Effects of long-term testosterone substitutive therapy on bone mineral content in men with hypergonadotrophic hypogonadism

Hypogonadism is one of the crucial risk factors for male osteopenia and ost eoporosis. There are few studies on the effects of long-term and consistent ly administered testosterone substitutive therapy on bone mineral density i n men with gonadal androgen deficiency, and their results have been suscept ible to various interpretations. The aim of our study was an evaluation of bone mineral content in 26 men, aged 18-57 years, with hypergonadotrophic h ypogonadism who underwent long-lasting androgen replacement therapy with te stosterone esters (Omnadren 250), which conditioned proper psychosomatic: a ndrogenization. The control group comprised 405 healthy men, aged 20 GO yea rs, a representative sample of the local male population. Among ail examine d men and in the control group. trabecular, cortical and total bone mineral content at the distal radius of the nondominant hand were assessed by peri pheral quantitative computed tomography using the Stratec 960 apparatus. Tn 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 sir; patients (23.1%;), the corti cal 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 ab ove -1 SD. Osteopenia was diagnosed in six hypogonadal males, whereas osteo porosis was found in one man (cortical bone mineral content below -2.5 SD). Only in seven of the examined men (26.9%) Tvas the total bone mineral cont ent found within normal ranges, whereas in 19 men (73.1%) the total bone mi neral content was below -1 SD (osteopenia). Despite the testosterone replac ement in hypogonadal men, the greatest reduction of bone mineral content wa s found in its trabecular and total values. Among all the men examined, the trabecular and total boner mineral contents were below the mean of our own reference values. The results show that long-term and consecutively admini stered testosterone replacement in conventional doses, despite the normaliz ation of serum androgen levels and the promotion of proper somatic developm ent, does not simultaneously eliminate hypogonadal osteopenia in every case . The individually differentiated response to exogenous androgens is a char acteristic feature of male hypogonadism. This study emphasizes the necessit y of regular measurements of bone mineral density in hypogonadal men, as th e densitometric parameters should bt accepted as an osteologic (and very im portant) marker of androgenization of the male organism.