Objective:

To investigate the effect of reproductive hormone treatment on bone mineral density (BMD) in men with hypogonadotropic hypogonadism (HH) compared to healthy control groups.

Key Findings:

• Men with HH exhibited low lumbar spine (LS) and femoral neck BMD, which improved with hormonal treatment, as evidenced by the meta-analysis.
• Meta-analysis indicated significantly lower LS BMD in men with HH compared to healthy controls (SMD −5.98; 95% CI; −11.5 to −0.47).
• Persistent low BMD may occur in men with congenital HH despite prolonged hormonal treatment.
• Higher BMD was associated with younger age at treatment initiation, partial HH, and elevated serum testosterone and estradiol levels.
• Fracture prevalence was high in studies that examined fractures as an outcome, indicating a need for further investigation.

Interpretation:

Current evidence suggests that while hormonal treatment improves BMD in men with HH, complete normalization of BMD may not be achieved, particularly in those with congenital forms of the condition, which has significant clinical implications.

Limitations:

• The studies included were small and observational, limiting the generalizability of findings.
• Lack of long-term data on BMD normalization and fracture risk in men with HH.
• Potential biases in observational studies may affect the reliability of the findings.

Conclusion:

Hormonal treatment can improve BMD in men with HH, but many may not achieve normal BMD levels, highlighting the need for further research, particularly larger studies to validate these findings.