Testosterone use as a treatment of cachexia in patients with schizophrenia: A case report

Aberrant feeding behaviours in schizophrenia, which could result in cachexia and starvation status, have been described in the literature. Testosterone is used as an adjunct treatment in patients with cancer and HIV-induced cachexia to increase lean body mass, and could be considered as a potential option for management of cachexia due to other causes such as schizophrenia. In this case report, we describe use of adjunct testosterone in a patient with schizophrenia and significant weight loss. We present a case report of a patient with chronic schizophrenia who was admitted to our Schizophrenia inpatient unit with relapse of psychosis, catatonia and significant weight loss/malnutrition. His weight on admission was 38.2 kg with a body mass index (BMI) of 14. He was treated with antipsychotic medications and ECT, to which he responded favourably. However, after 6 months in hospital and despite improvement of his mental status, his oral intake and weight were still suboptimal. He was started on intramuscular testosterone to enhance muscle mass, address low weight and improve energy. An improvement in energy, appetite and weight was observed. Following 13 weeks of regular treatment with testosterone, his weight increased from 45 kg to 52 kg, correlating to a 15.5% increase in total body weight. There were no adverse effects. Supplementary testosterone can be considered as an adjunct option for treatment of persistent cachexia in patients with schizophrenia who continue to struggle with low body weight and low energy, despite optimized psychiatric treatment.