T Nation

Osteoarthritis and Low Test...

My new endo has me off of all meds for 12 weeks and just last two weeks I started to get rib and chest pain. My primary doc and endo were both stumped and sent me for x-rays of my ribs and back and found compression fractures in T7, 8, and 9. as well as c6 and 7 and the radiologist diagnosed me with osteoarthritis. I see a lot on pubmed about low test and arthritis, has anyone else had anything like this?

I understand cortical steroids (asthma and sinuses) could have a connection to and I was removed from them obviously, my 24 hour ufc tested low normal while on them whatever that means.

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…I was sent for a BMD (Bone Mineral Density) test last month (first time) and it came back with ‘lower than normal’ test results. I’m a 38 year old male with secondary hypogonadism (pituitary adenoma for approx 20 years now)

My Endo tells me that I have Osteopenia, which is a precursor to Osteoporosis. He was actually rather ambiguous with the test results, claiming they don’t have a lot data available for men and BMD test results (for comparison’s sake that is). I was told that it is much more common to give a BMD test to a woman…hebs

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…at present, he’s hoping that my current HRT protocol is going to help. I’ve only been on HRT for four months now and doing the BMD scan was something that we just recently checked.

The only other thing that he’s recommended is taking 1200iu of Calcium per day. I’ll do some research on the GH, thanks for the suggestion…hebs

…I just found this study.

Interesting, it really goes against what my doctor was telling me about the T helping to increase my BMD.

Quote: "In andropausal men, T administration to achieve physiologic levels did not result in significant effects on bone metabolism or BMD, whereas GH + T increased one marker of bone formation and decreased one marker of bone resorption. "

If T is low, all the more if E is not [estrogenn dominance], the protein matrix in the bones can be wasting, causing OP. TRT reverses this! Short term research results are looking at process changes, not long term results.

yes, you need calcium, but that alone is useless!!!

You need:
Calcium
Vitamin D, perhaps 2000 - 3000iu per day
Vitamin C
Boron
Zinc
Folic Acid
Madnesium
Manganese
Vitamin K

Other things and generallly good state of health.

Some strength training will improve bone reformation. Do not load your spine.

“cortical steroids” do cause bone loss…
fluid retention
muscle weakness
obesity
thinning of the skin
bone necrosis
lower testosterone
very low DHEA

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Thanks for the info Ks and bushy. The guy I saw today seemed to think it mmay be be hormone related (still ordered tog et PT, nsaid’s, muscle relaxers and massage), so once I am back on trt and stable for a while he will want scans again. I am only one week out from the new set of bloodwork and the doctors appointment is on the 14.

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[quote]bushidobadboy wrote:
KSman wrote:
If T is low, all the more if E is not [estrogenn dominance], the protein matrix in the bones can be wasting, causing OP. TRT reverses this! Short term research results are looking at process changes, not long term results.

yes, you need calcium, but that alone is useless!!!

You need:
Calcium
Vitamin D, perhaps 2000 - 3000iu per day
Vitamin C
Boron
Zinc
Folic Acid
Madnesium
Manganese
Vitamin K

Other things and generallly good state of health.

Some strength training will improve bone reformation. Do not load your spine.

“cortical steroids” do cause bone loss…
fluid retention
muscle weakness
obesity
thinning of the skin
bone necrosis
lower testosterone
very low DHEA

KSman. Are you saying that T is more responsible for BMD than E is? Maybe I misread you, but I would have to argue that claim and assert that E is the important sex hormone regarding BMD. This is partly why there are so many OP postmenopausal women; they have no E but plenty of androgens.

This is also partly why I have reservations about reccommending that ALL TRT patients use an AI. E levels MUST be checked regularly when using an AI with such low doses of T, or E will sink too low and negatively affect both lipids and BMD.

Bushy[/quote]

E is considered the ‘ticket’ for women. Women can convert some E to T in peripheral tissues <-- very few references to this! Probably a non issue.

Adex as an AI, in TRT doses is well behaved. I get tested every 6 months and my serum E2 does not make any wild excursions.

Shippen:

E replacement reduces fractures by around 50%. E works by taming osteoclasts… … estrogen appears to have no effect on increasing the rate of bone formation… …progesterone is a powerful bone-building hormone.

T is bone builder. Some T will convert to E. T is needed to maintain the protein in the bones.

[quote]bushidobadboy wrote:
rfish1966 wrote:
Thanks for the info Ks and bushy. The guy I saw today seemed to think it mmay be be hormone related (still ordered tog et PT, nsaid’s, muscle relaxers and massage), so once I am back on trt and stable for a while he will want scans again. I am only one week out from the new set of bloodwork and the doctors appointment is on the 14.

Can you just clarify something for me please?

Are you sure it’s osteoarthritis you are on about, and not osteoporosis?

Compression Fx occur readily in OP patients, but not in those with normal BMD.

I’m confused.

Also, the comp Fx will alter your biomechanics, thereby altering the load on adjacent motion segments, leading to early degeneration or ‘arthritis’.

Bushy[/quote]
yeah it’s osteoarthritis atleast on the paperwork I have. I have it in t7 and t8 (broke 9 years ago) and c6 and c7 which never had a problem before. No one has said anything about getting a BMD scan by the way.

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[quote]bushidobadboy wrote:
KSman wrote:
E is considered the ‘ticket’ for women. Women can convert some E to T in peripheral tissues – very few references to this! Probably a non issue.

Adex as an AI, in TRT doses is well behaved. I get tested every 6 months and my serum E2 does not make any wild excursions.

Shippen:

E replacement reduces fractures by around 50. E works by taming osteoclasts… … estrogen appears to have no effect on increasing the rate of bone formation… …progesterone is a powerful bone-building hormone.

T is bone builder. Some T will convert to E. T is needed to maintain the protein in the bones.

KSMan, thanks for the response. In my physiology books, little (read ‘no’) mention is made of T in relation to BMD.

Women manufacture their T (and other androgens) in the interstitial cells of the adrenal medulla. This continues long after the ovaries have stopped producing E, yet they still get osteoporosis. This would seem to indicate that E is more important, or at least, that both T and E are needed to maintain healthy bones.

Can you please provide any links you have to back up the assertion that T is important to bone strength, since I would be keen to know more, thanks.

Bushy[/quote]

Women need T and have very little to start. When PM, there is only the adrenals, and they are tired and the DHEA feedstock is greatly diminished. With the increased BF loads that many PM women have, aromatization decreases T further.

I think that the bones are the same for men and women.

T levels, already low, go very low and many issues occur. This drop is sudden for PM. For men, it is mostly a slower progression, often with more life threatening consequences for the men who get fractures.

In:

UK:

USA:

The Testosterone Syndrome: The Critical Factor for Energy, Health and Sexuality: Reversing the Male Menopause (Paperback)

Chapter 9 has 5 medical research 5. The chapter is all about bone heath and hormones. I think that you would find it a must-read. I can’t do it justice by describing what is stated.

For any serious study of TRT issues, this book is fantastic. It was copywrited in 1998, and the depth is nevertheless astounding. It has solid info on things that seem to new issues today. This does speak to how backwards the medical community as a whole really is.

For those of us who have search and read for years, it puts everything together. Written for the common man, avoids medical terms when possible, it does go into depth that may will appreciate. It does suffer from things common to books written by doctor, but still one of the best or the best book of this type.

It does get into things for women, enough for guys to see the issues and to hear a call for action. It makes a completely solid argument that all women need HRT and that must include testosterone.

The book has an index that is useful, but sometimes not as deep as one would want for looking something up later that one recalls. Better that a book that is all case study stories with no index at all!

If you read only one TRT book, it must be this one.

The use of Anastrozole is one thing that was probably not in view when the book was written. The author is negative on injections, because injecting [every two or three weeks] seems to have problems. Strange that the obvious solution was not on the table.

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[quote]bushidobadboy wrote:
OK good. I have just ordered that, thanks a lot for the recommendation.

Bushy[/quote]

I actually have that book on my shelf in the area of books I have not read yet. I will check it out t his weekend.

Turned out to be a pretty good book.

Did my bloodwork and submitted my 24 hour UFC’s , one more week till I talk with the doctor now. I am not a patient person but atleast my doctor asked them to put my fax number on the labs since she probably won’t see them till my appointment on the 14th. So hopefully I will have some labs to post later this week. She would not test for E2 but since the form was in my care I added it as well as dhea since I was taking pregnenolone on the last DHEA test. Hopefully she won’t mind…even if she does I am paying for it so she can deal with…

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