Testosterone for Osteoporosis: Could Low T Be Weakening Bones?

When a bone density scan shows osteopenia or osteoporosis, most clinicians immediately think about prescribing medications such as bisphosphonates (alendronate, risedronate or ibandronate). Other FDA-approved drugs include denosumab (Prolia), teriparatide (Forteo) and romosozumab (Evenity). Such medications can help with weakened bones, but they do come with side effects. Here is a link to learn more about adverse reactions. What about a hormone like testosterone for osteoporosis? Such a concept has not been approved by the FDA. What are the pros and cons of such an approach?

Hormones Such as Estrogen or Testosterone for Osteoporosis?

Estrogen’s role in bone health is well known. Testosterone for osteoporosis is rarely mentioned. A review published in Frontiers in Reproductive Health (May 12, 2025) concludes:

“This review highlights that combining MHT [menopause hormone therapy] and structured exercise is most effective for enhancing BMD [bone mineral density] in menopausal women.”

When physicians refer to menopause hormone therapy, they mostly mean estrogen and progesterone. But testosterone is a critical hormone for both men and women. A review published in the journal Reviews in Urology (January, 2017) was titled:

“Revisiting the role of testosterone: Are we missing something?”

“Testosterone is a pleiotropic [multiple activities] hormone that plays an important role in the human body. Through its conversion to estrogen, testosterone affects bone health, including bone density. Recently, there has been a renewed interest in the systemic role of testosterone in pain, well-being, and cardiovascular function in both women and men.”

In particular, low testosterone levels are associated with lower bone mineral density and a higher risk of fractures.

In men with clearly low testosterone, treatment can improve bone density. In women, the research is more limited but suggests testosterone may play a role in bone strength, especially in combination with estrogen.

Despite this, testosterone is rarely discussed as part of an osteoporosis evaluation. That raises an important question: should doctors be thinking more about testosterone for osteoporosis when bones begin to weaken?

A Reader Wonders if Her Daughter Could Benefit from Testosterone for Osteoporosis and Other Symptoms:

Q. My poor daughter has been suffering ever since menopause. Her muscles are weak and she feels tired, but she can’t sleep and she has brain fog. I’m glad her doctor will be testing her hormone levels. If her testosterone is low, he is likely to prescribe this hormone.

It seems to me that supplemental testosterone adjusted to her needs might be helpful and could also reduce the risk of osteoporosis in the future. It’s too late for me, sadly. Am I mistaken?

A. We applaud the decision to monitor your daughter’s hormone levels. Low levels of estrogen and testosterone are associated with weaker bones in both men and women (Scientific Reports, March 25, 2023). https://www.nature.com/articles/s41598-023-32100-x

There is a surprising lack of clinical research on testosterone for osteoporosis prevention. One small study reported that testosterone pellet therapy improved bone density in the spine and hip (Journal of Clinical Densitometry, July-Sept. 2023). Another clinical trial found that combining testosterone with estrogen was better than estrogen alone for improving bone density in the hip and spine (Maturitas, April, 1995).

The Pros and Cons of Testosterone for Osteoporosis

Many men undergoing treatment for prostate cancer receive androgen deprivation therapy (ADT). In other words, their testosterone levels are dramatically reduced to extremely low levels. While very helpful for managing prostate cancer, such low testosterone levels can produce adverse cardiovascular effects and reduce muscle and bone strength.

Too much testosterone can also produce adverse reactions, especially in women. It can cause blemishes, hair growth and deepening of the voice. Getting levels just right requires very careful monitoring. Finding a clinician who is knowledgeable about balancing the benefits and risks of hormone therapy could be challenging.