Introduction: The Overlooked Benefit of TRT
By: Joe Miller Founder of 1st Optimal
As men age, declining testosterone levels are often blamed for fatigue, low libido, and muscle loss. But there’s another, less talked-about consequence: bone loss and increased fracture risk. A groundbreaking 2017 study published in JAMA Internal Medicine sheds new light on how testosterone replacement therapy (TRT) may significantly improve bone mineral density (BMD) and skeletal strength in men over 50.
But the story doesn’t stop at bone health. Recent public figures and celebrities, including Joe Rogan, Andrew Huberman, and Sylvester Stallone, have opened up about their hormone optimization journeys—putting TRT at the forefront of aging conversations.
Fun Fact: Actor and fitness icon Sylvester Stallone, now in his late 70s, has long been vocal about the importance of testosterone and bone strength to preserve function, appearance, and performance.
Testosterone’s Role in Bone Health
Testosterone is not just a sex hormone. It plays a critical role in maintaining bone integrity by stimulating bone-forming cells and limiting bone resorption. Low levels can result in:
- Decreased trabecular bone (the shock-absorbing interior)
- Loss of cortical bone (the outer, structural shell)
These changes increase the risk of osteoporosis, spine fractures, and hip injuries, particularly in men over 60.
🔬 How Testosterone Helps:
- Promotes osteoblast activity (bone-building cells)
- Converts to estradiol, a crucial hormone for bone preservation
- Enhances muscle mass, which also supports bone health
The Landmark 2017 Study: Testosterone and Bone Density
A randomized controlled trial conducted across nine U.S. academic centers studied 211 men aged 65+ with low testosterone.
Key Design Details:
- Duration: 12 months
- Method: Daily testosterone gel vs. placebo
- Assessments: Quantitative computed tomography (QCT)
Key Outcomes:
1. Increased Bone Density
- Men on TRT saw a 7.5% increase in spine trabecular vBMD
- Placebo group: only 0.8% improvement
- Gains also recorded in hip and peripheral bones
2. Improved Bone Strength
- TRT led to 8.5% increase in estimated spinal bone strength
- Finite Element Analysis (FEA) showed improved mechanical resistance
“We saw increases in both density and structural integrity, two hallmarks of real skeletal improvement,” said Dr. Peter Snyder, lead author of the study.
The Hormonal Mechanism: Testosterone + Estradiol
TRT’s benefit isn’t from testosterone alone. Much of its bone-building power comes from estradiol, a form of estrogen synthesized from testosterone.
Why This Matters:
- Estradiol is essential for bone health in both sexes
- In men, most estradiol is derived from testosterone
- Improvements in BMD and bone strength correlated with increases in both testosterone and estradiol
This confirms the dual-hormone advantage of TRT.
What About Fracture Risk?
While the study didn’t track fractures directly, it did show strong improvements in bone mechanics and density, both of which correlate with reduced fracture risk in older men.
Additional studies suggest that low estradiol and testosterone levels are strongly associated with hip and vertebral fractures in men over 60 (Fink et al., 2006).
Comparing TRT to Traditional Osteoporosis Medications
Drugs like bisphosphonates and teriparatide are designed for bone loss, but mainly studied in postmenopausal women.
In contrast:
- TRT improves multiple systems (muscle, libido, cognition, AND bone)
- May be ideal for men not responding to traditional meds or those with concurrent hypogonadism
Andrew Huberman, Ph.D., frequently discusses hormone optimization as a full-body upgrade—not just for performance, but for aging well.
Who Should Consider Testosterone Therapy for Bone Health?
TRT may be appropriate for:
- Men aged 50+ with confirmed low testosterone
- Those with early signs of osteopenia or osteoporosis
- Individuals experiencing declining strength, mobility, or balance
Safety, Monitoring, and Medical Oversight
TRT must be personalized and monitored regularly:
- Blood panels (total T, free T, estradiol, PSA, CBC)
- Bone scans (QCT or DEXA)
- Routine follow-ups with licensed providers
Common Myths:
- Weight gain? Mostly water in muscle tissue
- Prostate risk? No strong evidence in monitored TRT use
- Not natural? You naturally lose T after 30—it’s about restoring optimal function
Final Thoughts: Stronger Bones, Stronger Future
TRT is not a magic bullet, but for many aging men, it can be a foundational therapy that supports:
- Skeletal health
- Strength and mobility
- Confidence and vitality
As research continues to unfold, testosterone’s benefits on bone structure and fracture prevention should be a core part of the conversation around aging.
✅ Ready to Explore Testosterone Therapy with Medical Oversight?
At 1st Optimal, we take a lab-based, physician-guided approach to testosterone therapy, combining functional medicine with precision diagnostics to evaluate your health from every angle.
If you’re experiencing symptoms of low testosterone and want to understand how TRT could impact your bone health, energy, and longevity:
👉 Book your personalized consultation today
Stronger bones. Sharper energy. Smarter care.
1st Optimal – Optimize You, Uplift Others
🔗 Resources:
- JAMA Internal Medicine – 2017 Study
- NIH: Testosterone and Bone
- Cleveland Clinic: Osteoporosis in Men
- Endocrine Society Guidelines
- PubMed: Estradiol and Bone in Men
