Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism.
Abstract
Acquired hypogonadism is being increasingly recognized in adult men. However, the effects of long term testosterone replacement on bone density and body composition are largely unknown. We investigated 36 adult men with acquired hypogonadism (age, 22-69 yr; median, 58 yr), including 29 men with central hypogonadism and 7 men with primary hypogonadism, and 44 age-matched eugonadal controls. Baseline evaluation included body composition analysis by bioimpedance, determination of site-specific adipose area by dual energy quantitative computed tomography scan (QCT) of the lumbar spine, and measurements of spinal bone mineral density (BMD) using dual energy x-ray absortiometry, spinal trabecular BMD with QCT, and radial BMD with single photon absorptiometry. Percent body fat was significantly greater in the hypogonadal men compared to eugonadal men (mean +/- SEM, 26.4 +/- 1.1% vs. 19.2 +/- 0.8%; P < 0.01). The mean trabecular BMD determined by QCT for the hypogonadal men was 115 +/- 6 mg K2HPO4/cc. Spinal BMD was significantly lower than that in eugonadal controls (1.006 +/- 0.024 vs. 1.109 +/- 0.028 g/cm2; P = 0.02, respectively). Radial BMD was similar in both groups. Testosterone enanthate therapy was initiated in 29 hypogonadal men at a dose of 100 mg/week, and the subjects were evaluated at 6-month intervals for 18 months. During testosterone therapy, the percent body fat decreased 14 +/- 4% (P < 0.001). There was a 13 +/- 4% decrease in subcutaneous fat (P < 0.01) and a 7 +/- 2% increase in lean muscle mass (P = 0.01) during testosterone therapy. Spinal BMD and trabecular BMD increased by 5 +/- 1% (P < 0.001) and 14 +/- 3% (P < 0.001), respectively. Radial BMD did not change. Serum bone-specific alkaline phosphatase and urinary deoxypyridinoline excretion, markers of bone formation and resorption, respectively, decreased significantly over the 18 months (P = 0.003 and P = 0.04, respectively). We conclude that testosterone therapy given to adult men with acquired hypogonadism decreases sc fat and increases lean muscle mass. In addition, testosterone therapy reduces bone remodeling and increases trabecular bone density. The beneficial effects of androgen administration on body composition and bone density may provide additional indications for testosterone therapy in hypogonadal men.
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Testosterone replacement in men with authentic, pathologically-based hypogonadism reduces fat mass by 10%-15%.
“Testosterone replacement in men with authentic, pathologically-based hypogonadism reduces fat mass by 10%–15%.7778”
From Lowered testosterone in male obesity: Mechanisms, morbidity and management (2014) · cites this paper as [77]
Testosterone replacement increases libido, sexual motivation and sexual function, mood, sense of well-being, concentration, self-reported sense of energy, muscle mass and strength, and recovery of anemia related to testosterone deficiency.
“T replacement increases libido, sexual motivation and sexual function (134,135,138-143), mood (144), sense of well being, concentration (135,139,143,145-147), self-reported sense of energy (134,135), muscle mass and strength (132,148,149), and the recovery of anemia related to T deficiency (134).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [134]
Testosterone replacement increases bone mineral density and improves trabecular structure and bone mechanical properties.
“Treatment increases BMD (132-135) and improves trabecular structure (136) and bone mechanical properties (137).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [134]
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Sinha-Hikim, I., Roth, S. M., Lee, M. I., & Bhasin, S. (2003) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00370.2002 · Cited by 344 · see citing works
“TESTOSTERONE SUPPLEMENTATION increases muscle mass in healthy hypogonadal men (7, 11, 25, 43, 48, 49), older men with low testosterone levels (26, 44, 45), and men with chronic illnesses and low testosterone levels (5, 8, 14).”
BackgroundBasaria, S. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61126-5 · Cited by 328 · see citing works
The endocrine manifestations of anorexia nervosa: mechanisms and management
Haines, M. S., & Miller, K. K. (2016) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2016.175 · Cited by 322 · see citing works
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Lowered testosterone in male obesity: Mechanisms, morbidity and management
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The Dark Side of Testosterone Deficiency: I. Metabolic Syndrome and Erectile Dysfunction
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“A similar trend was found with the same dosage of T, given to hypogonadal men, over the course of 18 months (Katznelson et al, 1996) and with T gel treatment for 6 months (Swerdloff et al, 2003) and 42 months (Wang et al., 2004) It has also been observed that the % body fat reduction by T…”
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“In hypogonadal patients, testosterone treatment increased muscle mass and aBMD but not bone width.((52,53)) Data on IGF-I are similar.”
BackgroundTestosterone supplementation therapy for older men: potential benefits and risks
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Lessons From the Testosterone Trials
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“Increased BMI and waist – hip ratio (WHR) are seen in hypogonadal men ( 24 , 25) and reduced total testosterone levels have been found in obese young men (26 – 28).”
BackgroundTestosterone injection stimulates net protein synthesis but not tissue amino acid transport
Ferrando, A. A., Tipton, K. D., Doyle, D., Phillips, S. M., Cortiella, J., & Wolfe, R. R. (1998) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1998.275.5.e864 · Cited by 256 · see citing works
“Restoration of testosterone levels in hypogonadal (3, 8, 17) and elderly (19) men has been shown to increase skeletal muscle protein synthesis and lean body mass (8).”
BackgroundTestosterone regulation of Akt/mTORC1/FoxO3a signaling in skeletal muscle
White, J. P., Gao, S., Puppa, M., Sato, S., Welle, S. L., & Carson, J. A. (2012) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2012.10.019 · Cited by 250 · see citing works
“A reduction in circulating testosterone levels, referred to as hypogonadism is associated with a reduction in lean body mass and increased percentage of fat mass (Katznelson et al., 1996).”
BackgroundStorer, T. W., Magliano, L., Woodhouse, L. J., Lee, M. L., Dzekov, C., Dzekov, J., Casaburi, R. H., & Bhasin, S. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021231 · Cited by 248 · see citing works
Anabolic-Androgenic Steroid Therapy in the Treatment of Chronic Diseases
Basaria, S. S., Wahlstrom, J. T., & Dobs, A. S. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.11.7983 · Cited by 242 · see citing works
“• Clinical Review J Clin Endocrinol Metab, November 2001, 86(11):5108–5117 5111”
BackgroundInfluentialIntramuscular testosterone esters and plasma lipids in hypogonadal men: a meta-analysis
Whitsel, E. A., Boyko, E. J., Matsumoto, A. M., Anawalt, B. D., & Siscovick, D. S. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)00833-6 · Cited by 240 · see citing works
Effects of Androgen Administration in Men with the AIDS Wasting Syndrome
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“Sample size was based on the change in lean body mass in response to testosterone administration among adult men with acquired hypogonadism (8).”
BackgroundSelf-citationMcCarty, M. F. (1999) · Medical Hypotheses · doi:10.1054/mehy.1997.0684 · Cited by 234 · see citing works
HYPOGONADISM AND METABOLIC SYNDROME: IMPLICATIONS FOR TESTOSTERONE THERAPY
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Androgen Replacement Therapy in the Aging Male--A Critical Evaluation
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“As to osteoporosis, all studies show that in hypogonadal men androgen supplementation increases bone mass (100, 102, 103, 112), although normal adult bone mass is not reached (113).”
BackgroundSingh, A. B., Hsia, S. H., Alaupovic, P., Sinha‐Hikim, I., Woodhouse, L. J., Buchanan, T. A., Shen, R., Bross, R., Berman, N., & Bhasin, S. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.1.8172 · Cited by 225 · see citing works
“T replacement of young (8, 9, 12) and older hypogonadal men (5) decreases fat mass.”
BackgroundMiller, K. K., Biller, B. M. K., Beauregard, C., Lipman, J. G., Jones, J., Schoenfeld, D., Sherman, J. C., Swearingen, B., Loeffler, J. S., & Klibanski, A. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2596 · Cited by 223 · see citing works
Self-citationClarke, B. L., & Khosla, S. (2008) · Steroids · doi:10.1016/j.steroids.2008.10.003 · Cited by 225 · see citing works
“The increase in bone density in hypogonadal men is highly variable [54,70], and not seen in all studies [71], possibly due to differences in treatment duration, skeletal sites assessed, and study methodology.”
BackgroundInfluentialAnabolic-Androgenic Steroid Therapy in the Treatment of Chronic Diseases
Basaria, S. S. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.86.11.5108 · Cited by 223 · see citing works
Bhasin, S., Singh, A. B., Mac, R. P., Carter, B., Lee, M. I., & Cunningham, G. R. (2003) · Journal of Andrology · doi:10.1002/j.1939-4640.2003.tb02676.x · Cited by 219 · see citing works
Corona, G., Giagulli, V. A., Maseroli, E., Vignozzi, L., Aversa, A., Zitzmann, M., Saad, F., Mannucci, E., & Maggi, M. (2016) · European Journal of Endocrinology · doi:10.1530/eje-15-0262 · Cited by 217 · see citing works
Bhasin, S., Taylor, W. E., Singh, R., Artaza, J., Sinha-Hikim, I., Jasuja, R., Choi, H., & Gonzalez-Cadavid, N. F. (2003) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/58.12.m1103 · Cited by 215 · see citing works
The impact of sleep on age-related sarcopenia: Possible connections and clinical implications
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“GH deficiency syndrome and hypogonadism at a young age lead to decline in body composition, muscle strength and physical performance, resembling those found in healthy aged individuals (Cuneo et al., 1990; Katznelson et al., 1996).”
BackgroundEndogenous Sex Hormones and Cardiovascular Disease in Men
Muller, M., van der Schouw, Y. T., Thijssen, J. H. H., & Grobbee, D. E. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030611 · Cited by 210 · see citing works
Testosterone for the aging male; current evidence and recommended practice
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“A large number of trials have demonstrated a positive effect of testosterone treatment on bone mineral density (Katznelson et al 1996; Behre et al 1997; Leifke et al 1998; Snyder et al 2000; Zacharin et al 2003; Wang, Cunningham et al 2004; Aminorroaya et al 2005; Benito et al 2005) and bone…”
Sims, N. A., Clément-Lacroix, P., Minet, D., Fraslon, C., Gaillard-Kelly, M., Resche-Rigon, M., & Baron, R. (2003) · Journal of Clinical Investigation · doi:10.1172/jci200317246 · Cited by 200 · see citing works
Gonadal steroid–dependent effects on bone turnover and bone mineral density in men
Finkelstein, J. S., Lee, H., Leder, B. Z., Burnett-Bowie, S.-A. M., Goldstein, D. W., Hahn, C. W., Hirsch, S. C., Linker, A., Perros, N., Servais, A. B., et al. (2016) · Journal of Clinical Investigation · doi:10.1172/jci84137 · Cited by 198 · see citing works
Self-citationBone Loss in Men with Prostate Cancer Treated with Gonadotropin-Releasing Hormone Agonists1
Stoch, S. A., Parker, R. A., Chen, L., Bubley, G. J., Ko, Y., Vincelette, A., & Greenspan, S. L. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.6.7558 · Cited by 197 · see citing works
“Testosterone withdrawal is associated with an increase in total body fat and loss of lean body mass (15, 25); this is consistent with our findings.”
BackgroundResultInfluentialGao, W., Reiser, P. J., Coss, C. C., Phelps, M. A., Kearbey, J. D., Miller, D. D., & Dalton, J. T. (2005) · Endocrinology · doi:10.1210/en.2005-0572 · Cited by 192 · see citing works
Sinha‐Hikim, I., Arver, S., Beall, G. N., Shen, R., Guerrero, M., Sattler, F. R., Shikuma, C., Nelson, J. C., Landgren, B.-M., Mazer, N. A., et al. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.4.4718 · Cited by 192 · see citing works
Short-Term Oxandrolone Administration Stimulates Net Muscle Protein Synthesis in Young Men1
Sheffield-Moore, M., Urban, R. J., Wolf, S. E., Jiang, J., Catlin, D. H., Herndon, D. N., Wolfe, R. R., & Ferrando, A. A. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.8.5923 · Cited by 199 · see citing works
Effect of testosterone replacement on trabecular architecture in hypogonadal men
Benito, M., Vasilic, B., Wehrli, F. W., Bunker, B., Wald, M., Gomberg, B., Wright, A. C., Zemel, B., Cucchiara, A., & Snyder, P. J. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.050606 · Cited by 188 · see citing works
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Self-citationCorona, G., Giagulli, V. A., Maseroli, E., Vignozzi, L., Aversa, A., Zitzmann, M., Saad, F., Mannucci, E., & Maggi, M. (2016) · Journal of Endocrinological Investigation · doi:10.1007/s40618-016-0480-2 · Cited by 185 · see citing works
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Obesity and testicular function
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Wang, C. E., Swerdloff, R. S., Iranmanesh, A., Dobs, A. S., Snyder, P. J., Cunningham, G. R., Matsumoto, A. M., Weber, T. J., Berman, N., & the Testosterone Gel Study Group (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01271.x · Cited by 176 · see citing works
The pathogenesis, diagnosis, investigation and management of osteoporosis
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Dose-dependent effects of testosterone on regional adipose tissue distribution in healthy young men.
Woodhouse, L., Gupta, N., Bhasin, M., Singh, A. B., Ross, R., Phillips, J., & Bhasin, S. (2004) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2003-031492 · Cited by 159 · see citing works
Osteoporosis in men: Epidemiology, diagnosis, prevention, and treatment
Olszynski, W. P., Davison, K. S., Adachi, J. D., Brown, J. P., Cummings, S. R., Hanley, D. A., Harris, S. P., Hodsman, A. B., Kendler, D. L., McClung, M. R., et al. (2004) · Clinical Therapeutics · doi:10.1016/s0149-2918(04)90002-1 · Cited by 168 · see citing works
New horizons in treatment of osteoporosis
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“Data of clinical trials confirms the beneficial effect of testosterone on BMD for at least 2 years [99].”
BackgroundMünzer, T., Harman, S. M., Hees, P. S., Shapiro, E., Christmas, C., Bellantoni, M. F., Stevens, T. E., O’Connor, K. G., Pabst, K. M., Clair, C. S., et al. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.8.7773 · Cited by 166 · see citing works
“Nonelderly GH-deficient patients and hypogonadal men, like healthy aged individuals, exhibit increases in total-body fat and abdominal sc and V fat, which are improved after GH administration (24 –28) or T treatment ( 29 ), respectively.”
BackgroundInfluentialBhasin, S., Storer, T. W., Asbel-Sethi, N., Kilbourne, A. M., Hays, R. D., Sinha‐Hikim, I., Shen, R., Arver, S., & Beall, G. N. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.9.5079 · Cited by 165 · see citing works
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“…of testosterone administration on fat mass and distribution in men have been inconsistent across trials (Snyder et al., 2000; Wang et al., 2000; Katznelson et al., 1996); although many trials in middle-aged and older men have reported a reduction in whole body fat mass during testosterone…”
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Androgen deprivation therapy for prostate cancer: new concepts and concerns
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ORWOLL, E. S. (1998) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70009-8 · Cited by 157 · see citing works
Miller, K. K., Meenaghan, E. M., Lawson, E. A., Misra, M., Gleysteen, S., Schoenfeld, D., Herzog, D. B., & Klibanski, A. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0380 · Cited by 156 · see citing works
Self-citationDeterioration of Trabecular Architecture in Hypogonadal Men
Benito, M., Gomberg, B. R., Wehrli, F. W., Weening, R., Zemel, B. S., Wright, A. C., Song, H. K., Cucchiara, A. J., & Snyder, P. J. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021429 · Cited by 154 · see citing works
“photon absorptiometry of the distal radius (10) and 9% in another study by dual energy x-ray absorptiometry of the lumbar spine (11).”
BackgroundRisks and benefits of testosterone therapy in older men
Spitzer, M., Huang, G., Basaria, S., Travison, T. G., & Bhasin, S. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.73 · Cited by 154 · see citing works
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“((1,19,20))In a longitudinal study in a small group of ORX men, Stepa ́n et al.”
BackgroundMECHANISMS IN ENDOCRINOLOGY: The sexually dimorphic role of androgens in human metabolic disease
Schiffer, L., Kempegowda, P., Arlt, W., & O’Reilly, M. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0124 · Cited by 154 · see citing works
Leifke, E., Korner, H., Link, T. M., Behre, H. M., Peters, P., & Nieschlag, E. (1998) · European Journal of Endocrinology · doi:10.1530/eje.0.1380051 · Cited by 150 · see citing works
“A recent study has demonstrated a change in biochemical serum markers of bone metabolism in response to testosterone replacement therapy, suggesting a reduction in bone remodelling ( 8 ).”
Influential
- Authors
- Katznelson, L., Finkelstein, J. S., Schoenfeld, D. A., Rosenthal, D. I., Anderson, E. J., & Klibanski, A.
- Affiliations
- Massachusetts General Hospital (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1996-12
- Volume
- 81
- Issue
- 12
- Pages
- 4358-4365
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1974568933
- Semantic Scholar
- 829db808d1847d263af6c33d3397743284ea9f83
- Cited by
- 791
- References
- 38
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 12 · 2023: 13 · 2022: 16 · 2021: 15 · 2020: 15 · 2019: 14 · 2018: 17 · 2017: 18 · 2016: 22 · 2015: 24 · 2014: 17 · 2013: 29 · 2012: 35
- FWCI
- 19.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5f32dk008738-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-08738)
- National Center for Research Resources (RR 01066, M01RR001066)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Keywords
- testosterone replacement therapy, testosterone enanthate, bone mineral density, trabecular bone density, lean body mass, body composition, fat mass, central hypogonadism, hypergonadotropic hypogonadism, bone-specific alkaline phosphatase, urinary deoxypyridinoline, bone turnover markers, men's health, osteoporosis prevention
- MeSH terms
- Adult, Aged, Body Composition, Bone Development, Humans, Hypogonadism, Cholesterol, HDL, Longitudinal Studies, Male, Middle Aged, Parathyroid Hormone, Growth Hormone, Testosterone, Bone Density
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