Osteoporosis in male hypogonadism: responses to androgen substitution differ among men with primary and secondary hypogonadism.
BACKGROUND
No randomized study exists comparing the effects of different modes of androgen substitution on bone mineral density (BMD).


METHODS
We performed a prospective, randomized, 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.
Schubert
Markus
M
Klinik II und Poliklinik für Innere Medizin der Universität zu Köln, Cologne, Germany.
Bullmann
Catharina
C
Minnemann
Timo
T
Reiners
Christoph
C
Krone
Wilhelm
W
Jockenhövel
Friedrich
F
D000328:Adult; D000368:Aged; D000728:Androgens / Q000627:therapeutic use*; D015519:Bone Density / Q000235:genetics / Q000502:physiology; D013196:Dihydrotestosterone / Q000097:blood; D004311:Double-Blind Method; D004343:Drug Implants; D004958:Estradiol / Q000097:blood; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000150:complications* / Q000209:etiology; D008297:Male; D008655:Mesterolone / Q000627:therapeutic use; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D011446:Prospective Studies; D013256:Steroids / Q000627:therapeutic use; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use
D000728:Androgens; D004343:Drug Implants; D013256:Steroids; D013196:Dihydrotestosterone; D008655:Mesterolone; D013739:Testosterone; D004958:Estradiol; C004648:testosterone enanthate; C010792:testosterone undecanoate