You can also look for specialists in endocrinology or pain management who have experience treating patients with hormone therapies. They will likely perform a physical exam to check your overall health. During this visit, the doctor will ask you about your back pain, your medical history, and any other symptoms you might have. In persons with SCI, adipose tissue has been shown to accumulate within and between muscle groups7,8 and the accumulation of intramuscular fat (IMF) has previously been linked with impaired glucose tolerance.9,10 While the specific mechanisms regarding the impact of IMF on skeletal muscle metabolism remains to be elucidated, studies have suggested IMF impairs blood flow and releases pro-inflammatory mediators resulting in local inflammation.11,12 Such changes within the skeletal muscle of persons with SCI have profound implications in the progression of certain chronic diseases, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, which experiences an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury. With the hormone test results in hand, Dr. Sina referred Lisa to an endocrinologist for hormone replacement therapy (HRT) to address her low estrogen and testosterone levels. Lisa, a marketing executive in her late 40s, heard from her circle of friends that it’s important to stay active during perimenopause to maintain muscle mass and bone density. Detailed information on the study design and collected data can be found elsewhere . In addition, the SwiSCI biobank provides a platform for conducting research within the Inception Cohort of SwiSCI by cryopreserving serum, plasma, and peripheral blood mononuclear cells (PBMC), RNA, DNA and urine for research purposes. Study participants were involved in interdisciplinary rehabilitation approach tailored to person’s specific needs and aimed to optimize one’s functioning. Further, despite important physiological role of androgens in females, studies in women are uncommon 22,23. 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. 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). Thus, the current cohort was younger in age and relatively homogeneous which could explain the discrepancy between both studies. However, Bauman et al. study’s mean age group was 48 years old with age range from 21 to 78 years compared to the current mean age of 37 years old with age range 18 to 61 years. This is contrary to previous work , Bauman et al. demonstrated serum T decreases as persons with SCI age . Exogenous testosterone, by compensating the serum testosterone level. Along with quantification of CADM1 gene expression and its immunoreactivity, we evaluated sperm parameters andserum testosterone level post-SCI. In this experimental study, testosterone was administered immediately or after one week of SCIinduction. None of the included studies assessed bone fractures. Improving diet, staying active, and maintaining healthy blood sugar levels all support better musculoskeletal health. When these muscles are strong, the body moves in a more balanced way, reducing strain on the vertebrae and surrounding tissues. Many people with low testosterone experience muscle loss, especially around the midsection. Over time, people often notice improved posture, less muscle fatigue, and decreased back pain. Strengthening the core muscles, including the deep abdominal and back muscles, improves spinal stability. One area that has caught the attention of researchers and doctors is the use of testosterone therapy for back pain. The relationship between serum T levels and BMD is mediated by body weight in men with SCI. However, body weight or fat mass negatively influences circulating T levels in men with SCI.
