Testosterone Increases Spinal
Bone Density In HIV(+) Males
by Michael Mooney (June, 2001)
While many factors can cause bone loss in HIV(+) people, it is well-known that
decreased testosterone in males and females is associated with less bone
density. This is true whether a person is HIV(+) or HIV(-).
Other possible reasons people with HIV can lose bone are:
1. Side effects of anti-HIV medications
2. Use of corticosteroids
3. Poor nutrition, especially calcium and Vitamin D deficiencies.
In the abstract below, 200 mg of testosterone enanthate per week increased
spinal bone density.
Notably, the men in the study all had blood testosterone measurements
that were in the normal range. As we have been saying for 6 years, the
normal scale for testosterone measurements does not apply well to people
with HIV. People with HIV have been shown to often require blood testosterone
measurements that may be above the top of the normal scale, as shown by data
from studies of Rabkin and Wagner. (Click
here to read one study by Rabkin and Wagner.) This often requires dosing
that is twice as high as testosterone replacement administered to HIV(-) men.
If your doctor refuses to provide you with testosterone replacement because
you test in the normal range, but you have the symptoms of testosterone
deficiency, show them this data. If they still refuse to help you, we suggest
that you get another doctor, as this can be critical to your well-being and
survival.
Note that a co-author on this study is Dr. Steven Grinspoon of Harvard, who
is known for his expertise and insight in this area.
Fairfield,W.P., Finkelstein, J.S., Klibanski, A., Grinspoon, S.K. Osteopenia
in eugonadal men with acquired immune deficiency syndrome wasting
syndrome, J Clin Endocrinol Metab,86(5):2020-2026 (2001 May)
Abstract:
Multiple endocrine and metabolic consequences of human immunodeficiency virus (HN)
infection exist that may contribute to bone loss in men with the acquired immune
deficiency syndrome (AIDS) wasting syndrome. Recent studies suggest that
anabolic strategies can increase lean body mass in men with AIDS wasting. Prior
studies have not examined the effects of anabolic agents on bone mineral density
(BMD) or bone turnover in these men. To determine the effects of testosterone
and progressive resistance training on BMD and bone turnover in eugonadal men
with AIDS wasting, we randomly assigned 54 eugonadal men with AIDS wasting
(weight < 90% IBW or weight loss > 10% from preillness baseline) to
receive either testosterone enanthate (200 mg/week, im) or placebo and to
progressive resistance training (3 times/week) or no training in a 2 x 2
factorial study design for 3 months. The BMD of the lumbar spine, proximal
femur, and total body; lean body mass; and fat mass were measured by dual energy
x-ray absorptiometry. Total body scans were repeated after 12 weeks of therapy.
Baseline bone turnover and BMD were compared with those in 35 age-matched
healthy non-HIV-infected control subjects. Compared with controls, lumbar spine
BMD (1.021 +/- 0.018 us. 1.084 +/- 0.025 g/cm(2); P = 0.04) and total hip BMD
(0.951 +/- 0.017 us. 1.070 +/- 0.019 g/cm(2); P < 0.0001) were reduced in men
with AIDS wasting. T-scores were lower in men with AIDS wasting at the lumbar
spine (-0.62 +/- 0.17 us. - 0.07 +/- 0.23, P = 0.05) and total hip (- 0.65 +/-
0.11 us. +0.20 +/- 0.014, P < 0.0001). Total hip T scores were less than -
1.0 in 33% of men with AIDS wasting. Neither the use of protease inhibitors nor
the duration of protease inhibitors use correlated with BMD. Serum osteocalcin
levels were lower(3.63 +/- 0.29 vs. 4.54 +/- 0.31 nmol/L; P < 0.04) and
urinary N-telopeptide excretion was higher (45.4 +/- 4.5 us. 26.8 +/- 3.0 nmol
BCE/mmol creatinine; P = 0.004) in men with AIDS wasting than in controls.
Lumbar spine BMD, as assessed on regional total body dual energy x-ray
absorptiometry scan, increased over the 12-week treatment period in response to
testosterone (+2.4 +/- 1.3 vs. -1.3 +/- 1.0%, testosterone os, placebo,
respectively; P = 0.02), but not in response to training (+0.8 +/- 1.0 vs. +0.4
+/- 1.3%, training vs. no training; P = 0.70). Lumbar spine and total hip BMD
are reduced in eugonadal men with AIDS wasting. Biochemical markers of bone
turnover suggest that bone formation and bone resorption are uncoupled in these
men. Testosterone administration, but not resistance training, over 3 months
increases lumbar spine BMD in eugonadal men with AIDS wasting.
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