observed after castration or androgen deprivation therapy[13]. Furthermore, studies have shown that bone structuralparameters (e.g., bone microarchitecture, cortical and trabecular bone mineral density) are impaired in men withhypogonadism [14]. A placebo-controlled study including108 elderly men with mean testosterone levels of 12.8nmol/l found no overall effect of a 3-year testosterone replacement therapy on bone density. However, a significanttreatment effect with increased lumbar spine bone densitywas observed in elderly men with low pre-treatmenttestosterone levels (testosterone <10 nmol/l) [15]. In agreement with this study, a recent clinical trial showed thattestosterone replacement therapy in men with testosteronelevels in the low-normal range did not change bone density[12]. In two separate meta-analyses, there was a small benefit in lumbar spine bone mineral density in testosteronetreated elderly men without treatment-baseline testosterone level interaction
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