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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%.7778”
From Lowered testosterone in male obesity: Mechanisms, morbidity and management (2014) · cites this paper as [77]
In the citing paper
“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]
In the citing paper
“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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“Although treatment with testosterone in hypogonadal men increases bone mineral density (Katznelson et al 1996), it has not yet been established that this results in a reduction in fracture rate.”
Sex steroids and the male skeleton: a tale of two hormones
Callewaert, F., Boonen, S., & Vanderschueren, D. (2009) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2009.09.002 · Cited by 93
Alendronate Treatment in Men With Primary Osteoporosis: A Three-Year Longitudinal Study
Gonnelli, S., Cepollaro, C., Montagnani, A., et al. (2003) · Calcified Tissue International · doi:10.1007/s00223-002-1085-7 · Cited by 91
“Until 2 years ago, there were no therapies approved for men with primary osteoporosis; indeed, testosterone had been shown to increase BMD in hypogonadal men, but not in men with normal testosterone serum levels [7, 8].”
Zborowski, J. V., Cauley, J. A., Talbott, E. O., Guzick, D. S., & Winters, S. J. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.10.6902 · Cited by 89
Risks Versus Benefits of Testosterone Therapy in Elderly Men
Basaria, S. S., & Dobs, A. S. (1999) · Drugs & Aging · doi:10.2165/00002512-199915020-00006 · Cited by 90
“[67] Bone specific al-”
BackgroundChristmas, C., O'Connor, K. G., Harman, S. M., Tobin, J. D., Münzer, T., Bellantoni, M. F., Clair, C. S., Pabst, K. M., Sorkin, J. D., & Blackman, M. R. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.1.m12 · Cited by 90
“Katznelson L, Finkelstein JS, Schoenfeld DA, Rosenthal DI, Anderson EJ, Klibanski A. Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism.”
BackgroundOsteopenia in Eugonadal Men with Acquired Immune Deficiency Syndrome Wasting Syndrome1
Fairfield, W. P., Finkelstein, J. S., Klibanski, A., & Grinspoon, S. K. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.5.7515 · Cited by 89
“infected men with both congenital and acquired hypogonadism (9, 10).”
BackgroundSelf-citationCardiovascular Issues in Hypogonadism and Testosterone Therapy
Shabsigh, R., Katz, M. H., Yan, G., & Makhsida, N. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.10.009 · Cited by 89
Kenny, R. A., Prestwood, K. M., Gruman, C., Fabregas, G., Biskup, B., & Mansoor, G. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.7.m460 · Cited by 89
Vanderschueren, D., Vandenput, L., Boonen, S., Van Herck, E., Swinnen, J. V., & Bouillon, R. (2000) · Endocrinology · doi:10.1210/endo.141.5.7472 · Cited by 88
van den Bergh, J. P., Hermus, A. R. M. M., Spruyt, A. I., Sweep, F. C. G. J., Corstens, F. H. M., & SMALS, A. G. H. (2001) · Osteoporosis International · doi:10.1007/s001980170158 · Cited by 88
Androgens and the Regulation of Adiposity and Body Fat Distribution in Humans
Tchernof, A., Brochu, D., Maltais‐Payette, I., Mansour, M. F., Marchand, G. B., Carreau, A., & Kapeluto, J. (2018) · Comprehensive physiology · doi:10.1002/cphy.c170009 · Cited by 113
Testosterone and the aging male: To treat or not to treat?
Bain, J. (2010) · Maturitas · doi:10.1016/j.maturitas.2010.01.009 · Cited by 84
Turner, A., Chen, T. C., Barber, T. W., Malabanan, A. O., Holick, M. F., & Tangpricha, V. (2004) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2004.02125.x · Cited by 86
“Testosterone treatment of elderly men with hypogonadism increases BMD (Katznelson et al., 1996; Behre et al., 1997, 1999; Snyder et al., 1999; Amory et al., 2004).”
BackgroundTestosterone replacement therapy in older adult men
Tenover, J. L. (1999) · International Journal of Andrology · doi:10.1046/j.1365-2605.1999.00184.x · Cited by 84
Kenny, A. M., & Prestwood, K. M. (2000) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(05)70157-5 · Cited by 83
Bone mineral density in people living with HIV: a narrative review of the literature
Kruger, M., & Nell, T. A. (2017) · AIDS Research and Therapy · doi:10.1186/s12981-017-0162-y · Cited by 87
“When androgen levels are low, it is associated with bone loss and increased bone remodelling in men [113, 114]; however, a reduction in oestrogen seems to play a key role in the age-related decrease of BMD [115, 116].”
BackgroundSaad, F., & Gooren, L. J. (2010) · Journal of Obesity · doi:10.1155/2011/471584 · Cited by 82
“So, apparently while androgens induce visceral fat accumulation, once fat has been stored in the visceral depot it does not need continued androgen stimulation as opposed to maintenance of bone and muscle mass, which are lower in men with adult onset hypogonadism than in eugonadal controls [13].”
BackgroundMusculoskeletal Disorders in Chronic Obstructive Pulmonary Disease
Cielen, N., Maes, K., & Gayan‐Ramirez, G. (2014) · BioMed Research International · doi:10.1155/2014/965764 · Cited by 86
Testosterone Deficiency and Replacement
Howell, S., & Shalet, S. M. (2001) · Hormone Research in Paediatrics · doi:10.1159/000048142 · Cited by 82
“demonstrated a 15p increase in fat-free mass and an 11p decrease in fat mass following 6 months’ treatment with testosterone cipionate 3 mg/kg every 2 weeks, and this was associated with a 56p increase in protein synthesis. Similar changes were seen following 18 months’ treatment with testosterone enanthate in a study…”
BackgroundThe mutual dependence between bone and gonads
Karsenty, G. (2012) · Journal of Endocrinology · doi:10.1530/joe-11-0452 · Cited by 81
“…sexual dimorphism is mainly due to a stimulatory androgen action on periosteal bone formation in men, whereas an inhibitory estrogen-related action occurs in women (Bertelloni et al. 1995, Finkelstein et al. 1996, Katznelson et al. 1996, Seeman 2001, Venken et al. 2006, Kirmani et al. 2009).”
BackgroundAndrostenedione Does Not Stimulate Muscle Protein Anabolism in Young Healthy Men1
Rasmussen, B. B., Volpi, E., Gore, D. C., & Wolfe, R. R. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.1.6322 · Cited by 80
“2): phenylalanine entry into leg: Fin 5 CA 3 BF (1); phenylalanine exit from leg: Fout 5 CV 3 BF (2); net balance across the leg: NB 5 (CA 2 Cv) 3 BF (3); muscle inward transport: FM,A 5 {[(EM 2 EV)/(EA 2 EM)] 3 CV 1 CA} 3 BF (4); muscle outward transport: FV,M 5 {[(EM 2 EV)/(EA 2 EM)] 3 CV 1 CV} 3 BF (5); A-V shuntin…”
Effects of testosterone on body composition of the aging male
Mudali, S. (2004) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2004.01.004 · Cited by 77
Zhang, X. H., Liu, X. S., Vasilic, B., Wehrli, F. W., Benito, M., Rajapakse, C. S., Snyder, P. J., & Guo, X. E. (2008) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.080405 · Cited by 79
“in the United States have osteoporosis, whereas the lifetime risk of osteoporotic fractures in men has been estimated to be 13–25%.((4,5)) Among men evaluated for osteoporosis, 5–30% have no apparent cause other than hypogonadism.”
BackgroundBhasin, S. (2003) · Clinical Infectious Diseases · doi:10.1086/375878 · Cited by 78
“[42] 22–69 TE or TC 100 mg/week for 18 months 7 2% increase by bioelectrical impedance 14 4% decrease in % body fat, 13 4% decrease in SC fat ND”
BackgroundRana, K., Fam, B. C., Clarke, M. V., Pang, T. P. S., Zajac, J. D., & MacLean, H. E. (2011) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00584.2010 · Cited by 78
Androgen Effects on Adipose Tissue Architecture and Function in Nonhuman Primates
Varlamov, O., White, A. E., Carroll, J. M., Bethea, C. L., Reddy, A. P., Slayden, O. D., O’Rourke, R. W., & Roberts, C. T. (2012) · Endocrinology · doi:10.1210/en.2011-2111 · Cited by 74
Impact of obesity on hypogonadism in the andropause
TAN, R. S.-H., & Pu, S. J. (2002) · International Journal of Andrology · doi:10.1046/j.1365-2605.2002.00356.x · Cited by 76
Francomano, D., Bruzziches, R., Bárbaro, G., Lenzi, A., & Aversa, A. (2014) · Journal of Endocrinological Investigation · doi:10.1007/s40618-014-0066-9 · Cited by 76
“between male obesity with lower plasma T levels [4] and other studies have shown that low T levels are predictive for the development of visceral obesity [5] with an increase of fat mass and a decrease in lean body mass compared to eugonadal men [6].”
Background
Metadata
- 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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