Burn injury and the accompanying hormonal milieu result in a dramatic catabolism of skeletal muscle. The combination of hypercortisolemia and insufficient testosterone production contribute to a net efflux of amino acids from skeletal muscle, and in turn, a loss of muscle protein. This loss of skeletal muscle impedes the patients rehabilitation and increases the time required to return to work. It is the goal of this proposal to investigate the general hypothesis that testosterone normalization in the burned patient will ameliorate the hypercatabolism of skeletal muscle by increasing net protein synthesis and decreasing the net efflux of intracellular amino acids. A further goal of this proposal is to investigate the hypothesis that the effects of testosterone will be amplified by increased inward amino acid transport. Interventions which promote inward amino acid transport, such as amino acid infusion and resistance exercise, will be investigated in conjunction with testosterone administration. This proposal will evaluate the feasibility of rehabilitation. Upon discharge, testosterone normalization will be addressed by determining its effects on muscle protein synthesis and breakdown, lean body mass, muscle mass, and muscular strength.
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