The greatest increases are seen in the first year of therapy in patients with the lowest bone mass. 19 Men treated with glucocorticoids also respond to testosterone therapy. To date, no prospective studies in which hip fracture is the end point have been conducted in men. Nevertheless, testosterone replacement has beneficial effects on muscle mass and strength and libido and, in many patients, reduces fatigue. Testosterone delivery is a problem.
Oral preparations have toxic effects on the liver.
Intramuscular injections produce major peaks and troughs in testosterone concentration, and patients dislike them because of the accompanying discomfort. The use of scrotal transdermal patches necessitates shaving of the scrotum, and many elderly men find that such patches are too large. Moreover, application of testosterone to scrotal skin results in a high dihydrotestosterone level, which stimulates the prostate. Although nonscrotal transdermal patches are available, the rate of severe skin reactions we have observed in our patients has been much higher than we expected from the literature. Sublingual administration of testosterone is still in the testing phase.