Bone disease

The role of androgens in bone development and disorders is discussed in Chapter 7. Androgen therapy to treat osteoporosis has the advantage for fracture prevention of not only increasing bone mass but possessing potentially synergistic beneficial effects on muscular strength and mental function to prevent falls due to frailty, an independent contributor to osteoporotic fractures. The evidence supporting androgen therapy, however, is limited. For treatment of idiopathic osteoporosis, the largest randomised, placebo-controlled study, involving 327 patients treated for 9 months with 1 year of follow-up, had inadequate power to detect effects of androgen therapy (methandienone 2.5 mg daily) on fracture rates (Inkovaara etal. 1983). The only other controlled study randomised 21 men to receive either weekly injections of nandrolone decanoate 50 mg or no treatment for 12 months (Hamdy etal. 1998). It remains unclear whether the inconsistent and transient increase in bone density observed were due to the low dose, the minimally aromatised androgen or small sample size. Additionally, an uncontrolled study has claimed striking increase in lumbar (but not hip) bone density in non-androgen deficient men treated with testosterone ester injections 250 mg fortnightly for 6 months (Anderson etal. 1997).

An important area for androgen therapy to prevent or ameliorate bone loss and fractures may be steroid-induced osteoporosis. High dose glucocorticoid therapy is commonly used for its immunosuppressive or anti-inflammatory effects in autoimmune and chronic inflammatory diseases and in transplantation medicine. Two controlled studies have examined androgen therapy in men taking regular high dose glucocorticoid treatment. The first reported that testosterone may reverse the bone loss due to high-dose glucocorticoid therapy in 15 men with severe asthma (Reid et al. 1996). The subjects were randomly allocated to monthly testosterone injections (250 mg mixed testosterone esters) or no treatment for 12 months with the control group crossing over to testosterone treatment for the second 12-month period. After 12 months of testosterone treatment, lumbar spine bone mineral density increased by 5% compared with no change on placebo. However, no benefit was noted in bone density overall or in three other sites. The limitations of this study (unblinded, sub-replacement testosterone dose) are addressed in a larger study randomising 51 men to fortnightly injections of testosterone esters 200 mg, nandrolone decanoate 200 mg or matching oil vehicle placebo for 12 months (Crawford et al. 2003). This study observed improved muscular strength with both androgens but improved lumbar bone density and bone-specific quality of life only in men treated with testosterone. This highlights the importance of aromatisation in androgen therapy for bone but not muscle. Larger studies examining fracture outcome as well as earlier studies aimed to prevent the rapid initial bone loss would be most valuable.

Hair Loss Prevention

Hair Loss Prevention

The best start to preventing hair loss is understanding the basics of hair what it is, how it grows, what system malfunctions can cause it to stop growing. And this ebook will cover the bases for you. Note that the contents here are not presented from a medical practitioner, and that any and all dietary and medical planning should be made under the guidance of your own medical and health practitioners. This content only presents overviews of hair loss prevention research for educational purposes and does not replace medical advice from a professional physician.

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