The impact of low testosterone on bone health

When most people think about testosterone, they picture muscles, mood, and libido. What doesn’t often come to mind is bone health.

While osteoporosis is typically seen as something that affects women after menopause, it’s far from a female-only issue. Around one in five men over 50 will suffer a fracture linked to osteoporosis. And when men break a bone, the consequences are often more severe than they are for women, leading to more hospital stays, more complications, and a higher risk of death.¹

Behind much of this lies a gradual fall in testosterone that creeps in with age.

Osteoporosis is not just a women’s disease

Osteoporosis is a condition where bones become weaker and more likely to break. This happens because the body loses too much bone, makes too little new bone, or both, eventually resulting in fragile bones that can fracture with minor bumps or falls.²

Globally, millions of people are affected by osteoporosis. Hip, spine, and wrist fractures are among the most common and most dangerous. For men, the problem often flies under the radar. But research shows that the risk of dying after a hip fracture is higher in men than women. In fact, one study found that men in their 60s were nearly twice as likely to die within five years of a fracture compared to women of the same age.³

The role of testosterone in bone strength

Testosterone helps keep bones strong in several ways. It boosts the activity of cells that build bone (called osteoblasts), reduces the breakdown of bone by other cells (osteoclasts), and converts into oestrogen in the body. While oestrogen is usually associated with women, it’s vital for men’s bone health too. In fact, much of the bone-preserving effect of testosterone happens because it gets turned into oestrogen.^1,3

As men age, testosterone levels drop. This is natural. But in some men, levels fall far enough to cause noticeable problems, a condition known as hypogonadism. Alongside low energy, reduced libido, and muscle loss, one of the lesser-known effects is loss of bone density.⁴

And the lower the testosterone, the greater the risk.

How big is the risk?

By the time men hit their 70s and 80s, the risk of osteoporosis and fractures rises sharply.^1-3 This is also when testosterone tends to be at its lowest.⁴ According to data, men over 80 are just as likely to develop osteoporosis as women, yet they’re far less likely to be tested or treated.³

It doesn’t help that osteoporosis doesn’t cause symptoms until something breaks. Bone loss happens quietly, in the background. Often, the first sign of a problem is a fractured wrist, spine, or hip after a fall.¹

Can testosterone therapy help?

Testosterone replacement therapy (TRT) is often used to treat symptoms of low testosterone in men, and some studies suggest it can improve bone mineral density, particularly in the spine and hips.

A 2020 study found that TRT increased spinal bone density by around 4% compared to placebo.⁵ However, TRT hasn’t been proven to prevent fractures, which is ultimately the most important outcome.³ And it comes with potential risks such as raised red blood cell counts, prostate side effects, and concerns around heart health.

Because of this, TRT is not routinely recommended just to treat osteoporosis. But in men with low testosterone and bone loss, it might be one part of a broader strategy to strengthen bones.

What should men be doing?

Even without testosterone therapy, there’s a lot men can do to protect their bones:^1,3

• Get a bone density test (DEXA scan) if you’re over 70, have low testosterone, or a history of fractures.

• Exercise regularly, especially with resistance and weight-bearing activities.

• Get enough calcium and vitamin D through food or supplements.

• Cut down on alcohol and stop smoking as both speed up bone loss.

• Opt for a blood test to see if your testosterone levels could be to blame.

The numan take

We often talk about testosterone in terms of how men feel. But it’s also about how well their bodies hold together. Paying attention to it could help prevent the kind of injuries that change lives, and shorten them.

References

1. ^{Mohamad NV, Soelaiman IN, Chin KY. A concise review of testosterone and bone health. Clinical interventions in aging. 2016;11: 1317–1324.}

2. ^{Vilaca T, Eastell R, Schini M. Osteoporosis in men. The lancet. Diabetes & endocrinology. 2022;10(4): 273–283.}

3. ^{Shigehara K, Izumi K, Kadono Y, Mizokami A. Testosterone and bone health in men: A narrative review. Journal of clinical medicine. 2021;10(3): 530.}

4. ^{Nassar GN, Leslie SW. Physiology, testosterone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.}

5. ^{Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clinical endocrinology. 2005;63(3): 280–293.}