All study procedures were conducted according to the Declaration of Helsinki. JD helped analyze the data, interpret the results, write the original draft of the manuscript, revising the paper; ASG designed the study, helped in data analysis, drafting the results, writing and revising the manuscript and providing funding to conduct the trial. Total and regional bone mineral density (BMD) and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry. Serum T levels were measured after an overnight fast. Body composition assessments were measured in 53 men with chronic SCI. This mini-review presents evidence for TRT as a potential strategy to aid in the management of body composition changes and to improve metabolism in persons with SCI.
The data in this study are cross-sectional and are compiled from two separate studies using the same methods of measuring body composition and metabolic profiles. Combined with previous findings , the current results suggest that an increase in serum T may attenuate loss in muscle mass, decrease ectopic adiposity and improve cardiometabolic profile by possibly inducing mitochondrial biogenesis. Previous findings demonstrated that serum T is positively correlated with total trunk muscle CSA in men with SCI . Positive relationships were found between serum T and lean mass analyzed by DXA and absolute whole thigh skeletal muscle CSA analyzed by MRI only after accounting for BMI.
Within weeks since injury, testosterone level decreases, and thereafter may reach normal values within 4–6 months post-injury, which is fairly supported by our study that reported a significant increase in total testosterone and DHEA-S prior to discharge from first inpatient rehabilitation. Over a period of initial rehabilitation stay (between admission or within 16–40 post-injury to up to 10 days before discharge), total testosterone and DHEA-S levels increased significantly, while we observed no significant changes in other hormones (free testosterone, SHBG, or DHEA). A decline in androgen hormones and abnormalities of the hypothalamic-pituitary-gonadal (HPG) axis has been repeatedly reported in individuals with chronic spinal cord injury (SCI), with more than 40% of men having testosterone levels below normal age-specific cut-offs 1,2.
Back pain can come from muscles, bones, nerves, discs, joints, posture, or inflammation. While low testosterone can play a role in muscle weakness, poor posture, and bone loss, it is only one of many possible causes. Even though TRT supports muscles and bones, it is not considered a direct back pain treatment. While bone density improvements usually take months to years to develop, they may help lower the risk of painful bone problems later in life.
The review authors appear to have presumed that blinding was used in several studies but the justification for this was not clear. Two reviewers independently selected studies, assessed validity and extracted the data, thereby reducing the potential for reviewer bias and errors. However, the search terms were not reported and only published studies were eligible; this raised the possibility of publication bias, as the authors acknowledged. The review addressed a clear question that was defined in terms of the participants, intervention, outcomes and study design. Subgroup analyses showed no significant interaction between treatment and use of glucocorticoids, testosterone level at baseline, age, duration of follow-up and losses to follow-up. Testosterone and transdermal testosterone for femoral neck BMD. The review authors stated that this explained the heterogeneity among studies evaluating lumbar spine BMD (no data were presented).
If your testosterone levels are low, and other causes of your back pain are ruled out, the doctor may consider testosterone therapy as a treatment option. While it may not work for everyone, many patients with low testosterone levels and chronic back pain experience significant benefits. Overall, the effectiveness of testosterone therapy for back pain is supported by various clinical studies and patient outcomes.
Men with low serum T have more unfavorable body composition and cardiometabolic health outcomes after SCI. Thus, to develop timely preventive strategies, future methodologically sound longitudinal studies are required to disentangle the complex association between hormone levels and aging, visceral adiposity, physical inactivity and functional recovery post-injury. In this study we observed an improvement in total testosterone and DHEA-S in men over first inpatient rehabilitation.
In conclusion, testosterone therapy shows promise as a treatment for back pain, but it's important to understand both its benefits and risks. It is important to find a healthcare provider who is experienced with testosterone therapy. Starting testosterone therapy for back pain can be a detailed process.
Conversely, healthy testosterone levels help maintain strong bones and muscle mass, which supports overall spinal health. Effect of spinal cord injury (SCI) and different patterns of testosterone administration during acute and chronic phases post-injury on serum testosterone levels. Serum testosterone levels may influence body composition and cardiometabolic health in men with spinal cord injury. In a relatively young able-bodied population, producing a hypogonadal state by hormonal manipulation resulted in a loss of lean body tissue.37 Reversal of hypogonadism in younger ****s has been shown to improve muscle mass and strength.38 A recent study has demonstrated that T replacement therapy for 12 months significantly improved lean body tissue in persons with SCI.39 A decrement in muscle mass and strength as a consequence of hypogonadism in persons aging with SCI may, eventually, contribute to lack of function and independence.

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