TRT and Osteoporosis: What Testosterone Does to Bone Density and Fracture Risk
TRT can raise bone density in men with confirmed hypogonadism, but it has not been shown to reduce fractures. In TRAVERSE, clinical fractures were more common with testosterone than placebo. So TRT may treat low T and improve bone density, but it is not an osteoporosis treatment or a substitute for proven fracture-prevention care when risk is high.
That sounds like a contradiction. Better bones on the scan, more breaks in real life? It isn't, once you see what the scan measures and what it doesn't. We'll show you. We'll also show you the add-on drug that can work against bone density when estrogen is pushed too low — and that some TRT programs make available.
Three things change the answer for you:
- Already broke a hip or spine bone from a minor fall, or your T-score is −2.5 or lower? Start with a bone workup. Testosterone alone isn't the plan.
- Taking an estrogen blocker like anastrozole with your TRT? Ask about it. Lowering estrogen can lower bone density in men.
- Haven't had low testosterone confirmed with repeat morning blood tests? Do that first. The bone benefits in studies showed up in men with clearly low levels.
Affiliate disclosure: TRT Provider Guide may earn compensation through certain provider links. Commercial relationships do not change our editorial conclusions. Full disclosure.
TRT Provider Guide is the independent decision resource for testosterone replacement therapy — helping U.S. adults understand how low testosterone is evaluated, compare online and local care models and providers, and choose the next step that fits their health needs, fertility plans, budget, state, and care preferences, with every material claim verified and dated.
Is TRT part of the answer for your bones?
This page is educational information, not medical advice. If you fall and can't stand, can't put weight on a leg, or get sudden severe back pain after a minor fall, get urgent or emergency care.
TRT and osteoporosis: does testosterone actually help?
TRT raises bone density in men with truly low testosterone, mostly at the spine, in placebo-controlled trials. What hasn't been shown is fewer broken bones — the outcome that actually matters. That's why major medical groups treat testosterone as a low-T treatment that may help bone, not as a primary osteoporosis treatment.
Quick definitions first, because they matter for everything below:
- Osteoporosis is a disease of reduced bone strength that raises fracture risk. In men age 50 and older, a DXA T-score of −2.5 or lower at key sites can establish the diagnosis even before a fracture; a hip or vertebral fragility fracture can also establish osteoporosis regardless of the T-score.
- Bone mineral density (BMD) is how much mineral is packed into your bone. A DXA scan (also called a DEXA scan) measures it with a low-dose X-ray.
- Osteopenia means bone density is lower than normal but not yet in the osteoporosis range.
Here's the idea that ties this whole page together: a better number on a scan is not the same as fewer fractures. Bone mineral density is an important risk marker, but fracture outcomes are what tell us whether a treatment has actually prevented broken bones.
The Endocrine Society's testosterone guideline lands in the same place: testosterone can increase bone density in hypogonadal men, but it should not be used as monotherapy to prevent fractures in men at high fracture risk. A 2024 international guideline on male osteoporosis from ESCEO (the European Society for Clinical and Economic Aspects of Osteoporosis) likewise recommends treating osteoporosis according to fracture risk rather than treating testosterone as the fracture-prevention drug.
We pulled the key studies into one table so you can see the pattern for yourself. Look at the column in bold.
Bone density vs. broken bones: what eight key studies actually measured
Assembled by TRT Provider Guide from the original studies, October 2026. "Odds ratio" and "adjusted odds" compare the chance of an event between two groups. Observational studies show links, not cause and effect.
Read down that bold column. The randomized bone studies show that testosterone can improve several density or bone-strength measures in hypogonadal men. The randomized fracture evidence has not shown fracture protection. That's the whole story in one glance.
Why didn't stronger bones mean fewer fractures in the big trial?
In TRAVERSE, 3.50% of men on testosterone gel had a clinical fracture over about three years, compared with 2.46% on placebo. The researchers didn't expect this and don't know why. Leading ideas include more physical activity and falls, effects on the outer layer of bone, and who was enrolled — none of them proven.
TRAVERSE was mainly built to answer a heart-safety question. But the researchers planned a fracture analysis from the start, and it was large: 2,601 men on testosterone and 2,603 on placebo. That makes it the strongest fracture evidence we have.
The TRAVERSE result in plain numbers
Headlines said testosterone meant a "43% higher" fracture risk. That's true, but it sounds scarier than the real-world difference. Here's the same result several ways, using the published counts.
Rows 3 and 6 are our arithmetic from the published counts. The year-3 figures come from the trial report.
So: the published proportions differ by about 10 fractures per 1,000 men over a median 3.19 years. The trial found a statistically significant higher time-to-fracture risk with testosterone, but it did not establish why that happened. Either way, this is the opposite of evidence for fracture protection.
Who was in the study — and who wasn't
Every man had symptoms of low testosterone and two low fasting morning tests under 300 ng/dL. All had heart disease or a high risk of it. They were 63 on average.
Two details matter if you're trying to decide whether this applies to you. TRAVERSE enrolled men with cardiovascular disease or elevated cardiovascular risk, so it does not represent every man with hypogonadism. It also should not be stretched to answer questions about men with severe pituitary or testicular disease who were not the main population studied.
What the researchers couldn't measure
The trial didn't track falls for everyone. It didn't measure bone density during the study. Some men didn't use their gel consistently. And testosterone levels rose less than planned.
Most fractures in both TRAVERSE groups were associated with trauma, commonly falls, and the most common fracture sites were the ribs, wrist and ankle. The 2026 meta-analysis points in the same direction: clinical fractures were higher overall, while major osteoporotic, vertebral and hip fractures were not significantly different. One proposed explanation is greater injury exposure as activity changes, but that remains a hypothesis.
Here's what is settled: the editorial's bottom line was that men at high risk of fragility fractures should get an osteoporosis drug with proven fracture benefit — no matter what they decide about testosterone. Current reviews and guidelines reach the same practical conclusion: testosterone should not be the only fracture-prevention treatment for a high-risk man.
Avoid the two wrong conclusions
You'll see both of these online. Neither holds up.
Wrong conclusion #1: "TRT raises bone density, so it prevents fractures." The trials that counted fractures didn't show that. Density is part of fracture risk, not all of it. Falls, balance, bone structure and what you do all matter too.
Wrong conclusion #2: "Men on TRT broke more bones, so testosterone weakens bones." Also not shown. TRAVERSE did not measure bone density during the fracture study, while separate randomized trials show testosterone can improve BMD. Nobody has proven why the fracture difference occurred.
The honest middle: TRT is not fracture protection. Plan your bone care as if it isn't.
Should you stop TRT because of this?
Not on your own. TRT is prescribed when a clinician determines testosterone treatment is appropriate for hypogonadism, not as a fracture-prevention drug. Bring the fracture result up with your clinician. Ask about your fracture risk, whether you need a bone scan, and whether any add-on medicines may affect bone. Testosterone is a controlled prescription medicine — don't stop or change it without your clinician. Our guide to stopping TRT explains what that conversation involves.
If you already have osteoporosis or have had a fragility fracture, the bone workup comes before choosing any TRT provider — online or local.
The right TRT provider is not the same for every person — it depends on whether low testosterone has been properly evaluated, your symptoms and health history, your fertility plans, your state, your insurance or cash-pay preference, your treatment-format preference, your budget, and whether online or in-person care is the better starting point. Some situations belong with primary care, urology, endocrinology, reproductive urology, or urgent or emergency care when the symptoms warrant it. Because a general answer cannot resolve those for you, review the care-route table and appointment checklist on this page with your clinician. TRT Provider Guide's Find My TRT Path tool compares online TRT programs; it does not assess bone health, choose a specialist, or prepare personalized appointment questions. Compare programs only after your clinician-led bone and low-testosterone evaluation.
Find My TRT Path is educational and non-diagnostic. It does not confirm low testosterone or osteoporosis, decide medical eligibility, or guarantee a prescription.
Can low testosterone cause osteoporosis?
Low testosterone can contribute to bone loss in men, especially when hypogonadism is substantial or prolonged. Much of male bone homeostasis depends on estradiol, which the body makes from testosterone. But osteoporosis has many possible causes, so low bone density is not proof that low testosterone is the reason.
Men get osteoporosis more often than most people think. According to the Bone Health & Osteoporosis Foundation:
- Up to 1 in 4 men over 50 will break a bone because of osteoporosis.
- About 2 million American men already have it, and about 12 million more are at risk.
- About 80,000 men break a hip each year.
- Men are more likely than women to die within a year after a hip fracture.
Among men 65 and older, the U.S. Preventive Services Task Force puts the share with osteoporosis at 5.7%.
Why estrogen matters in men
This surprises a lot of men, so it's worth slowing down on. Your body turns some testosterone into estradiol using an enzyme called aromatase. In men, estradiol does much of the work of keeping bone from breaking down.
A careful 2016 study switched off the natural hormones of 198 healthy men, then added them back at different levels. When estrogen production was blocked, spine bone density dropped — no matter how much testosterone the men got. The researchers concluded that estrogen mainly runs bone upkeep in adult men. They also found bone loss generally didn't start until testosterone fell below about 200 ng/dL or estradiol below about 10 pg/mL.
Two practical takeaways. First, a borderline testosterone result isn't necessarily what thinned your bones. Second, any drug that pushes your estrogen down deserves a hard look. We'll come back to that.
Other causes to rule out
Low testosterone is one cause, not the only one. The Bone Health & Osteoporosis Foundation lists family history, steroid medicines, smoking, heavy drinking, not exercising, prostate cancer, rheumatoid arthritis, and chronic kidney, lung or gut disease. Low body weight and an earlier adult fracture raise risk too.
So "I have osteoporosis, therefore I need TRT" skips a step. The better question is: "What's causing my bone loss — and is low testosterone one of the reasons?"
Is it different for younger men?
Not as different as you'd hope. In a 2014 study of 399 men under 50 with low testosterone and sexual or fertility problems, more than a third had osteopenia. Bone loss isn't only an old man's problem.
If you have osteoporosis, should your testosterone be checked?
Often, yes — as one part of looking for causes. The ESCEO guideline suggests checking total testosterone before starting osteoporosis treatment, and the American Urological Association says clinicians should consider testing men with bone density loss even without other symptoms. But one result doesn't diagnose low testosterone, and osteoporosis alone doesn't prove testosterone is the cause.
How low testosterone is actually diagnosed
A few terms first:
- Total testosterone is all the testosterone in your blood.
- Free testosterone is the fraction of testosterone that is not bound to blood proteins.
- SHBG (sex hormone–binding globulin) is one of the main proteins that binds testosterone. When SHBG is altered or total testosterone is near the lower limit, guidelines say a reliable free-testosterone measurement or calculation may help interpret the result.
- Hypogonadism is the medical name for testosterone deficiency.
The Endocrine Society's July 2026 statement stresses that diagnosis needs symptoms of low testosterone plus consistently low, accurately measured testosterone in blood tests. Its guideline calls for at least two early-morning fasting tests. The American Urological Association agrees that neither symptoms alone nor a lab number alone is enough.
Why one low test isn't enough
Testosterone swings during the day and from day to day. Illness, poor sleep and some medicines can push it down for a while. A single low result is a reason to confirm the result in the proper clinical context, not a diagnosis by itself.
Why this comes before any talk of TRT
If you have osteoporosis and your testosterone really is low, your doctor also needs to know why. Very low levels, or a pattern pointing to the pituitary gland, call for a closer look before treatment. Two blood tests help here: LH (luteinizing hormone) and FSH (follicle-stimulating hormone), the brain signals that tell the testicles to work. Our guides to what hypogonadism is and how high prolactin can lower testosterone cover that workup.
Do you need a bone density (DXA) scan before or during TRT?
A DXA scan can make sense when a man has osteoporosis risk factors, and hypogonadism is one recognized risk factor. Endocrine Society guidance recommends DXA for men 70 and older and for men 50–69 with additional risk factors. Medicare covers bone-mass measurement only in listed situations; low testosterone by itself is not one of Medicare's listed eligibility categories.
Do any of these apply to you?
Tick them off in your head:
- I'm 70 or older.
- I'm 50–69 and I've broken a bone as an adult, I smoke, or I'm underweight.
- I've taken prednisone or a similar steroid medicine for three months or more.
- I'm on hormone therapy for prostate cancer.
- My testosterone has been confirmed very low, or a doctor found a cause like a pituitary problem.
If even one fits, ask your doctor whether a DXA makes sense before or soon after you start TRT.
Who says you should get one — and who pays
Guidelines and coverage rules don't line up neatly. Here's where each one stands.
The Endocrine Society asked Medicare back in 2012 to cover bone scans for men with low testosterone, the same way it covers at-risk women. That hasn't happened. If you have private insurance, check your plan — coverage varies. Ask your doctor what the scan will cost before you book it.
What your DXA numbers mean
For men age 50 and older, DXA is usually interpreted with a T-score, which compares bone density with a healthy young-adult reference:
- −1.0 and above: normal bone density
- Between −1.0 and −2.5: low bone density (often called osteopenia)
- −2.5 or lower: osteoporosis
For younger men, a Z-score is generally more useful than applying the older-adult T-score labels by themselves. A clinician should interpret the scan with age, fracture history and possible secondary causes in mind.
Doctors may combine DXA results with FRAX, a calculator that estimates 10-year probability of a major osteoporotic fracture or hip fracture. You can see the official FRAX website, but treatment decisions should use the tool in clinical context rather than a number alone.
How often to repeat it
The Endocrine Society suggests a follow-up DXA every one to two years for men on osteoporosis treatment, and less often once results are stable. Bone changes slowly. Scanning every few months won't tell you much.
If you take TRT, do you still need osteoporosis treatment?
If your fracture risk is high, testosterone should not be your only fracture-prevention plan. Guidelines support an osteoporosis therapy with proven antifracture efficacy when risk is high, even when TRT is also appropriate for confirmed hypogonadism. In lower-risk hypogonadal men, the Endocrine Society says clinicians may sometimes defer an osteoporosis drug while they assess the BMD response to testosterone.
TRT and osteoporosis medicine solve different problems. TRT treats appropriately diagnosed hypogonadism. Osteoporosis medicines are chosen to reduce fracture risk. When you have both conditions, the two treatment decisions may need to run together — coordinated, not swapped for each other.
Your bones + your testosterone: which care route fits?
We built this from the Endocrine Society's guideline on osteoporosis in men, the ESCEO guideline, the European Academy of Andrology guideline, and the TRAVERSE editorial. Find the row that sounds most like you.
Educational framework, not a diagnosis or treatment algorithm. FRAX thresholds and treatment choices depend on the guideline, country and clinical context.
"Can I just take TRT instead of Fosamax?"
If your fracture risk is high, guidelines say no. Bone medicines such as alendronate (Fosamax) have shown they lower fractures. Testosterone hasn't. The ESCEO guideline names oral bisphosphonates like alendronate or risedronate as first-line treatment for men at high fracture risk, with denosumab or zoledronic acid as the next options. Men at very high risk may start with a bone-building medicine instead.
An older Endocrine Society osteoporosis guideline also described a narrow fallback: testosterone could be considered in some men with high fracture risk, testosterone below 200 ng/dL on more than one test, and contraindications to approved osteoporosis drugs. That is not a general substitute for current osteoporosis treatment and belongs with an endocrinologist or bone specialist.
If you've already had a fragility fracture
A fragility fracture is a broken bone from a fall from standing height or less — or from no real injury at all. If you've had one, the question changes. It's no longer "Could TRT help my bones?" It's "Why did this break, and what lowers my chance of the next one?"
That's a job for your primary care doctor, an endocrinologist, or a bone specialist. Don't let a TRT program delay it. If low testosterone turns out to be part of the picture, it can be treated alongside your bone care — not instead of it.
Who should coordinate both treatments?
A TRT prescriber should not replace the clinician managing your osteoporosis. Keep primary care, endocrinology or a bone-health specialist involved in your bone plan, and share your TRT plan and lab results so the clinicians can see the whole picture.
Comparing TRT programs comes after your bone workup. Review your bone care and low-testosterone evaluation with your clinician first. If comparing online TRT programs is appropriate, Find My TRT Path can help with that comparison. It does not provide a bone-aware care route, select a specialist, or prepare personalized appointment questions. Use the appointment checklist on this page with your clinician. Compare online TRT programs → Educational and non-diagnostic. It doesn't confirm low testosterone or osteoporosis.
Do estrogen blockers on TRT hurt your bones?
They can. Estrogen is a key bone hormone in men. In a one-year trial of older men, the estrogen blocker anastrozole lowered spine bone density compared with placebo, even though testosterone went up. If an estrogen blocker is added to your TRT, ask why, how your estradiol will be checked, and whether your bones need watching.
This is the part most TRT pages skip.
An aromatase inhibitor is a pill that blocks your body from turning testosterone into estrogen. Anastrozole is the most common one. It's approved for certain breast cancers; using it in men is off-label, meaning a prescriber chooses it outside its approved use. Some TRT programs add it to keep estrogen down.
The bone evidence doesn't favor doing that casually:
- In the 2009 trial, 69 men 60 and older took anastrozole or placebo for a year. Their testosterone rose — and their spine bone density fell compared with placebo.
- In the 2016 study, blocking estrogen production dropped spine bone density no matter how much testosterone the men received.
- In the 2014 study of younger men, spine density went down in men treated with anastrozole or clomiphene and up in men on TRT. That one was small and observational, so treat it as a warning sign, not proof.
None of this means an estrogen blocker is never right. Some men have a specific reason for one. It means it shouldn't be automatic — and you're entitled to ask.
Questions to ask about estrogen on TRT
- Will you check my estradiol before I start and while I'm on treatment?
- Do you add an estrogen blocker routinely, or only for a specific reason?
- If you add one, will you check my bone density?
What about clomiphene or enclomiphene instead of TRT?
These are not TRT, and they aren't "natural TRT." They push the body to make more of its own testosterone. Clomiphene is FDA-approved for ovulation problems in women; using it in men is off-label. Enclomiphene isn't an FDA-approved drug. Men often consider them to protect fertility, because testosterone from outside the body can lower sperm production.
On bones, the only signal we found is the small 2014 study above, where spine density dropped on clomiphene. That's not enough to rule these drugs out. It is enough to say they aren't proven bone-friendly either. If you're trying to have children, a reproductive urologist is the right first stop — and ask about your bones while you're there. See our guides to TRT and fertility, enclomiphene with TRT and hCG with TRT.
Does the type of testosterone matter for your bones?
We found no head-to-head trial showing that injections, gels or oral testosterone prevent fractures better than another treatment format. The biggest bone and fracture trials used FDA-approved daily gel (the Testosterone Trials and TRAVERSE) or long-acting injectable testosterone undecanoate (T4DM). Compounded testosterone was not the product tested in those trials.
Choose your treatment format — injection, gel, cream, patch or capsule — based on your routine, cost, insurance and your clinician's advice. Bone claims shouldn't drive that choice, because there's no evidence that one format protects bone better than another.
One distinction does matter. FDA-approved testosterone products went through the FDA's review for safety, effectiveness and quality. Compounded testosterone is mixed by a pharmacy for an individual prescription and doesn't go through that review. That fact alone does not tell you whether a particular compounded prescription is safe or unsafe. It does mean the study results above came from different products. Our guides to injections vs. gel and oral testosterone compare the formats.
How long does TRT take to change bone density, and how is it checked?
In trials, bone density rose within the first year (the Testosterone Trials) and continued to improve over two years (T4DM). Bone changes slowly. Endocrine Society guidance uses repeat DXA after about one to two years when monitoring osteoporosis treatment or evaluating BMD response to TRT in selected hypogonadal men. Ask up front who will order and interpret your scans.
Here's what to watch on TRT, why it matters, and who usually handles it:
Your bone checklist for your next appointment
Screenshot this or print it. These are the questions your situation makes worth asking:
- Based on my age and history, should I have a DXA scan — and will my insurance or Medicare cover it?
- What's my 10-year fracture risk, and does it put me in the range where a bone medicine is recommended?
- Has my low testosterone been confirmed with two early-morning tests? Do we know the cause?
- If I start TRT, will you check my estradiol? Do you add estrogen blockers routinely?
- If I need both TRT and a bone medicine, who coordinates them?
- When should we repeat my DXA?
- What can I do about falls — balance, vision, medicines, my home?
Can TRT reverse osteoporosis?
No one can promise that. Testosterone may raise bone density in men with confirmed hypogonadism, but a higher T-score does not prove that osteoporosis has been "reversed" or that fracture risk is solved. If you have osteoporosis, fracture prevention has to be addressed on its own merits.
Be wary of any clinic, ad or influencer who says TRT "rebuilds" or "reverses" bone loss. A rising T-score can look like a reversal on paper. But the trials that counted real fractures didn't find protection.
What else protects your bones while you're on TRT?
The basics still do heavy lifting: enough calcium and vitamin D, regular weight-bearing and strength exercise, not smoking, limiting alcohol, and preventing falls. Fall prevention matters even more given that most extra fractures in TRAVERSE followed trauma. When risk is high, a proven bone medicine is the step up.
- Calcium: The Endocrine Society's male-osteoporosis guideline recommends about 1,000–1,200 mg of calcium a day for men with or at risk of osteoporosis, using food first when practical.
- Vitamin D: Its guideline suggests a supplement if your blood level is low. Ask your doctor to check it.
- Move with load: Weight-bearing exercise like walking, plus strength and balance training.
- Fall-proof your life: Good lighting, no loose rugs, sturdy shoes, regular eye checks, and a review of medicines that make you dizzy.
- Smoking and alcohol: Smoking and excessive alcohol use are recognized osteoporosis and fracture-risk factors.
One more thought. If you become more active after starting TRT, build back into higher-risk activities gradually. Greater injury exposure has been proposed as one possible explanation for the TRAVERSE fracture signal, but it has not been proven.
Special situations
A few situations change the bone advice entirely: prostate cancer hormone therapy, long-term steroid use, very low testosterone with a possible pituitary cause, trying to have children, and women looking into testosterone. Each one belongs with a specific kind of doctor first.
Prostate cancer and hormone therapy
Hormone therapy for prostate cancer (androgen deprivation therapy) drops testosterone on purpose and causes fast bone loss. Your oncologist or urologist handles bone protection, often with a DXA and a bone medicine. TRT generally isn't used during that treatment. See TRT after prostate cancer.
Long-term steroid medicines
Prednisone and similar medicines can thin bone quickly. Taking them is one of the reasons Medicare covers a DXA. The doctor managing your steroid should also manage your bone plan.
Very low testosterone or a pituitary cause
Very low testosterone, or abnormal LH and FSH results, needs a cause workup with an endocrinologist before any TRT program. These men were also left out of TRAVERSE, so the fracture result may not describe them.
Trying to have children
Testosterone from outside the body can lower sperm production. If you want children soon, raise it before starting anything — and know that non-testosterone options aren't proven bone-friendly either. A reproductive urologist is the right first stop.
Women researching testosterone and osteoporosis
This page is about men. Testosterone isn't an FDA-approved osteoporosis treatment for women. A menopause-focused clinician can explain the bone options that are.
What changed in 2025–2026 — and does it affect bone advice?
The FDA removed earlier cardiovascular-risk boxed-warning language from testosterone labeling in 2025 and required blood-pressure warnings. In June 2026, HHS announced that FDA was requesting additional label changes, including removal of the limitation-of-use language for age-related hypogonadism. Those actions did not turn TRT into an osteoporosis or fracture treatment. Federal telemedicine flexibilities for controlled-substance prescribing currently run through December 31, 2026.
- February 28, 2025: The FDA announced class-wide label changes for testosterone products. It removed boxed-warning language about increased heart risk, added TRAVERSE results to the labels, and required warnings about increased blood pressure.
- June 18, 2026: HHS announced FDA requests to remove the label's limitation on age-related low testosterone and to update prostate cancer and enlarged-prostate information. These are requested changes; drugmakers have to submit updated labels and the FDA has to review them.
- July 16, 2026: The Endocrine Society issued a statement stressing accurate diagnosis, weighing benefits against risks, and screening and monitoring once treatment starts.
- Telemedicine: Testosterone is a Schedule III controlled substance. Under the current federal temporary extension, a DEA-registered practitioner may prescribe Schedule II–V controlled substances by telemedicine without a prior in-person medical evaluation when the rule's conditions are met, through December 31, 2026. State law and the clinician's licensing or DEA authority still matter, and a future federal framework may change after that date.
What we actually verified
We read the original trials, current guidelines, FDA and federal prescribing updates, and Medicare's coverage rules. We kept randomized fracture outcomes separate from bone-density outcomes and separated current evidence from older guideline suggestions. This page is editorial research and has not been medically reviewed.
Verification date: October 27, 2026 (unless a different date is shown)
Sources checked: The TRAVERSE fracture study and its editorial in the New England Journal of Medicine; the Testosterone Trials Bone Trial; the T4DM bone study; the 2022 BMD meta-analysis and the published 2026 Maturitas fracture meta-analysis; the 2009 anastrozole trial; the 2016 hormone-threshold study; the 2014 study of younger men; the 2025 insurance-claims study; Endocrine Society osteoporosis and testosterone guidelines plus its July 2026 statement; the 2024 ESCEO male-osteoporosis guideline; the European Academy of Andrology guideline; the American Urological Association testosterone-deficiency guideline; the 2025 USPSTF recommendation; Medicare.gov; FDA's 2025 labeling action; HHS's June 2026 label-update announcement; current federal telemedicine rules; DEA scheduling information; and the Bone Health & Osteoporosis Foundation.
Facts we confirmed from primary or authoritative sources:
- Testosterone raised bone density in men with low testosterone in randomized trials.
- The largest randomized fracture analysis found more clinical fractures on testosterone, not fewer.
- Guidelines recommend proven bone medicine for men at high fracture risk, whether or not they use TRT.
- An estrogen blocker lowered spine bone density in older men in a randomized trial.
- Medicare's bone density coverage categories don't include low testosterone alone.
What we could not determine from current evidence:
- Why men in TRAVERSE had more fractures. The trial established the signal, not the mechanism.
- Whether fracture risk differs by testosterone formulation.
- Whether improving BMD with TRT translates into fracture protection in a subgroup not yet studied adequately.
Our editorial conclusions: TRT should not be treated as fracture protection; men with established osteoporosis or high fracture risk should have bone-specific care; and the fracture-vs-BMD distinction should be explained before any TRT-provider decision. These judgments are drawn from the evidence above and our documented How We Review TRT Providers method.
What this page can't tell you: whether TRT will raise your bone density, whether you personally need testosterone, or whether you need an osteoporosis medicine. Those take a clinician who knows your history.
This is a public-source research guide, not a hands-on clinical evaluation. See our Editorial Standards. Spot something out of date? Tell us through our corrections process.
Frequently asked questions
Does testosterone increase bone density?
Yes, in appropriately selected men with hypogonadism. Placebo-controlled trials found gains in several spine and hip bone-density measures, with larger effects at some spine measures. The response is not proof of fracture prevention.
Does TRT reduce fracture risk?
It hasn't been shown to. In TRAVERSE, 3.50% of men on testosterone had a clinical fracture over a median 3.19 years, compared with 2.46% on placebo. A published 2026 meta-analysis also found more clinical fractures overall, while major osteoporotic, hip and vertebral fractures were not significantly different.
Is TRT FDA-approved to treat osteoporosis?
No. FDA-approved testosterone products are approved to treat testosterone deficiency. Osteoporosis isn't their approved use, and the Endocrine Society says testosterone generally isn't recommended as the main osteoporosis treatment for men.
Can low testosterone cause osteoporosis?
Low testosterone can contribute to bone loss in men, partly because the body converts testosterone to estradiol, which is important for bone homeostasis. But osteoporosis has many other causes, so low bone density does not prove low testosterone is to blame.
Should I get a DXA scan if I have low testosterone?
Ask your clinician. Endocrine Society guidance recommends DXA for men 70 and older and for men 50–69 with risk factors; hypogonadism is one recognized risk factor. The 2025 USPSTF says evidence is insufficient to recommend for or against routine population screening in men, which is not the same as saying an individual man should never be tested.
Does Medicare cover a bone density scan for men?
Yes, in listed situations: X-rays showing possible osteoporosis or spine fractures, steroid use, primary hyperparathyroidism, or monitoring an osteoporosis drug. It covers one scan every 24 months. Low testosterone alone isn't a listed reason.
Does anastrozole cause bone loss in men?
In a one-year trial of men 60 and older, anastrozole lowered spine bone density compared with placebo, even though testosterone rose. If it's added to your TRT, ask why and whether your bones should be monitored.
Can I take TRT instead of Fosamax?
Not as a substitute when your fracture risk is high. Osteoporosis medicines with antifracture evidence are used to reduce fracture risk; testosterone has not shown that benefit. An older Endocrine Society guideline described testosterone as a narrow fallback in certain men who could not use approved osteoporosis drugs, not as the usual plan.
Can I take TRT and osteoporosis medicine together?
They can be used together when both conditions independently need treatment. TRT addresses hypogonadism; osteoporosis treatment addresses fracture risk. High-risk men should not rely on testosterone alone for fracture prevention.
How long does TRT take to improve bone density?
In trials, bone density improved within a year and continued to change over two years. Endocrine Society guidance uses repeat DXA after about one to two years when monitoring osteoporosis treatment or assessing BMD response to TRT in selected men.
Can TRT reverse osteoporosis?
No one can promise that. TRT may raise bone density in men with confirmed hypogonadism, but a better DXA number does not prove osteoporosis has been reversed or that fracture risk is controlled.
Does enclomiphene or clomiphene help bone density?
That hasn't been shown. A small 2014 study found spine density fell in younger men on clomiphene. Neither drug is TRT: clomiphene is used off-label in men, and enclomiphene isn't FDA-approved.
Should I stop TRT because of the fracture study?
Not on your own. The difference was small, and TRT is prescribed for symptoms. Talk with your clinician about your fracture risk, whether you need a DXA, and any add-on medicines before changing anything.
Ready to compare online TRT programs after your clinician-led bone and low-testosterone evaluation? Use our free Find My TRT Path tool.
Last verified: October 27, 2026
Sources
- Snyder PJ, et al. Testosterone Treatment and Fractures in Men with Hypogonadism. New England Journal of Medicine. 2024;390:203–211.
- Testosterone Treatment and Fractures in Older Men (editorial). New England Journal of Medicine. 2024;390:267–268.
- Anagnostis P, et al. Effect of testosterone replacement therapy on fracture risk in hypogonadal men: A systematic review and meta-analysis of randomized controlled trials. Maturitas. 2026;209:108961.
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