Body composition changes after testosterone replacement therapy following spinal cord injury and aging: a mini review

Research output: Contribution to journalReview articlepeer-review


  • Pam Moore
  • Joshua Harman
  • Refka Khalil
  • Ranjodh Gill
  • Teodoro Castillo
  • Robert Adler
  • Ashraf Gorgey

Colleges, School and Institutes


CONTEXT: Hypogonadism is a male clinical condition in which the body does not produce enough testosterone. Testosterone plays a key role in maintaining body composition, bone mineral density, sexual function, mood, erythropoiesis, cognition and quality of life. Hypogonadism can occur due to several underlying pathologies during aging and in men with physical disabilities, such as spinal cord injury (SCI). This condition is often under diagnosed and as a result, symptoms undertreated.

METHODS: In this mini-review, we propose that testosterone replacement therapy (TRT) might be a viable strategy to improve lean body mass (LBM) and fat mass (FM) in men with SCI.

EVIDENCE SYNTHESIS: Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled aging men, we present evidence that, relative to placebo, transdermal TRT can increase LBM and reduce FM over 3 – 36 months. The impact of TRT on bone mineral density and metabolism is also discussed, with particular relevance for persons with SCI. Moreover, the risks of TRT remain controversial and pertinent safety considerations related to transdermal administration are outlined.

CONCLUSION: Further research is necessary to help develop clinical guidelines for the specific dose and duration of TRT in persons with SCI. Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, who experience an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury.


Original languageEnglish
Pages (from-to)624-636
Number of pages13
JournalJournal of Spinal Cord Medicine
Issue number6
Early online date13 Aug 2017
Publication statusPublished - 2 Nov 2018


  • Testosterone replacement therapy, body composition, lean body mass, fat mass, spinal cord injury