit in kilo-Newtons or Kn), a measure of bone strength, assessed by high-resolution peripheral quantitative computer tomography of the radius from baseline to 12 months. An increase in failure load indicates increase in bone strength while the reduction suggests the opposite

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Failure Load at the Radius From Baseline to 12 Months,
% change from baselineAnastrozolePlacebo
Percent Change in Failure Load at the Radius From Baseline to 12 Months,0.27 ± 8.70.40 ± 7.3
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.87
SecondaryPercent Change in C-terminal Telopeptide of Type I Collagen (CTX)

Percent change in serum C-terminal telopeptide of type I collagen (CTX) (unit in ng/ml), a marker of bone resorption, from baseline to 12 months. An increase in CTX indicates increased bone resorption which contributes to bone loss, while a reduction suggests decreased bone resorption.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in C-terminal Telopeptide of Type I Collagen (CTX)
% change from baselineAnastrozolePlacebo
Percent Change in C-terminal Telopeptide of Type I Collagen (CTX)-19.9 ± 84.6-28.9 ± 96.2
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.42
SecondaryPercent Change in Osteocalcin From Baseline to 12 Months.

Percent change in serum osteocalcin (unit in ng/ml), a marker of bone formation, from baseline to 12 months. An increase in osteocalcin suggests an increase in bone formation.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Osteocalcin From Baseline to 12 Months.
% change from baselineAnastrozolePlacebo
Percent Change in Osteocalcin From Baseline to 12 Months.-4.21 ± 17534.16 ± 217.7
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.92
SecondaryPercent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 Months

Percent change in serum N-terminal propeptide (P1NP) (unit in ng/ml), a marker of bone formation, from baseline to 12 months. An increase in P1NP suggests an increase in bone formation.

Time frame:
12 months
Reported as:
Mean · % change from baseline
Percent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 Months
% change from baselineAnastrozolePlacebo
Percent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 Months23.71 ± 84.831.73 ± 172.7
Statistical analysis
  • Anastrozole vs Placebo · Kruskal-Wallis · p = 0.47

Adverse events

Collected over 7 years and 1 month. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Anastrozole0/61 (0%)4/61 (6.6%)14/61 (23%)
Placebo0/60 (0%)1/60 (1.7%)10/60 (16.7%)
Most frequent serious events
Most frequent serious events
EventAnastrozolePlacebo
admitted for continuous electroencephalogram (EEG) studiesNervous system disorders0/611/60
Cardiac arrhythmiaCardiac disorders1/610/60
hemorrhoid infectionGastrointestinal disorders1/610/60
COVID-19 infectionInfections and infestations1/610/60
complication from cataract ssurgeryEye disorders1/610/60
Most frequent other events
Showing 10 of 12
Most frequent other events
EventAnastrozolePlacebo
back pain, foot pain, shoulder pain and knee joint painMusculoskeletal and connective tissue disorders6/615/60
chest painCardiac disorders2/610/60
hemorrhoid infectionGastrointestinal disorders2/610/60
diarrheaGastrointestinal disorders0/611/60
kidney stonesRenal and urinary disorders0/611/60
dehydrationVascular disorders0/611/60
sciaticaNervous system disorders0/611/60
hair lossSkin and subcutaneous tissue disorders0/611/60
vasectomy operationRenal and urinary disorders1/610/60
ear surgeryEar and labyrinth disorders1/610/60

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)AnastrozolePlaceboTotal
<=18 years000
Between 18 and 65 years6160121
>=65 years000
Age, Continuous
Age, Continuous(years)AnastrozolePlaceboTotal
Mean50.7 ± 7.251.6 ± 7.951.2 ± 7.5
Sex: Female, Male
Sex: Female, Male(Participants)AnastrozolePlaceboTotal
Female000
Male6160121
Race (NIH/OMB)
Race (NIH/OMB)(Participants)AnastrozolePlaceboTotal
American Indian or Alaska Native011
Asian000
Native Hawaiian or Other Pacific Islander101
Black or African American253055
White342963
More than one race101
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(participants)AnastrozolePlaceboTotal
United States6160121
Testosterone level
Testosterone level(ng/dl)AnastrozolePlaceboTotal
Mean228.0 ± 50.7232.1 ± 54.8230 ± 52.6
08

Study locations

1 site
  • Michael E. DeBakey VAMC
    Houston, Texas 77030, United States
09

References and documents

Publications

  • Schneider G, Kirschner MA, Berkowitz R, Ertel NH. Increased estrogen production in obese men. J Clin Endocrinol Metab. 1979 Apr;48(4):633-8. doi: 10.1210/jcem-48-4-633. PubMed 429508 ↗
  • Corona G, Rastrelli G, Monami M, Saad F, Luconi M, Lucchese M, Facchiano E, Sforza A, Forti G, Mannucci E, Maggi M. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol. 2013 May 2;168(6):829-43. doi: 10.1530/EJE-12-0955. Print 2013 Jun. PubMed 23482592 ↗
  • Armamento-Villareal R, Aguirre LE, Qualls C, Villareal DT. Effect of Lifestyle Intervention on the Hormonal Profile of Frail, Obese Older Men. J Nutr Health Aging. 2016 Mar;20(3):334-40. doi: 10.1007/s12603-016-0698-x. PubMed 26892583 ↗
  • Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, Bremner WJ, McKinlay JB. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002 Feb;87(2):589-98. doi: 10.1210/jcem.87.2.8201. PubMed 11836290 ↗
  • Khosla S, Melton LJ 3rd, Atkinson EJ, O'Fallon WM. Relationship of serum sex steroid levels to longitudinal changes in bone density in young versus elderly men. J Clin Endocrinol Metab. 2001 Aug;86(8):3555-61. doi: 10.1210/jcem.86.8.7736. PubMed 11502778 ↗
  • Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009 Jun;5(3):427-48. doi: 10.2147/tcrm.s3025. Epub 2009 Jun 22. PubMed 19707253 ↗
  • Kaplan SA, Lee JY, O'Neill EA, Meehan AG, Kusek JW. Prevalence of low testosterone and its relationship to body mass index in older men with lower urinary tract symptoms associated with benign prostatic hyperplasia. Aging Male. 2013 Dec;16(4):169-72. doi: 10.3109/13685538.2013.844786. Epub 2013 Oct 17. PubMed 24134648 ↗
  • Dhindsa S, Miller MG, McWhirter CL, Mager DE, Ghanim H, Chaudhuri A, Dandona P. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care. 2010 Jun;33(6):1186-92. doi: 10.2337/dc09-1649. Epub 2010 Mar 3. PubMed 20200299 ↗
  • Giagulli VA, Kaufman JM, Vermeulen A. Pathogenesis of the decreased androgen levels in obese men. J Clin Endocrinol Metab. 1994 Oct;79(4):997-1000. doi: 10.1210/jcem.79.4.7962311. PubMed 7962311 ↗
  • Strain GW, Zumoff B, Kream J, Strain JJ, Deucher R, Rosenfeld RS, Levin J, Fukushima DK. Mild Hypogonadotropic hypogonadism in obese men. Metabolism. 1982 Sep;31(9):871-5. doi: 10.1016/0026-0495(82)90175-5. PubMed 6811834 ↗
  • Joad S, Ballato E, Deepika F, Gregori G, Fleires-Gutierrez AL, Colleluori G, Aguirre L, Chen R, Russo V, Fuenmayor Lopez VC, Qualls C, Villareal DT, Armamento-Villareal R. Hemoglobin A1c Threshold for Reduction in Bone Turnover in Men With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne). 2021 Dec 28;12:788107. doi: 10.3389/fendo.2021.788107. eCollection 2021. PubMed 35027909 ↗
  • Vigevano F, Gregori G, Colleluori G, Chen R, Autemrongsawat V, Napoli N, Qualls C, Villareal DT, Armamento-Villareal R. In Men With Obesity, T2DM Is Associated With Poor Trabecular Microarchitecture and Bone Strength and Low Bone Turnover. J Clin Endocrinol Metab. 2021 Apr 23;106(5):1362-1376. doi: 10.1210/clinem/dgab061. PubMed 33537757 ↗

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: Undecided

10

Updates

1 registry update since Sep 25, 2026
Results
Results posted
posted Oct 19, 2026
Start date
Apr 15, 2018→May 1, 2018
Oct 19, 2026
Primary completion
May 31, 2025→Jun 30, 2025
Oct 19, 2026
Study completion
May 31, 2025→Jun 30, 2026
Oct 19, 2026
Interventions
Arm changed Weight loss plus placebo→placebo; Weight loss plus anastrozole→anastrozole
Oct 19, 2026
Primary outcomes
4 added, 4 removed
What changed in the outcomes
  • AddedChange in Serum Testosterone From Baseline to 12 MonthsTime frame: 12 months
  • AddedPercent Change in Muscle Strength From Baseline to 12 MonthsTime frame: 12 months
  • AddedPercent Change in Total Lean Mass From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.Time frame: 12 months
  • RemovedHormonal Profile ChangesTime frame: 12 months
  • RemovedChanges in muscle strengthTime frame: 12 months
  • RemovedChanges in Lean massTime frame: 12 months
  • RemovedChanges in total hip bone mineral density (BMD)Time frame: 12 months
Oct 19, 2026
Documents
Secondary outcomes
4 edited, 12 added, 12 removed
What changed in the outcomes
  • EditedChanges in thigh muscle volumeThigh Muscle VolumeTime frame: 12 months
  • EditedChanges in symptomsSymptoms of hypogonadismHypogonadism Using International Index of Erectile Function (IIEF) QuestionnaireTime frame: 12 months
  • EditedChanges in symptomsSymptoms of hypogonadismHypogonadism and ObesityTime frame: 12 months
  • EditedChangesPercent Change in volumetric bone densityTotal Volumetric Bone Density of the RadiusTime frame: 12 months
  • AddedChange in Estradiol From Baseline to 12 Months.Time frame: 12 months
  • AddedChange in Luteinizing Hormone Levels From Baseline to 12 Months.Time frame: 12 months
  • AddedChange in Follicle Stimulating Hormone Levels From Baseline to 12 MonthsTime frame: 12 months
  • AddedPercent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Hemoglobin A1C From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Low Density Cholesterol Levels From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Failure Load at the Radius From Baseline to 12 Months,Time frame: 12 months
  • AddedPercent Change in C-terminal Telopeptide of Type I Collagen (CTX)Time frame: 12 months
  • AddedPercent Change in Osteocalcin From Baseline to 12 Months.Time frame: 12 months
  • AddedPercent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 MonthsTime frame: 12 months
  • RemovedOther gonadal hormoneTime frame: 12 months
  • RemovedPituitary hormoneTime frame: 12 months
  • RemovedPituitary hormoneTime frame: 12 months
  • RemovedChanges in symptoms of hypogonadismTime frame: 12 months
  • RemovedChanges in visceral adipose tissuesTime frame: 12 months
  • RemovedChanges in metabolic risk factorsTime frame: 12 months
  • RemovedChanges in metabolic risk factorsTime frame: 12 months
  • RemovedChanges in metabolic risk factorsTime frame: 12 months
  • RemovedChanges in bone qualityTime frame: 12 months
  • RemovedChanges in bone markersTime frame: 12 months
  • RemovedChanges in bone markersTime frame: 12 months
  • RemovedChanges in bone markersTime frame: 12 months
Oct 19, 2026
Show all 1 update
  1. Oct 19, 2026
    Results posted
    Start date Apr 15, 2018→May 1, 2018
    Primary completion May 31, 2025→Jun 30, 2025
    Study completion May 31, 2025→Jun 30, 2026
    Primary outcomes 4 added, 4 removed
    What changed in the outcomes
    • AddedChange in Serum Testosterone From Baseline to 12 MonthsTime frame: 12 months
    • AddedPercent Change in Muscle Strength From Baseline to 12 MonthsTime frame: 12 months
    • AddedPercent Change in Total Lean Mass From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Total Hip Areal Bone Mineral Density From Baseline to 12 Months.Time frame: 12 months
    • RemovedHormonal Profile ChangesTime frame: 12 months
    • RemovedChanges in muscle strengthTime frame: 12 months
    • RemovedChanges in Lean massTime frame: 12 months
    • RemovedChanges in total hip bone mineral density (BMD)Time frame: 12 months
    Secondary outcomes 4 edited, 12 added, 12 removed
    What changed in the outcomes
    • EditedChanges in thigh muscle volumeThigh Muscle VolumeTime frame: 12 months
    • EditedChanges in symptomsSymptoms of hypogonadismHypogonadism Using International Index of Erectile Function (IIEF) QuestionnaireTime frame: 12 months
    • EditedChanges in symptomsSymptoms of hypogonadismHypogonadism and ObesityTime frame: 12 months
    • EditedChangesPercent Change in volumetric bone densityTotal Volumetric Bone Density of the RadiusTime frame: 12 months
    • AddedChange in Estradiol From Baseline to 12 Months.Time frame: 12 months
    • AddedChange in Luteinizing Hormone Levels From Baseline to 12 Months.Time frame: 12 months
    • AddedChange in Follicle Stimulating Hormone Levels From Baseline to 12 MonthsTime frame: 12 months
    • AddedPercent Change in Symptoms of Hypogonadism Using the Androgen Deficiency in Aging Male (ADAM) Questionnaire From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Visceral Adipose Tissue Volume From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Hemoglobin A1C From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Low Density Cholesterol Levels From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Homeostatic Model Assessment for Insulin Resistance From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Failure Load at the Radius From Baseline to 12 Months,Time frame: 12 months
    • AddedPercent Change in C-terminal Telopeptide of Type I Collagen (CTX)Time frame: 12 months
    • AddedPercent Change in Osteocalcin From Baseline to 12 Months.Time frame: 12 months
    • AddedPercent Change in Procollagen Type 1 N-terminal Propeptide (P1NP) From Baseline to 12 MonthsTime frame: 12 months
    • RemovedOther gonadal hormoneTime frame: 12 months
    • RemovedPituitary hormoneTime frame: 12 months
    • RemovedPituitary hormoneTime frame: 12 months
    • RemovedChanges in symptoms of hypogonadismTime frame: 12 months
    • RemovedChanges in visceral adipose tissuesTime frame: 12 months
    • RemovedChanges in metabolic risk factorsTime frame: 12 months
    • RemovedChanges in metabolic risk factorsTime frame: 12 months
    • RemovedChanges in metabolic risk factorsTime frame: 12 months
    • RemovedChanges in bone qualityTime frame: 12 months
    • RemovedChanges in bone markersTime frame: 12 months
    • RemovedChanges in bone markersTime frame: 12 months
    • RemovedChanges in bone markersTime frame: 12 months
    Interventions Arm changed Weight loss plus placebo→placebo; Weight loss plus anastrozole→anastrozole
    + 5 other changes: identifiers, verification date, responsible party, conditions and index terms

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

11

Registry details

Key details

Study ID
NCT03490513
Responsible party
Reina Villareal MD (Professor of Medicine, Baylor College of Medicine) — Principal investigator
First posted
Apr 6, 2018
Start date
May 1, 2018
Primary completion
Jun 30, 2025
Completion
Jun 30, 2026
Results posted
Oct 19, 2026
Last update
Oct 19, 2026

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Studies of the drug tested here: Anastrozole

Start the discussion