Bone Mineral Density Should Be Checked in All Hypogonadal Men

Urology Practice Management - June 2014, Vol 3, No 3 published on June 19, 2014 in Best Practices
Rosemary Frei, MSc

A recent retrospective study of 114 patients with hypogonadism has led to the conclusion that men with this condition should be screened with dual-energy x-ray absorptiometry (DEXA) for low bone mineral density (BMD). Almost half of the men who participated in this study with testosterone levels below 300
 ng/dL were found in the retrospective chart review to have either osteopenia or osteoporosis.1

Presented at the American Society of Andrology’s 2014 Annual Meeting, the study examined BMD scans on patients with clinical hypogonadism. Participants presented with clinical symptoms as well as biochemical deficiencies. Hypogonadism among the older adult male population is expected to increase in coming years; the mean ± standard deviation age of the cohort in this study was 48.3 ± 13.7 years.1,2

“Even though the Endocrine Society’s 2010 guidelines state that hypogonadal men should get DEXA scans only when they have severe testosterone deficiency – that is, below 150 ng/dL – we found you still have just as much of a chance of having hypogonadism below 300 ng/dL, and no levels below this are predictive of having worse BMD,” Igor Sorokin, MD, third-year urology resident at the Albany Medical College and lead author of a poster presentation on the results, told Urology Practice Management. “The study confirms that any male coming to your clinic with hypogonadism should get a baseline DEXA regardless of previous treatment.”3

Hypogonadism is associated with a number of comorbidities; symptoms include reduced libido/erectile dysfunction, reduced muscle mass and strength, increased adiposity, and depressed mood and fatigue. It has also long been recognized as a risk factor for osteoporosis and osteopenia. However, there has been very little investigation of the strength of this association and of what factors are the strongest predictors of low BMD.1,2

Andrew McCullough, MD, surgery professor, Division of Urology, Albany Medical College, led the team who reviewed the records of 114 consecutive patients who were being treated for hypogonadism between February 2011 and September 2013 at the Men’s Health Center. Hypogonadism is defined as the presence of both symptoms and serum testosterone levels of <300 ng/dL. The subjects had all undergone BMD assessment.1

Forty-four (38.6%) of the men had been found on DEXA screening to have osteopenia and 9 (7.9%) had osteoporosis. Their mean testosterone level at diagnosis was 183 ng/dL. The researchers found lower total and mean testosterone were not significantly associated with lower BMD, nor were longer duration of hypogonadism or higher serum estradiol levels.1

Former or current smoking was associated with a higher prevalence of osteopenia and osteoporosis: 57% of people with osteopenia were former or current smokers, whereas 43% were never-smokers, and the respective numbers for subjects with osteoporosis were 78% and 22%.

The team did not find a correlation between total testosterone levels and t-scores of the spine, hip, or femoral neck. They did find higher total testosterone levels in men who had previously received testosterone treatment than in those who had not received such treatment, but previous testosterone treatment was not associated with higher BMD.1


  1. Sorokin I, et al. Prevalence of bone density deficiencies in men presenting for hypogonadism treatment: do we need to worry? American Society of Andrology’s 39th Annual Meeting, April 4-8, 2014, Atlanta. Poster #69.
  2. Dandona P,  Rosenberg MT. A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract. 2010;64(6):682-696.
  3. The Endocrine Society’s Clinical Guidelines. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. 2010. Accessed May 6, 2014.


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Last modified: June 19, 2014
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