Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors

Paul E. Wischmeyer, Oscar E. Suman, Rosemary Kozar, Steven E. Wolf, Jeroen Molinger, Amy M. Pastva

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Purpose of review ICU survivors frequently suffer significant, prolonged physical disability. 'ICU Survivorship', or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testosterone analogues combined with structured exercise is a promising novel intervention to improve 'ICU Survivorship'. Recent findings One explanation for lack of success in addressing post-ICU physical disability is most ICU patients exhibit severe testosterone deficiencies early in ICU that drives persistent catabolism despite rehabilitation efforts. Oxandrolone is an FDA-approved testosterone analogue for treating muscle weakness in ICU patients. A growing number of trials with this agent combined with structured exercise show clinical benefit, including improved physical function and safety in burns and other catabolic states. However, no trials of oxandrolone/testosterone and exercise in nonburn ICU populations have been conducted. Summary Critical illness leads to a catabolic state, including severe testosterone deficiency that persists throughout hospital stay, and results in persistent muscle weakness and physical dysfunction. The combination of an anabolic agent with adequate nutrition and structured exercise is likely essential to optimize muscle mass/strength and physical function in ICU survivors. Further research in ICU populations is needed.

Original languageEnglish (US)
Pages (from-to)508-515
Number of pages8
JournalCurrent Opinion in Critical Care
Issue number5
StatePublished - Oct 2020


  • Critical illness
  • Muscle
  • Oxandrolone
  • Rehabilitation
  • Testosterone

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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