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Effects of long-term testosterone substitutive therapy on bone mineral content in men with hypergonadotrophic
M Medras1, E A Jankowska, E Rogucka
1Department of Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland. ela@antro.pan.wroc.pl
Abstract:
Hypogonadism is one of the crucial risk factors for male osteopenia and osteoporosis. There are few studies on the effects of long-term and consistently administered testosterone substitutive therapy on bone mineral density in men with gonadal androgen deficiency, and their results have been susceptible to various interpretations. The aim of our study was an evaluation of bone mineral content in 26 men, aged 18-57 years, with hypergonadotrophic hypogonadism who underwent long-lasting androgen re-placement therapy with testosterone esters (Omnadren 250), which conditioned proper psychosomatic androgenization. The control group comprised 405 healthy men, aged 20-60 years, a representative sample of the local male population. Among all examined men and in the control group, trabecular, cortical and total bone mineral content at the distal radius of the nondominant hand were assessed by peripheral quantitative computed tomography using the Stratec 960 apparatus. In 11 hypogonadal men (42.3%), the trabecular bone mineral content was found to be within normal ranges; in 15 patients (57.7%) its values were below -1 standard deviation (SD) (osteopenia). In six patients (23.1%), the cortical bone mineral content was between +1 SD and the arithmetic mean, X; in 13 examined men (50%), the cortical bone mineral content was below X and above -1 SD. Osteopenia was diagnosed in six hypogonadal males, whereas osteoporosis was found in one man (cortical bone mineral content below -2.5 SD). Only in seven of the examined men (26.9%) was the total bone mineral content found within normal ranges, whereas in 19 men (73.1%) the total bone mineral content was below -1 SD (osteopenia). Despite the testosterone replacement in hypogonadal men, the greatest reduction of bone mineral content was found in its trabecular and total values. Among all the men examined, the trabecular and total bone mineral contents were below the mean of our own reference values. The results show that long-term and consecutively administered testosterone replacement in conventional doses, despite the normalization of serum androgen levels and the promotion of proper somatic development, does not simultaneously eliminate hypogonadal osteopenia in every case. The individually differentiated response to exogenous androgens is a characteristic feature of male hypogonadism. This study emphasizes the necessity of regular measurements of bone mineral density in hypogonadal men, as the densitometric parameters should be accepted as an osteologic (and very important) marker of androgenization of the male organism.
Insights
Testosterone replacement therapy for hypogonadism improves bone density in some men, but osteopenia persists in many. Regular bone density monitoring is crucial for hypogonadal men undergoing treatment.
Area of Science:
- Endocrinology
- Bone Metabolism
- Andrology
Background:
- Hypogonadism is a significant risk factor for male osteopenia and osteoporosis.
- Limited research exists on the long-term effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) in hypogonadal men.
- Previous studies on TRT and BMD in men have yielded varied interpretations.
Purpose of the Study:
- To evaluate bone mineral content (BMC) in hypogonadal men undergoing long-term TRT.
- To assess the effectiveness of testosterone esters (Omnadren 250) in improving BMD in men with hypergonadotrophic hypogonadism.
- To compare BMC in treated hypogonadal men with a control group of healthy men.
Main Methods:
- BMC was measured in 26 hypogonadal men (aged 18-57) and 405 healthy men (aged 20-60) using peripheral quantitative computed tomography (pQCT).
- Trabecular, cortical, and total BMC were assessed at the distal radius of the non-dominant hand.
- Men with hypogonadism received long-lasting androgen replacement therapy with testosterone esters.
Main Results:
- Osteopenia was prevalent, with 57.7% of hypogonadal men showing reduced trabecular BMC and 73.1% exhibiting reduced total BMC.
- One hypogonadal man was diagnosed with osteoporosis (cortical BMC below -2.5 SD).
- Despite TRT, trabecular and total BMC remained below the mean values of the reference group, indicating persistent bone loss.
Conclusions:
- Long-term TRT in conventional doses may not fully resolve hypogonadal osteopenia, even with normalized androgen levels.
- Individual responses to exogenous androgens vary significantly in hypogonadal men.
- Regular BMD measurements are essential for monitoring androgenization and managing bone health in hypogonadal men.