We would like to respond to the thoughtful comments of Dr Mikhail. For the most part, we believe the apparent disagreement (ie, testosterone as a treatment for osteoporosis in men) expressed by Mikhail has more to do with semantics than substance. We agree that hypogonadal elderly men with osteoporosis likely will benefit from treatment with exogenous testosterone. However, in our study,1 in which we determined the number of men and women with hip fractures who were treated for osteoporosis, we tallied patients who were taking calcium and vitamin D only, patients taking a Food and Drug Administration–approved antiresorptive agent for the treatment and/or prevention of osteoporosis (namely, estrogen, calcitonin, raloxifene, alendronate, risedronate), and patients taking both calcium and vitamin D and an antiresorptive agent. Testosterone is not approved by the Food and Drug Administration for the treatment or prevention of osteoporosis. No studies have shown that testosterone decreases fracture risk in hypogonadal elderly men. There is no basis for a strategy of using testosterone solely for the purpose of treating low bone mineral density in men. Thus, we justifiably did not include testosterone as an "osteoporosis treatment."
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