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Use of Testosterone in Men With HIV Is Associated With Higher Bone Mineral Density

David Bai, PharmD
Men with HIV who use testosterone have greater bone mass density (BMD) T-scores at the lumbar spine, total hip, and femoral neck compared with nonusers, according to the results of a recent study.

Testosterone is a hormone replacement therapy often prescribed for patients with low muscle mass, energy, or libido. In men with low serum testosterone levels, the use of testosterone replacement has been shown to increase BMD, decreasing rates of osteoporosis.

HIV is a disease state that is connected to low BMD originating from a multitude of factors including antiretroviral therapy, HIV inflammation, and vitamin D deficiency. Because of low BMD, patients with HIV tend to have higher rates of osteoporosis and fractures.

In the study, the use of testosterone replacement in men with HIV is being evaluated to determine whether testosterone use and BMD are correlated in this population.

The study population included men with and without HIV infection who have sex with men, based on the Multicenter AIDS Cohort Study. Compared with men without HIV, those with HIV reported significantly higher testosterone use in age groups 50 to 59 (17% vs 3%; P <.001) and 60 to 69 (27% vs 5%; P <.001). Of the 3 BMD test sites, lumbar spine, total hip, and femoral neck, only the total hip’s BMD T-score was significantly lower in patients with HIV compared with patients without HIV (0.0 vs 0.3; P <.045).

In men with or without HIV, the use of testosterone led to significantly higher BMD T-scores at the lumbar spine (P = .003). Although the mean BMD T-scores were higher at the total hip and the femoral neck for testosterone users, they did not reach statistical significance (P = .3 and P = .1, respectively). Looking at BMD T-scores for men with virologically suppressed HIV alone, investigators found significantly higher BMD T-scores related to testosterone use at the lumbar spine (P = .002) and total hip (P =.03) and borderline significance at the femoral neck (P = .06). These findings suggest that testosterone use may preserve BMD in men with HIV.

Although these results may provide a basis for including testosterone replacement in all men with HIV, there is still a need to analyze fracture risk reduction and cardiovascular risk when testosterone is administered long term.


Grant PM, Li X, Jacobson LP, et al. Effect of testosterone use on bone mineral density in HIV-infected men [published online November 1, 2018]. AIDS Res Hum Retroviruses. doi: 10.1089/AID.2018.0150.

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