Future research

As indicated by the trial involving MENT as a synthetic androgen, the future lies with substances which have a prostate-sparing effect but can exert the beneficial effects of androgens. This could be facilitated by selective androgen receptor modulators (SARMS), which are currently under development (see Chapter 20). It will be crucial for the efficacy of these substances that their aromatization-endproducts exert sufficient effects at the estrogen receptor. This is especially the case in regard to bone tissue. Future trials involving such SARMS will need to address bone metabolism and density as a pivotal endpoint.

7.5 Key messages

Osteoporosis is common in men, especially with advancing age.

Hypogonadism is a major risk factor for the development of osteoporosis in men.

• Androgens can stimulate osteoblasts and inhibit osteoclasts, thus preventing bone loss.

• The efficacy of testosterone substitution in hypogonadal men to prevent osteoporosis has been demonstrated.

• Aromatization of testosterone to estradiol is of pivotal importance for this effect, although testosterone itself exerts intrinsic activity on bone tissue.

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