Prevalence of symptomatic androgen deficiency in men. Factors associated with vertebral fractures in men treated with androgen deprivation therapy for prostate cancer. Androgen supplementation in eugonadal men with osteoporosis-effects of 6 months of treatment on bone mineral density and cardiovascular risk factors. Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample. Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial Correlates of low testosterone in men with chronic spinal cord injury Diethylstilbesterol revisited: androgen deprivation, osteoporosis and prostate cancer. Osteoporosis in Male Hypogonadism: Responses to Androgen Substitution Differ among Men with Primary and Secondary Hypogonadism Testosterone supplementation improves spatial and verbal memory in healthy older men Testosterone therapy increases sexual desire in ageing men with low–normal testosterone levels and symptoms of androgen deficiency Decreased testosterone levels in men with rheumatoid arthritis: effect of low dose prednisone therapy. An osteoporosis screening tool for Chinese men Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study.
CONTEXT Despite recognition that and rogen deficiency in men should be defined according to biochemical and clinical criteria , most prevalence estimates are based on low testosterone levels alone . OBJECTIVE The objective of this study was to examine the association between symptoms of and rogen deficiency and low total and calculated free testosterone levels and estimate the prevalence of symptomatic and rogen deficiency in men . DESIGN This study was a population -based , observational survey . PARTICIPANTS A total of 1,475 Black , Hispanic , and white men , between the ages of 30 - 79 yr , with complete data on testosterone , SHBG , and symptoms of and rogen deficiency , and who are not taking medications that impact sex steroid levels were r and omly selected from the Boston Area Community Health Survey . OUTCOME Outcomes were measured as symptomatic and rogen deficiency , defined as low total ( < 300 ng/dl ) and free ( < 5 ng/dl ) testosterone plus presence of low libido , erectile dysfunction , osteoporosis or fracture , or two or more of following symptoms : sleep disturbance , depressed mood , lethargy , or diminished physical performance . RESULTS Mean age of the sample was 47.3 + /- 12.5 yr . Approximately 24 % of subjects had total testosterone less than 300 ng/dl , and 11 % of subjects had free testosterone less than 5 ng/dl . Prevalence of symptoms were as follows : low libido ( 12 % ) , erectile dysfunction ( 16 % ) , osteoporosis/fracture ( 1 % ) , and two or more of the nonspecific symptoms ( 20 % ) . Low testosterone levels were associated with symptoms , but many men with low testosterone levels were asymptomatic ( e.g. in men 50 + yr , 47.6 % ) . Crude prevalence of symptomatic and rogen deficiency was 5.6 % ( 95 % confidence interval : 3.6 % , 8.6 % ) , and was not significantly related to race and ethnic group . Prevalence was low in men less than 70 yr ( 3.1 - 7.0 % ) and increased markedly with age to 18.4 % among 70 yr olds . Projection of these estimates to the year 2025 suggests that there will be as many as 6.5 million American men ages 30 - 79 yr with symptomatic and rogen deficiency , an increase of 38 % from 2000 population estimates . CONCLUSIONS Prevalence of symptomatic and rogen deficiency in men 30 and 79 yr of age is 5.6 % and increases substantially with age . The aging of the U.S. male population will cause a large increase in the burden of symptomatic and rogen deficiency . Future work should address the clinical significance of low testosterone levels in asymptomatic men PURPOSE And rogen deprivation therapy for prostate cancer causes accelerated loss of bone mineral density and is associated with increased fracture risk . We evaluated risk factors associated with vertebral fractures among men enrolled in a fracture prevention trial . MATERIAL S AND METHODS Analysis included men receiving and rogen deprivation therapy for prostate cancer and enrolled in a phase III fracture prevention trial . All men were 70 years old or older or had a low bone mineral density ( T-score less than -1.5 for the lumbar spine or total hip ) . We analyzed demographic and laboratory characteristics of men with and those without vertebral fractures at study entry . RESULTS Of the 1,244 subjects 162 ( 13.0 % ) had a vertebral fracture at baseline . The 2 factors significantly associated with vertebral fractures were white race ( p=0.028 compared with nonwhite race ) and osteoporosis ( p=0.002 for osteoporosis at any site , p=0.053 for osteoporosis at the spine , p=0.002 for osteoporosis at the hip ) . Lower bone mineral density was also significantly associated with vertebral fractures when analyzed as a continuous variable . Factors not associated with vertebral fractures included age , country of residence , and rogen deprivation therapy duration at baseline , and rogen deprivation therapy mode , body mass index , testosterone , estradiol , C-telopeptide , bone specific alkaline phosphatase and osteocalcin . Results were similar in analyses limited to men 70 years old or older . CONCLUSIONS White race and low bone mineral density were significantly associated with vertebral fractures in this study of men treated with and rogen deprivation for prostate cancer . These observations should inform the assessment and management of fracture risk among such men This open , prospect i ve therapeutic trial studied the effects of regular moderate and rogen supplementation on bone mineral density in eugonadal men with established osteoporosis , and collected data on the safety of and rogen therapy used in this setting . 23 men , aged 34 - 73 years , with vertebral crush fractures and back pain , in whom secondary causes of osteoporosis had been excluded , were treated with fortnightly intramuscular injections of 250 mg testosterone esters ( Sustanon 250(R ) ) for 6 months . Blood pressure was recorded monthly ; fasting lipids , glucose , haematocrit , plasma viscosity , and testosterone levels were measured every 3 months . Psychological effects were assessed using the Hospital Anxiety and Depression Scale ( HADS ) and General Health Question naire ( GHQ ) , together with question ing on libido changes . Principal outcomes measured were changes in bone mineral density at the hip and spine by dual-energy X-ray absorptiometry ( DEXA ) over the treatment period . 21 men completed the study period .  Mean bone mineral density at the lumbar spine increased from 0.799 g/cm(2 ) to 0.839 g/cm(2 ) during treatment ( p < 0 . 001 ) , a rise of 5 % in 6 months . Bone mineral density at the hip did not change . There were significant , favorable changes in diastolic blood pressure ( -4.7 mmHg , p < 0.01 ) , serum triglyceride levels ( -0.405 mmol/L , p < 0.01 ) , and total cholesterol ( -0.27 mmol/L , p < 0.05 ) . Adverse changes included a fall in HDL cholesterol ( -0.087 mmol/L , p < 0.05 ) and a rise in plasma viscosity which was significant at 3 months but not at 6 months . The expected rises in hematocrit ( 0.434 to 0.456 ) and FAI ( 0.504 to 0.887 ) occurred . We conclude that testosterone supplementation significantly increased bone mineral density in this heterogeneous group of men with idiopathic primary osteoporosis , without an overall adverse effect on cardiovascular risk factors . This treatment warrants further evaluation in a r and omized , controlled trial CONTEXT Risk factors for low testosterone and symptomatic and rogen deficiency ( AD ) may be modifiable . OBJECTIVE Our objective was to examine demographic , anthropometric , and medical correlates of low testosterone and symptomatic AD . DESIGN Data were used from the Boston Area Community Health Survey , an epidemiological study conducted from 2002 - 2005 . SETTING Data were obtained from a community-based r and om sample of racially and ethnically diverse men . PATIENTS OR OTHER PARTICIPANTS Data were available for 1822 men . MAIN OUTCOME MEASURES Multivariate logistic regression  was used to estimate odds ratios ( OR ) and 95 % confidence intervals ( CI ) for associations of covariates with 1 ) low testosterone and 2 ) symptomatic AD . The operational definition of low testosterone was serum total testosterone less than 300 ng/dl and free testosterone less than 5 ng/dl ; symptomatic AD was defined as the additional presence of symptoms : any of low libido , erectile dysfunction , or osteoporosis or two or more of sleep disturbance , depressed mood , lethargy , or diminished physical performance . RESULTS Factors associated with low testosterone included age ( OR = 1.36 ; 95 % CI= 1.11 - 1.66 , per decade ) , low per-capita income ( $ 6000 or less per household member vs. more than $ 30,000 ; OR = 2.86 ; 95 % CI = 1.39 - 5.87 ) , and waist circumference ( per 10-cm increase ; OR = 1.75 ; 95 % CI = 1.45 - 2.12 ) . Only age ( OR = 1.36 ; 95 % CI = 1.04 - 1.77 ) , waist circumference ( OR = 1.88 ; 95 % CI = 1.44 - 2.47 ) , and health status ( OR = 0.21 ; 95 % CI = 0.05 - 0.92 , excellent vs. fair/poor ) were associated with our construct of symptomatic AD . Of all variables , waist circumference was the most important contributor in both models . CONCLUSIONS Waist circumference is a potentially modifiable risk factor for low testosterone and symptomatic AD . Manifestation of symptoms may be a consequence of generally poor health status Abstract Symptomatic and rogen deficiency is common in patients taking opioid analgesics , as these drugs potently suppress the hypothalamic – pituitary – gonadal axis . However , the efficacy of testosterone replacement in this setting remains unclear . The objective of this trial was to evaluate the efficacy of testosterone replacement on pain perception and other and rogen-dependent outcomes in men with opioid-induced and rogen deficiency . We conducted a r and omized , double-blind , parallel placebo-controlled trial at an outpatient academic research center . Participants were men aged 18 to 64 years on opioid analgesics for chronic noncancer pain , and total testosterone levels were < 350 ng/dL. Participants were r and omly assigned to 14 weeks of daily transdermal gel that contained 5 g of testosterone or placebo . Primary outcomes were changes in self-reported clinical pain and objective ly assessed pain sensitivity . Sexual function , quality of life , and body composition were also assessed . The mean age was 49 years . The median total and free testosterone levels at baseline were 243 ng/dL and 47 pg/mL and 251 ng/dL and 43 pg/mL in the testosterone and placebo arm , respectively . Of the 84 r and omized participants , 65 had follow-up data on efficacy outcomes . Compared with men assigned to the placebo arm , those assigned to testosterone replacement experienced greater improvements in pressure and mechanical hyperalgesia , sexual desire , and role limitation due to emotional problems . Testosterone administration was also associated with an improvement in body composition . There were no between-group differences in changes in self-reported pain . In conclusion , in men with opioid-induced and rogen deficiency , testosterone administration improved pain sensitivity , sexual desire , body composition , and aspects of quality of life Although high rates of serum testosterone deficiency have been reported in men with spinal cord injury ( SCI ) , its determinants and attributes are not yet established . The aim of this study was to recognize , among putative determinants and attributes of and rogen deficiency , those significantly associated to low testosterone after adjustment for confounders recognizable in men with chronic SCI . A biochemical and rogen deficiency ( total testosterone < 300 ng/dL ) was exhibited by 18 of 51 patients ( 35.3 % ) . Significant correlates of testosterone levels were as follows : weekly leisure time physical activity ( LTPA )  explored by the LTPA Question naire for people with SCI , body mass index ( BMI ) , homeostatic model assessment of insulin resistance ( HOMA‐IR ) , triglycerides and sexual symptoms , explored by the aging males ' symptom ( AMS ) question naire . At the multiple linear regression analysis , among putative determinants of low testosterone , only weekly LTPA and BMI exhibited a significant association with testosterone levels , explaining 54.2 and 9.0 % of testosterone variability respectively . At the linear regression models , among various putative attributes of and rogen deficiency , only lower sexual desire and , at a lesser extent , higher HOMA‐IR , exhibited significant associations with lower testosterone levels , after adjustment for BMI , age , comorbidities and weekly LTPA . In conclusion , poor LTPA , high BMI and low sexual desire are independent predictors of low testosterone in men with chronic SCI . This is relevant to clinical practice , as all these features are routinely assessed in rehabilitation setting s for SCI . As poor LTPA and high BMI are modifiable life‐style related risk factors , prospect i ve studies could clarify whether life‐style modification could increase the level of testosterone and improve the low sexual desire , relevant clinical attribute of low testosterone in men with SCI PURPOSE It is well described in the urological literature that and rogen deprivation can result in accelerated bone breakdown and osteoporosis . Therefore , we evaluate the degree of bone breakdown in patients on conventional and rogen deprivation with those on diethylstilbesterol alone or in conjunction with luteinizing hormone releasing hormone agonists  or orchiectomy . MATERIAL S AND METHODS During an 18-month period a total of 54 patients with clinical ly localized prostate cancer and 24 with benign prostatic hyperplasia were evaluated . All patients with prostate cancer were either treated with external beam radiotherapy without and rogen deprivation or were started on and rogen deprivation therapy . All patients were prospect ively followed and evaluated for serum testosterone and estradiol along with urinary collagen type I cross-linked N-telopeptides . Three separate morning urine sample s on 3 separate months were collected on each patient and analyzed for N-telopeptides . To correct for different levels of renal function , all N-telopeptides were measured as a ratio of urinary N-telopeptides/urine creatinine . All patients with any bone or skeletal abnormalities were excluded from study as were those with osseous metastatic disease . RESULTS There was a statistically significant ( p < 0.05 ) higher level of urinary N-telopeptides/creatinine in patients on and rogen deprivation therapy  who were not treated with diethylstilbesterol . The estrogenic effect of diethylstilbesterol protects one from bone resorption .  Patients on diethylstilbesterol  did not have any higher levels of bone breakdown than patients with benign prostatic hyperplasia or those who never received any and rogen deprivation . CONCLUSIONS Rapid bone turnover and resorption can be prevented with 1 mg . diethylstilbesterol alone or in conjunction with other modes of and rogen deprivation . Therefore , diethylstilbesterol should be considered as monotherpy in men who require long-term anti and rogen therapy Background : No r and omized study exists comparing the effects of different modes of and rogen substitution on bone mineral density ( BMD ) . Methods : We performed a prospect i ve , r and omized , trial assigning 53 hypogonadal men to the following treatment groups : mesterolone 100 mg p.o . daily , testosterone undecanoate 160 mg p.o . daily , testosterone enanthate 250 mg i.m . every 21 days , or a single subcutaneous implantation of 1,200 mg crystalline testosterone .  The BMD was determined by peripheral quantitative computed tomography . Results : At baseline , men with secondary hypogonadism ( n = 33 ) had a lower BMD ( –1.52 ± 0.23 SDS ; Z-scores ) than men with primary hypogonadism ( n = 20 , –0.87 ± 0.23 SDS , p < 0.01 ) . In men with primary hypogonadism , the BMD increased dose dependently ( crystalline testosterone + 7.0 ± 1.3 % , testosterone enanthate + 4.8 ± 0.2 % , testosterone undecanoate + 3.4 ± 2.5 % , mesterolone + 0.8 ± 1.6 % ) after 6 months of therapy . Only secondary hypogonadal men treated with testosterone enanthate experienced an increase of the BMD . Conclusions : In primary hypogonadal men the BMD responds dose dependently to testosterone substitution , whereas in secondary hypogonadism only testosterone enanthate treatment significantly increased the BMD Objective : To determine the relationship between exogenous testosterone administration and cognitive abilities in a population of healthy older men . Background : Serum levels of total and bioavailable testosterone gradually decrease with age in men and are associated with reductions in muscle mass , osteoporosis , decreased sexual activity , and changes in cognition . Methods : Twenty-five healthy , community-dwelling volunteers , aged 50 to 80 years , completed a r and omized , double-blind , placebo-controlled study . Participants received weekly intramuscular injections of either 100 mg testosterone enanthate or placebo ( saline ) for 6 weeks . Cognitive evaluations were conducted at baseline , week 3 , and week 6 of treatment by use of a battery of neuropsychologic tests . Results : Circulating total testosterone was raised an average of 130 % from baseline at week 3 and 116 % at week 6 in the treatment group . Because of aromatization of testosterone , estradiol increased an average of 77 % at week 3 and 73 % at week 6 in the treatment group . Significant improvements in cognition were observed for spatial memory ( recall of a walking route ) , spatial ability ( block construction ) , and verbal memory ( recall of a short story ) in older men treated with testosterone compared with baseline and the placebo group , although improvements were not evident for all measures . Conclusions : The results suggest that short-term testosterone administration enhances cognitive function in healthy older men . However , it remains unclear whether these improvements in cognition are attributable to increased testosterone or estradiol levels , or both . The potential role of testosterone vs its metabolites on cognition requires further research Although decline in sexual function is a common reason for ageing men to seek advice regarding testosterone therapy , placebo-controlled trial data have been unable to show a consistent , beneficial role for testosterone . The objective of this study was to determine the effect of testosterone therapy on sexual function in non-obese ageing men with symptoms of and rogen deficiency and low – normal serum testosterone levels . A total of 60 men aged 55 years or older in good general health with total testosterone ( TT ) levels < 15 nM , and with symptoms suggestive of and rogen deficiency , were r and omized in a double-blinded protocol to transdermal testosterone patches or placebo for 12 months  . Sexual function was assessed using the International Index of Erectile Function at weeks 0 , 26 and 52 . In men receiving testosterone TT levels increased by 30 % ( P=0.01 ) and luteinizing hormone decreased by 50 % ( P<0.001 ) . Relative to placebo , testosterone therapy improved sexual desire ( P=0.04 ) ; however other parameters of sexual function including erectile function were unaffected by the treatment . Ageing men in good general health and with symptoms of and rogen deficiency and low – normal serum testosterone levels receiving 12 months of transdermal testosterone therapy experienced , relative to placebo , improved sexual desire but no effect on other parameters of sexual function OBJECTIVE To determine whether men with rheumatoid arthritis ( RA ) have abnormal hypothalamic-pituitary-gonadal axis function and to measure the effects of low dose prednisone therapy in these patients . METHODS We measured testosterone , follicle stimulating hormone ( FSH ) , and luteinizing hormone ( LH ) in 36 men aged 38 - 75 ( mean age + /- 1 sd = 62 + /- 10 years ) who had longst and ing active RA ( mean disease duration = 17 + /- 12 years ) and in 70 healthy elderly male controls , aged 53 - 83 ( mean age 68 = + /- 6 years ) . We divided the group with RA into those taking no prednisone ( n = 12 ) and those taking 5 to 10 mg/day of prednisone ( n = 24 ) and analyzed these groups separately to determine whether low doses of prednisone affected testosterone levels . RESULTS Compared to the healthy controls , patients with RA not taking prednisone had normal testosterone levels but significantly elevated levels of FSH and LH ( p < 0.01 for both comparisons ) . In contrast , patients with RA taking prednisone had significantly lower testosterone levels ( p < 0.05 ) , but levels of FSH and LH were only slightly elevated compared to controls . Compared to patients not taking prednisone , patients taking prednisone had lower levels of testosterone , FSH , and LH . CONCLUSION Male patients with RA who are not taking prednisone have significantly elevated levels of FSH and LH with normal testosterone levels , suggesting a state of compensated partial gonadal failure . Male patients with RA taking low doses of prednisone have lower testosterone and gonadotropin levels , suggesting that prednisone may suppress the hypothalmic-pituitary-testicular axis . Since testosterone affects immune function as well as bone and muscle metabolism , and rogen deficiency in some men with RA may predispose these patients to more severe disease and to increased complications of steroid therapy such as myopathy and osteoporosis Several osteoporosis risk instruments have been proposed to select women for bone densitometry , but no vali date d instruments are currently available for men . This study aims to address this deficiency by developing and validating a Male Osteoporosis Screening Tool ( MOST ) for Chinese men . Two thous and ambulatory men , aged 65 and above , were recruited from the general community in Hong Kong , and a cohort of 1,970 men with valid total hip and lumbar spine dual-energy X-ray absorptiometry ( DXA ) measurements was included in the current analysis . A 60 % r and om sample was selected as the training sample for developing the screening tool , and the remaining 40 % constituted the validation sample . Logistic regression and receiver operating characteristic ( ROC ) analysis were used to identify the simplest combination of risk factors to be included in the screening tool for predicting osteoporosis at the femoral neck , total hip , or lumbar spine . Body weight and quantitative ultrasound index ( QUI ) were found to contribute significantly to the area under the ROC curve ( AUC ) , yielding an AUC of 0.823 in the training sample . The result ing MOST had a sensitivity of 94 % and a specificity of 46 % when using a cutoff score of 3 . MOST had an AUC of 0.839 in the validation sample . The risk of osteoporosis was 1 % among those with MOST scores ≤2 , but 72 % among those with MOST scores > 7 . Using a cutoff of 3 , the negative predictive value was 97.5 % which suggests that the 42 % with MOST scores ≤3 may be accurately screened out as being without osteoporosis , thus saving two fifths of our DXA re sources . The positive predictive value was 72 % when using a cutoff of 7 , implying that MOST can not replace DXA for case-finding purpose s. Nevertheless , for re source allocation and patient satisfaction , it is prudent and economical to offer DXA screening first to the 6 % with MOST scores > 7 Little is known about the descriptive epidemiology of and rogen deficiency . In this study , we sought to address this issue by providing estimates of the crude and age-specific prevalence and incidence rates of and rogen deficiency in a r and omly sample d population -based cohort of middle-aged and older men . Data on and rogen deficiency ( defined using both signs/symptoms plus total and calculated free testosterone ) were available for n = 1691 ( baseline ) and n = 1087 ( follow-up ) men from the Massachusetts Male Aging Study .  Crude and age-specific prevalence and incidence rates were calculated . Based on these estimates , projections for the number of cases of and rogen deficiency in the 40- to 69-yr-old U.S. male population were computed . Estimates of the crude prevalence of and rogen deficiency at baseline and follow-up were 6.0 and 12.3 % , respectively . Prevalence increased significantly with age . From baseline age-specific prevalence data , it is estimated that there are approximately 2.4 million 40- to 69-yr-old U.S. males with and rogen deficiency . The crude incidence rate of and rogen deficiency was 12.3 per 1,000 person-years , and the rate increased significantly ( P < 0.0001 ) with age . Based on these incidence data , we can expect approximately 481,000 new cases of and rogen deficiency per year in U.S. men 40 - 69 yr old
Intramuscular testosterone moderately increased lumbar bone density in men ; the results on femoral neck bone density are inconclusive .
Without bone fracture data , the available trials offer weak and indirect inferences about the clinical efficacy of testosterone on osteoporosis prevention and treatment in men
CONTEXT And rogen-deficient men are at increased risk of osteoporosis .
The extent to which testosterone can prevent and treat osteoporosis in men remains unclear .