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Long-Term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men
Abstract
In both men and women, a decrease in bone mineral density (BMD) is a major symptom of hypogonadism. Although the effects of estrogens on osteoporosis in women are well documented, comparatively little is known about the effects of long term testosterone substitution on BMD in hypogonadal men. Therefore, we studied BMD in 72 hypogonadal patients (37 men with primary and 35 men with secondary hypogonadism) under testosterone substitution therapy that continued for up to 16 yr. Thirty-two of these men were also seen before initiation of therapy. At annual intervals, trabecular BMD of the lumbar spine was measured by quantitative computed tomography, a true volumetric and reproducible method for long term serial BMD measurements. Serum levels of testosterone increased to the normal range in all androgen-treated hypogonadal men. The most significant increase in BMD was seen during the first year of testosterone treatment in previously untreated patients, when BMD increased from 95.2 ± 5.9 to 120.0 ± 6.1 mg/cm3 hydroxyapatite (mean ± se). Long term testosterone treatment maintained BMD in the age-dependent reference range in all 72 hypogonadal men, independent of the type of hypogonadism. Transdermal testosterone patches applied to the scrotum were as effective in normalizing BMD as im testosterone enanthate injections. In summary, testosterone therapy increases BMD in hypogonadal men regardless of age. The greatest increase is seen during the first year of treatment in previously untreated patients with low initial BMD. In hypogonadal men, BMD can be normalized and maintained in the normal range by continuous, long term testosterone substitution.
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“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 [135]
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“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 [135]
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“T therapy in males with central hypogonadism reduces fat mass and increases fat-free mass (132,135,140,148,149).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [135]
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Metadata
- Authors
- Behre, H. M., Kliesch, S., Leifke, E., Link, T. M., & Nieschlag, E.
- Affiliations
- University of Münster (DE)
- Corresponding author
- Nieschlag, Eberhard
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1997-08-01
- Volume
- 82
- Issue
- 8
- Pages
- 2386-2390
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2163320305
- Semantic Scholar
- 8c83f4c5d1798e90b32e461c6499e89accd38287
- Cited by
- 559
- References
- 49
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 11 · 2023: 10 · 2022: 14 · 2021: 14 · 2020: 11 · 2019: 18 · 2018: 14 · 2017: 12 · 2016: 8 · 2015: 18 · 2014: 19 · 2013: 18 · 2012: 26
- FWCI
- 17.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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 › Menopause: Health Impacts and Treatments
- Keywords
- testosterone replacement therapy, bone mineral density, hypogonadism, male hypogonadism, hypergonadotropic hypogonadism, secondary hypogonadism, osteoporosis, testosterone enanthate, long-term treatment outcomes
- MeSH terms
- Administration, Cutaneous, Administration, Oral, Adolescent, Adult, Aged, Humans, Hypogonadism, Injections, Intramuscular, Male, Middle Aged, Regression Analysis, Testosterone, Bone Density
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