1. Androgen and Bone Woraluk Somboonporn Faculty of Medicine Khon Kaen University

2. Androgen and Bone General aspect of androgen action Androgen therapy in men Androgen therapy in women

3. General aspect of androgen action Loss of estrogens or androgens increases the rate of bone remodelling resorption > formation Vanderschueren et al. Endocrine Reviews. 2004

4. General aspect of androgen action Maintain cancellous bone mass via ER and AR Increase cortical bone size via stimulation of both longitudinal and radial growth Vanderschueren et al. Endocrine Reviews. 2004

5. General aspect of androgen action Maintain cancellous bone mass via ER and AR increase cortical bone size Biphasic effect on endochondral formation At the start of puberty: stimulate endochondral bone formation At the end of puberty: induce epiphyseal closure (clearly mediated via aromatization and interaction with ERα Vanderschueren et al. Endocrine Reviews. 2004

6. Androgen therapy in women

7. At 12 months Somboonporn W et al 2005 Cochrane Library (In press )

8. At 24 months Somboonporn W et al 2005 Cochrane Library (In press )

9. Androgen therapy in women Three studies showed inconsistent results. Two studies showed no significant effect between treatment groups (1,2) Another study demonstrated a significantly greater improvement (3) (1,2) Garnett 1992; Watts 1995 (3) Barrett-Conner 1999

10. Androgen therapy in women Bone markers One open randomized study reported a significant increase in all bone formation markers. (1) (1) Raisz 1996

11. Clinical application A systematic review indicates a benefit of adding testosterone to HT to improve sexual outcome. Somboonporn W et al 2005 Cochrane Library (In press )

12. Clinical application BUT No information as to which patients are most likely to benefit from testosterone therapy. The safety data is limited to surrogate endpoints in the small number of subjects exposed to a very short term use.

13. Androgen therapy in women We cannot make recommendation for routine use of testosterone in postmenopausal women. Somboonporn W. Seminars in reproductive medicine. In press

14. Androgen therapy in men

15. Vanderschueren et al. Endocrine Reviews. 2004

16. Androgen therapy in men T replacement in indications other than overt hypogonadism Young men with delayed puberty PADAM Eugonadal men Glucocorticoid-treated men suffering from osteoporosis Vanderschueren et al. Endocrine Reviews. 2004

17. Androgen therapy in men T replacement in indications other than overt hypogonadism Young men with delayed puberty PADAM Eugonadal men Glucocorticoid-treated men suffering from osteoporosis Current scientific evidence does not allow recommending T replacement Vanderschueren et al. Endocrine Reviews. 2004