Short answer: It raises bone density, but it has not been shown to prevent fractures. In the Testosterone Trials, a year of testosterone gel raised spine bone density in older men with low testosterone. In the larger TRAVERSE fracture study, men on testosterone gel had more fractures than men on placebo, 3.5% against 2.5%, and the AndroGel 1.62% label now reports that result.
In the bone part of the Testosterone Trials (Snyder 2017), 211 men aged 65 or older with testosterone below 275 ng/dL used testosterone or placebo gel for a year. CT scans showed that trabecular bone density in the spine rose 7.5% on testosterone against 0.8% on placebo, and estimated spine strength rose 10.8% against 2.4%. The gains were larger in the spine than the hip. Density on a standard DXA scan of the spine rose too, but by less than the CT measure.
The authors said a larger, longer trial would be needed to know whether this lowers fracture risk. See bone mineral density.
That larger trial came from TRAVERSE, which followed 5,204 men aged 45 to 80 with low testosterone and heart disease or high heart risk. Men applied testosterone gel or placebo gel daily, and every reported fracture was checked against medical records (Snyder 2024). To qualify, men needed two morning testosterone levels under 300 ng/dL and at least one symptom of low testosterone.
| Group | Men with a fracture | Share |
|---|---|---|
| Testosterone gel | 91 of 2,601 | 3.50% |
| Placebo gel | 64 of 2,603 | 2.46% |
The hazard ratio was 1.43, and the rate looked higher on testosterone for every fracture type measured. The authors concluded that testosterone did not lower fractures and that the rate was numerically higher. The AndroGel 1.62% and Xyosted labels list bone fracture at 3.5% against 2.5% among the events that were more common with testosterone gel in TRAVERSE (section 6.1).
The trial was not designed to explain why. It used daily gel in men with heart risk, so it does not show results for injections or for younger men.
Testosterone labels are not approved to treat osteoporosis. Forteo is approved to increase bone mass in men with primary or hypogonadal osteoporosis at high risk of fracture (section 1), and other medicines are approved for men too, listed in osteoporosis medicines for men.
A man on testosterone with a past fracture, a family history of osteoporosis or long-term steroid use can ask whether a bone density scan and a bone-specific medicine make sense. Falls, vitamin D and calcium intake are part of the same talk. Dose Track keeps testosterone doses, lab results and notes on falls or fractures in one timeline for that visit.
Read more on Dose Track: Osteoporosis medicines for men · Bone mineral density · AndroGel side effects · Low testosterone