CLINICAL STUDY Adequacy of androgen replacement influences bone density response to testosterone in androgen-deficient men

Objective: Androgen deficiency (AD) leads to bone loss and contributes to osteoporotic fractures in men. Although low bone mineral density (BMD) in AD men is improved by testosterone replacement, the responses vary between individuals but the determinants of this variability are not well defined. Design and methods: Retrospective review of dual energy X-ray absorptiometry (DEXA) of the lumbar spine and proximal femur in men with established AD requiring regular androgen replacement therapy (ART). After a DEXA scan all men were treated with testosterone implants (800 mg,,6 month intervals). Patients were classified as having a congenital, childhood, or post-pubertal onset, as well as according to the adequacy of treatment prior to their first DEXA scan as untreated, partially treated or well treated. Results: Men with AD requiring regular ART (n 169, aged 46.3^1.1 years, range 22 –84 years) underwent a DEXA scan prior to being treated with testosterone implants (800 mg,,6 month inter-vals). In cross-sectional analysis at the time of the first DEXA scan untreated men (n 24) had sig-nificantly reduced age-adjusted BMD at all four sites (L1–L4, femoral neck, Ward’s triangle and trochanter). Well-treated men (n 77) had significantly better age-adjusted BMD at all four site