Osteoporosis

[daifu-orchid (imported)]

Pardon the necropostia, but I just went for my annual physical, and the doc considered that I should do without T, as he thinks it caused a genital dysphoria. He denied the importance of T to bone health, and thought that if I lacked energy to exercise, I should be started on an antidepressant.

I was greatly surprised at this view, as it seems out of keeping with current views here, and the bone health thread above.

Has best practice changed recently, or did I just find an unusual opinion?

I like my bones, and hope they stay good!

How is it with you?

[Wolf-Pup (imported)]

When I was Low T for however many years, it led to Osteopenia which is one step above osteoporosis. I went on bone pills (Boniva) and Testosterone. Took a few years, but my bones returned to normal. I still take T and calcium supplements.

At a minimum, I'd get a second opinion.

[JesusA (imported)]

Antidepressants will not increase bone mineral density. If one is castrated, then they become deficient in not just T, but also estradiol (E2). It is primarily E2 and not T that protects the bones from demineralization and becoming fragile (i.e., osteoporosis).

When women go through menopause, their E2 levels naturally drop...and their risk of osteoporosis goes up.

Men have E2 in their bodies too, which the aromatase enzyme in our bodies makes directly from T. So, when a male is T deprived—as, say, a prostate cancer patient on androgen deprivation therapy or as a voluntary eunuch—he doesn't have enough T to convert to E2 to protect the bones.

A solution here can be taking a bit of add-back E2 through the skin to replace the E2 that would be produced from T. There are E2 cutaneous patches and gel products primarily sold to menopausal women. But they can also be used by men at risk of osteoporosis. [Note: one should avoid oral estrogens as they increase the risk of blood clots. Taking E2 through the skin appears to be safer.]

Granted one can also take oral drugs like Fosamax (bisphosphonates), but drugs of that class have their own side effects. And there are other oral agents (e.g., Denosumab—trade names Prolia and Xgeva) that can be used to treat osteoporosis. Again, they have side effects.

One other thing that helps protect the skeleton from become fragile is exercise that involves impact loading. That is sports like running, tennis, racquet ball. But one should check with their MDs about whether it is safe to exercise.

Exercising is easier if one has others to do it with.

The merits of exercise for androgen-deprived males is discussed in the book Androgen Deprivation Therapy. There is a whole chapter on exercise there; e.g., what are safe ones do to, what is a reasonable level.

Exercise also helps with mood. I thus would recommend getting to the gym and working hard enough to sweat as an alternative to taking anti-depressants. But if one is too depressed to get to the gym, then one could take an anti-depressant to help get oneself activated. But, to cycle back to where this started anti-depressants alone will not protect bone.

[daifu-orchid (imported)]

Fortunately, I am active, exercise, and currently I believe, well.

I posted the good Dr's advice as it seemed to differ significantly from "received wisdom", and what I remembered of 17-ketosteroid chemistry and physiology a long time ago.

(Not generally a great fan of Wikis for reliability, but here is a wonderful but terse summary of Testosterone, chemistry, physiology, including normal levels:

https://en.wikipedia.org/wiki/Testosterone )

Reluctantly, I suspect that the core of this encounter was the reluctance of my good Leech to deal with issues so freely discussed here on EA. Special thanks to all the crew of EA for making this unique meeting place possible!

[Begoneboy (imported)]

Way back when I was still extremely physical with the everyday endurance issues of blue water cruising after removal of the testes et all I began to notice loss of some of that endurance and stamina as I've shared before. As well as some diminished strength so began thinking of the possibility of bone density loss while pondering how to regain those other attributes I felt quietly slipping behind in the waves. I read a good bit of what the "T" levels didn't do for bone density and how it was a certain amount of "E" produced in all humans male or female that aided in keeping bone density at youthful levels. Hence, I began daily taking some "E" and to my surprise those attributes that had slipped behind began returning. So I reasoned with myself that I shouldn't be overly concerned about loss of bone density as long as I kept up with taking some "E". OK, full disclosure, I perhaps overdid the "E" which certainly brought about other physical and maybe even mental change over time. However, my most recent DEXA results indicated my bone density was that of a young adult as had the couple DEXA results I had previously. So yes, it is something that we should all be concerned with whether castrated or not. As age is not very kind to the many functions of our bodies.

[seanthomas (imported)]

Special thanks to all the crew of EA for making this unique meeting place possible!

Ditto daifu-orchid, although there is plenty of "fluff" here it's a tremendous resource for all things castration related. I had actually created my own blog before finding EA primarily because none of the real questions I had when deciding to undergo castration were answered elsewhere. No matter the source it was the same generic information and even my doctor seemed to simply plagiarize Wikipedia.

Disappointing that my urologist never mentioned bone density loss when he took me off TRT, but then as always I did my own research. As a no-testosterone Eunuch I take 1000IU of calcium daily and do my best to work out at least twice a week and walk at least a mile each day to stave off bone density loss. Although castrated only a few years ago I was probably androgen deficient several years before. I suppose that means I had better schedule the bone density test pretty soon.

[Wolf-Pup (imported)]

EA is great you get personal experience (me) with book knowledge (Jesus) as well as others. Most other sites you will get a bunch of guess and hearsay

[kastranja (imported)]

[Note: one should avoid oral estrogens as they increase the risk of blood clots. Taking E2 through the skin appears to be safer.]

Thanks Jesus for this good and comprehensive summary.

One thing I would like to add: According to newer trials and surveys, the risk for blood clots taking newer pharmaceutical forms of estradiol (E2) does not seem to be higher than without estradiol replacement.

The higher risk obviously was connected to taking ethinyl estradiol, a variant used widely before ca. 2005. It has a higher potency and different pharmacokinetic properties. It is more widely used in contraceptiva and has received some attention and controversy due to blood clots, embolism and maybe deths of women taking it for birth control.

Newer forms like estradiol hemihydrate (unconjugated estrogen, also called 17beta-estradiol or E2) do not show a much increased risk for venous thrombosis events. See https://doi.org/10.1016/j.jcte.2015.02.003 and other papers on the topic of HRT in transgender patients. It looks also (according to that paper) as though there might be a predisposition for higher thrombosis risk on estradiol stemming from a specific genetic defect.

I myself am taking 1-2 mg oral 17beta-estradiolhemihydrate since about 24 months, after I had been castrated 28 months ago now. I had a bone density scan done shortly after the castration and am planning to get the next one towards the end of this year. I mainly started the estrogen because of the severe hot flashes which prevented me from sleeping about three months after the castration. I am also welcoming the feminizing effects, although I consider myself non-binary and not trans female.

I am currently trying to get a prescription from an endocrinologist, but that is a bit difficult as long as you do not identify as m2f, at least in Germany.

[Fixet (imported)]

I have Osteoporosis, lumbar T -3.4 and hip -2.5

I started to using estradiol patch (systen 50), and my last dexa scan using estradiol for 11 months i hadgood improvement.

my lumbar is -3.0 and hip -2.4 overall 8% improvement i believe.

[Jan_Linde (imported)]

After I had been castrated I got a lecture from my doctor about the risk of osteoporosis, part of the reason I now take low dose testosterone replacement. He also recommended weight bearing exercises and running as a way to keep up bone density.