Hormones

Testosterone therapy, anemia and bone: what newer studies show

Testosterone corrected anemia in more men than placebo and strengthened spine bone. But a large trial found it did not prevent fractures. Here's the full picture.

Published · 2 min read

Testosterone affects more than energy and sex drive. It helps the body make red blood cells and keep bone strong. Recent trials measured both, with some surprises.

Anemia: more men corrected

Anemia, a low red blood cell count, is common in men with low testosterone and can cause tiredness and shortness of breath.

In a study within the TRAVERSE trial, 815 men with low testosterone and anemia received testosterone or placebo. Anemia was corrected in:

  • 41.0% of men on testosterone vs 27.5% on placebo at 6 months
  • 45.0% vs 33.9% at 12 months

Among men who did not have anemia at the start, fewer on testosterone developed it: 7.2% vs 10.4% at 6 months.

The flip side: testosterone can push the red blood cell count too high. That's why your blood count is checked regularly during treatment.

Bone: stronger, but not fewer fractures

In the Testosterone Trials, older men with low testosterone who used testosterone for a year had a 10.8% increase in the estimated strength of spine bone, compared with 2.4% on placebo. Bone density rose more in the spine than in the hip.

Stronger bone on a scan should mean fewer broken bones. But when the much larger TRAVERSE trial counted actual fractures over about three years, the result went the other way: 3.50% of men on testosterone had a fracture vs 2.46% on placebo. Testosterone did not reduce fractures, and the number was higher.

The researchers don't yet know why. One possibility is an effect on the outer layer of bone. Whatever the reason, the lesson is clear: testosterone is not a treatment for osteoporosis, and men at risk of fractures need a proper bone assessment and, if needed, a treatment proven to prevent fractures.

What this means for you

  • If you have low testosterone and anemia, treatment may help correct it, with your blood count monitored along the way.
  • If you're concerned about bone health, testosterone isn't the answer on its own. Your doctor will look at bone separately.
  • Every treatment decision should weigh benefits against risks, using your own labs.

Read how we monitor testosterone therapy, or see what's in our at-home blood panel.

Sources

  1. Pencina KM, et al. Testosterone and anemia in men with hypogonadism (TRAVERSE anemia study). JAMA Netw Open. 2023;6(10):e2340030. doi.org/10.1001/jamanetworkopen.2023.40030
  2. Snyder PJ, et al. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone. JAMA Intern Med. 2017;177(4):471–479. doi.org/10.1001/jamainternmed.2016.9539
  3. Snyder PJ, et al. Testosterone treatment and fractures in men with hypogonadism (TRAVERSE). N Engl J Med. 2024.

This article is for general education and is not medical advice. Talk to a physician about your own symptoms and treatment options.

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