role of testosterone for the treatment of osteoporosis?
Men with osteoporosis and symptoms of hypogonadism may benefit from testosterone replacement therapy (TRT), especially if the serum testosterone level is <150 ng/dL. TRT increases bone mass in men with baseline low testosterone levels, but there has been no fracture reduction data reported; therefore, it is not an FDA-approved treatment for osteoporosis. Testosterone can be administered intramuscularly (100–400 mg every 1–4 weeks; lower doses at more frequent intervals are preferred), as a transdermal patch (AndroDerm) or cream (Testim, AndroGel, Fortesta, Axiron), or as a buccal patch (Striant). Injectable testosterone pellets are not recommended because supraphysiologic testosterone levels often result from this therapy. TRT has not been shown to cause prostate cancer but has clearly been shown to increase the risk of growth of existing prostate cancer. TRT can precipitate or worsen sleep apnea. Evidence regarding cardiovascular safety of testosterone is currently controversial; however, the cardiovascular risk does appear to be increased in men who have on-treatment serum testosterone levels in the supraphysiologic range. Patients without improvement in hypogonadal symptoms should not continue testosterone as other therapies for osteoporosis are more beneficial.