{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T19:08:38Z","timestamp":1780772918933,"version":"3.54.1"},"reference-count":90,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>High-dose testosterone replacement therapy (TRT), paired with finasteride (type II 5\u03b1-reductase inhibitor), improves body composition, muscle strength, and bone mineral density (BMD) in older men, without inducing prostate enlargement\u2014a side effect associated with TRT. Men with spinal cord injury (SCI) exhibit neuromuscular impairment, muscle atrophy, bone loss, and increased central adiposity, along with low testosterone. However, sparse evidence supports TRT efficacy after SCI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This parallel-group, double-blind, placebo-controlled, and randomized clinical trial (RCT) is a pilot study that enrolled men (<jats:italic>N<\/jats:italic>\u202f=\u202f12) with low to low\u2013normal testosterone and gait impairments after chronic motor-incomplete SCI. Participants received high-dose intramuscular TRT (testosterone-enanthate, 125\u202fmg\/week) with finasteride (5\u202fmg\/day) vs. vehicle+placebo for 12\u202fmonths. Change relative to baseline was determined for body composition, musculoskeletal outcomes, and prostate size, with effect sizes calculated between groups using Hedges\u2019 <jats:italic>g<\/jats:italic>. Adverse events and feasibility were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TRT\u202f+\u202ffinasteride consistently increased testosterone (<jats:italic>g<\/jats:italic>\u202f=\u202f1.16\u20133.08) and estradiol (<jats:italic>g<\/jats:italic>\u202f=\u202f0.43\u20133.48), while concomitantly reducing dihydrotestosterone (<jats:italic>g<\/jats:italic>\u202f=\u202f0.31\u20132.27). Very large effect sizes at both 6 and 12\u202fmonths suggest TRT\u202f+\u202ffinasteride increased whole-body fat-free (lean) mass (+3\u20134% vs. baseline, <jats:italic>g<\/jats:italic>\u202f=\u202f2.12\u20132.14) and knee extensor (KE) whole-muscle cross-sectional area (+8\u201311% vs. baseline, <jats:italic>g<\/jats:italic>\u202f=\u202f2.06\u20132.53) more than vehicle+placebo. Moderate-to-large effect sizes suggest TRT\u202f+\u202ffinasteride increased KE maximal voluntary isometric torque (+15\u201340% vs. baseline, <jats:italic>g<\/jats:italic>\u202f=\u202f0.47\u20131.01) and femoral neck and distal femur BMD from 6\u202fmonths onward (<jats:italic>g<\/jats:italic>\u202f=\u202f0.51\u20131.13), compared with vehicle+placebo, and reduced fat mass 9\u201314% within the whole-body, trunk, and android (visceral) regions at 12\u202fmonths (<jats:italic>g<\/jats:italic>\u202f=\u202f0.77\u20131.27). TRT\u202f+\u202ffinasteride also produced small effect sizes favoring lesser prostate growth than vehicle+placebo (<jats:italic>g<\/jats:italic>\u202f=\u202f0.31\u20130.43). The participant retention, drug compliance, and incidence and severity of adverse events were similar among the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These data provide proof-of-concept and rationale for larger RCTs aimed at discerning the impact of TRT\u202f+\u202ffinasteride on body composition, musculoskeletal health, and physical function in men with SCI, along with effect sizes and variance of responses to assist in planning subsequent trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>, identifier NCT02248701.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1479264","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T05:13:29Z","timestamp":1733894009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Musculoskeletal and body composition response to high-dose testosterone with finasteride after chronic incomplete spinal cord injury\u2014a randomized, double-blind, and placebo-controlled pilot study"],"prefix":"10.3389","volume":"15","author":[{"given":"Dana M.","family":"Otzel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine F.","family":"Conover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Marangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayachandra R.","family":"Kura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic K.","family":"Iannaccone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris M.","family":"Gregory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher F.","family":"Sonntag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Wokhlu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans K.","family":"Ghayee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"McPhaul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Plumlee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B.","family":"Sammel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua F.","family":"Yarrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.coph.2021.07.023","article-title":"Pharmacologic approaches to prevent skeletal muscle atrophy after spinal cord injury","volume":"60","author":"Otzel","year":"2021","journal-title":"Curr Opin Pharmacol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/B978-0-12-801238-3.11219-X","article-title":"Effects of spinal cord injury and related conditions","volume-title":"Encyclopedia of bone biology","author":"Yarrow","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1017\/S0007114523000831","article-title":"Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review","volume":"130","author":"Alazzam","year":"2023","journal-title":"Br J Nutr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.pmrj.2017.08.404","article-title":"Relationship between gonadal function and Cardiometabolic risk in young men with chronic spinal cord injury","volume":"10","author":"Sullivan","year":"2018","journal-title":"PM R"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1007\/s11154-022-09742-9","article-title":"Endocrinological and inflammatory markers in individuals with spinal cord injury: a systematic review and meta-analysis","volume":"23","author":"Boehl","year":"2022","journal-title":"Rev Endocr Metab Disord"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1111\/j.1749-6632.2010.05806.x","article-title":"Bone and muscle loss after spinal cord injury: organ interactions","volume":"1211","author":"Qin","year":"2010","journal-title":"Ann N Y Acad Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1038\/s41393-018-0207-7","article-title":"Serum testosterone levels may influence body composition and cardiometabolic health in men with spinal cord injury","volume":"57","author":"Abilmona","year":"2019","journal-title":"Spinal Cord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1097\/PHM.0b013e3181837f4f","article-title":"Testosterone levels among men with spinal cord injury: relationship between time since injury and laboratory values","volume":"87","author":"Clark","year":"2008","journal-title":"Am J Phys Med Rehabil"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/01.phm.0000228617.94079.4a","article-title":"Testosterone levels among men with spinal cord injury admitted to inpatient rehabilitation","volume":"85","author":"Schopp","year":"2006","journal-title":"Am J Phys Med Rehabil"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.pmrj.2016.11.005","article-title":"Prevalence and etiology of hypogonadism in young men with chronic spinal cord injury: a cross-sectional analysis from two university-based rehabilitation centers","volume":"9","author":"Sullivan","year":"2017","journal-title":"PM R"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.pmrj.2011.07.008","article-title":"Prevalence of testosterone deficiency after spinal cord injury","volume":"3","author":"Durga","year":"2011","journal-title":"PM R"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1179\/2045772313Y.0000000122","article-title":"Age-related prevalence of low testosterone in men with spinal cord injury","volume":"37","author":"Bauman","year":"2014","journal-title":"J Spinal Cord Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1080\/10790268.2017.1357917","article-title":"Body composition changes with testosterone replacement therapy following spinal cord injury and aging: a mini review","volume":"41","author":"Nightingale","year":"2018","journal-title":"J Spinal Cord Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"7523996","DOI":"10.1155\/2021\/7523996","article-title":"Association between serum testosterone levels and body composition among men 20-59 years of age","volume":"2021","author":"Ye","year":"2021","journal-title":"Int J Endocrinol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"5897","DOI":"10.1038\/s41598-018-24347-6","article-title":"Testosterone deficiency, weakness, and multimorbidity in men","volume":"8","author":"Peterson","year":"2018","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"E1035","DOI":"10.1152\/ajpendo.00111.2015","article-title":"Injection of testosterone may be safer and more effective than transdermal administration for combating loss of muscle and bone in older men","volume":"308","author":"Borst","year":"2015","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2647","DOI":"10.1210\/jcem.84.8.5885","article-title":"Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age","volume":"84","author":"Snyder","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1056\/NEJMoa054629","article-title":"DHEA in elderly women and DHEA or testosterone in elderly men","volume":"355","author":"Nair","year":"2006","journal-title":"N Engl J Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1210\/jc.2016-2771","article-title":"Effects of testosterone supplementation for 3 years on muscle performance and physical function in older men","volume":"102","author":"Storer","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1210\/jc.2012-3695","article-title":"Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels","volume":"98","author":"Hildreth","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1111\/j.1532-5415.2010.02865.x","article-title":"Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty","volume":"58","author":"Kenny","year":"2010","journal-title":"J Am Geriatr Soc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"M266","DOI":"10.1093\/gerona\/56.5.m266","article-title":"Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels","volume":"56","author":"Kenny","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"E601","DOI":"10.1152\/ajpendo.00362.2001","article-title":"Testosterone administration to older men improves muscle function: molecular and physiological mechanisms","volume":"282","author":"Ferrando","year":"2002","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"E1831","DOI":"10.1210\/jc.2011-1262","article-title":"A randomized pilot study of monthly cycled testosterone replacement or continuous testosterone replacement versus placebo in older men","volume":"96","author":"Sheffield-Moore","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"E433","DOI":"10.1152\/ajpendo.00592.2013","article-title":"Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial","volume":"306","author":"Borst","year":"2014","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1002\/jcsm.12291","article-title":"Muscular responses to testosterone replacement vary by administration route: a systematic review and meta-analysis","volume":"9","author":"Skinner","year":"2018","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1210\/jc.2006-0036","article-title":"Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials","volume":"91","author":"Tracz","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"338","DOI":"10.12998\/wjcc.v3.i4.338","article-title":"Review of health risks of low testosterone and testosterone administration","volume":"3","author":"Jia","year":"2015","journal-title":"World J Clin Cases"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1111\/andr.12806","article-title":"Association between prostate-specific antigen and serum testosterone: a systematic review and meta-analysis","volume":"8","author":"Kim","year":"2020","journal-title":"Andrology"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e410","DOI":"10.1097\/MD.0000000000000410","article-title":"The effect of testosterone replacement therapy on prostate-specific antigen (PSA) levels in men being treated for hypogonadism: a systematic review and meta-analysis","volume":"94","author":"Kang","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"853","DOI":"10.3892\/etm.2015.2957","article-title":"Efficacy and safety of testosterone replacement therapy in men with hypogonadism: a meta-analysis study of placebo-controlled trials","volume":"11","author":"Guo","year":"2016","journal-title":"Exp Ther Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1210\/jc.2004-1933","article-title":"Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T","volume":"90","author":"Page","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1210\/jc.2003-031110","article-title":"Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone","volume":"89","author":"Amory","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1055\/s-0031-1280797","article-title":"A small-scale clinical trial to determine the safety and efficacy of testosterone replacement therapy in hypogonadal men with spinal cord injury","volume":"43","author":"Bauman","year":"2011","journal-title":"Horm Metab Res"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2631","DOI":"10.1089\/neu.2018.6136","article-title":"Low-dose testosterone and evoked resistance exercise after spinal cord injury on cardio-metabolic risk factors: an open-label randomized clinical trial","volume":"36","author":"Gorgey","year":"2019","journal-title":"J Neurotrauma"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1249\/MSS.0000000000001975","article-title":"Testosterone and resistance training improve muscle quality in spinal cord injury","volume":"51","author":"Holman","year":"2019","journal-title":"Med Sci Sports Exerc"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1038\/s41393-019-0364-3","article-title":"A secondary analysis of testosterone and electrically evoked resistance training versus testosterone only (TEREX-SCI) on untrained muscles after spinal cord injury: a pilot randomized clinical trial","volume":"58","author":"Gorgey","year":"2020","journal-title":"Spinal Cord"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1152\/japplphysiol.00865.2019","article-title":"Sixteen weeks of testosterone with or without evoked resistance training on protein expression, fiber hypertrophy and mitochondrial health after spinal cord injury","volume":"128","author":"Gorgey","year":"2020","journal-title":"J Appl Physiol (1985)"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1007\/s00198-020-05778-2","article-title":"Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study","volume":"32","author":"Holman","year":"2021","journal-title":"Osteoporos Int"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1089\/neu.2013.3155","article-title":"Testosterone dose dependently prevents bone and muscle loss in rodents after spinal cord injury","volume":"31","author":"Yarrow","year":"2014","journal-title":"J Neurotrauma"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"2972","DOI":"10.1089\/neu.2016.4814","article-title":"Testosterone plus finasteride prevents bone loss without prostate growth in a rodent spinal cord injury model","volume":"34","author":"Yarrow","year":"2017","journal-title":"J Neurotrauma"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1002\/jnr.24564","article-title":"Locomotor training with adjuvant testosterone preserves cancellous bone and promotes muscle plasticity in male rats after severe spinal cord injury","volume":"98","author":"Yarrow","year":"2020","journal-title":"J Neurosci Res"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e0194440","DOI":"10.1371\/journal.pone.0194440","article-title":"Effects of pharmacologic sclerostin inhibition or testosterone administration on soleus muscle atrophy in rodents after spinal cord injury","volume":"13","author":"Phillips","year":"2018","journal-title":"PLoS One"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/pri.1588","article-title":"Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury","volume":"19","author":"Mishra","year":"2014","journal-title":"Physiother Res Int"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1038\/sc.2011.20","article-title":"United States (US) multi-center study to assess the validity and reliability of the spinal cord Independence measure (SCIM III)","volume":"49","author":"Anderson","year":"2011","journal-title":"Spinal Cord"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1177\/1545968309341059","article-title":"Falls in persons with spinal cord injury: validity and reliability of the berg balance scale","volume":"24","author":"Wirz","year":"2010","journal-title":"Neurorehabil Neural Repair"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/PHM.0b013e3181c560eb","article-title":"Walking index for spinal cord injury version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilities","volume":"89","author":"Marino","year":"2010","journal-title":"Am J Phys Med Rehabil"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"185","DOI":"10.3233\/NRE-2009-0467","article-title":"Comparison of the CIQ and CHART Short form in assessing community integration in individuals with chronic spinal cord injury: a pilot study","volume":"24","author":"Gontkovsky","year":"2009","journal-title":"NeuroRehabilitation"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s11136-008-9418-2","article-title":"Updated U.S. population standard for the veterans RAND 12-item health survey (VR-12)","volume":"18","author":"Selim","year":"2009","journal-title":"Qual Life Res"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1249\/01.MSS.0000079081.08476.EA","article-title":"The validity of the Stanford seven-day physical activity recall in young adults","volume":"35","author":"Washburn","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1038\/ejcn.2011.209","article-title":"Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study","volume":"66","author":"Wong","year":"2012","journal-title":"Eur J Clin Nutr"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jocd.2007.12.009","article-title":"Dual-energy X-ray absorptiometry technical issues: the 2007 ISCD official positions","volume":"11","author":"Simonelli","year":"2008","journal-title":"J Clin Densitom"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1038\/sc.2016.170","article-title":"Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury","volume":"55","author":"Peppler","year":"2017","journal-title":"Spinal Cord"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.apmr.2004.02.010","article-title":"Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests","volume":"86","author":"van Hedel","year":"2005","journal-title":"Arch Phys Med Rehabil"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"366.e17","DOI":"10.1016\/j.jamda.2016.12.077","article-title":"High prevalence of low serum biologically active testosterone in older male veterans","volume":"18","author":"Conover","year":"2017","journal-title":"J Am Med Dir Assoc"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1257523","DOI":"10.3389\/fmed.2023.1257523","article-title":"Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study","volume":"10","author":"Xing","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1044\/cicsd_33_S_42","article-title":"Calculating and synthesizing effect sizes","volume":"33","author":"Turner","year":"2006","journal-title":"Contemp Issues Commun Sci Disord"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1187\/cbe.13-04-0082","article-title":"The other half of the story: effect size analysis in quantitative research","volume":"12","author":"Maher","year":"2013","journal-title":"CBE Life Sci Educ"},{"key":"ref59","first-page":"326","article-title":"The catabolic effect of trauma of the spinal cord and its investigative treatment with testosterone propionate; preliminary report","volume":"25","author":"Cooper","year":"1950","journal-title":"Proc Staff Meet Mayo Clin"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1001\/jama.1951.02920260017005","article-title":"Testosterone propionate as a nitrogen-sparing agent after spinal cord injury","volume":"145","author":"Cooper","year":"1951","journal-title":"JAMA J Am Med Assoc"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1179\/2045772314Y.0000000206","article-title":"Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy","volume":"38","author":"Bauman","year":"2015","journal-title":"J Spinal Cord Med"},{"key":"ref62","volume-title":"Institute of Medicine. Testosterone and aging: Clinical research directions","author":"Liverman","year":"2004"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"3955","DOI":"10.1210\/jc.2010-0102","article-title":"The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men","volume":"95","author":"Lakshman","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1249\/JES.0000000000000056","article-title":"Testosterone and adult male bone: actions independent of 5alpha-reductase and aromatase","volume":"43","author":"Yarrow","year":"2015","journal-title":"Exerc Sport Sci Rev"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"4669","DOI":"10.1210\/jc.2006-0822","article-title":"Differences in the apparent metabolic clearance rate of testosterone in young and older men with gonadotropin suppression receiving graded doses of testosterone","volume":"91","author":"Coviello","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1210\/jc.2006-2203","article-title":"The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men","volume":"92","author":"Amory","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1001\/jama.2012.227","article-title":"Effect of testosterone supplementation with and without a dual 5alpha-reductase inhibitor on fat-free mass in men with suppressed testosterone production: a randomized controlled trial","volume":"307","author":"Bhasin","year":"2012","journal-title":"JAMA"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1056\/NEJMoa1206168","article-title":"Gonadal steroids and body composition, strength, and sexual function in men","volume":"369","author":"Finkelstein","year":"2013","journal-title":"N Engl J Med"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1359\/jbmr.071212","article-title":"Regulation of bone turnover by sex steroids in men","volume":"23","author":"Sanyal","year":"2008","journal-title":"J Bone Miner Res"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1210\/jc.2002-021036","article-title":"Differential effects of androgens and estrogens on bone turnover in normal men","volume":"88","author":"Leder","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1172\/JCI84137","article-title":"Gonadal steroid-dependent effects on bone turnover and bone mineral density in men","volume":"126","author":"Finkelstein","year":"2016","journal-title":"J Clin Invest"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1310\/sci2102-133","article-title":"Lower extremity strength is correlated with walking function after incomplete SCI","volume":"21","author":"DiPiro","year":"2015","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"S142","DOI":"10.1086\/375878","article-title":"Effects of testosterone administration on fat distribution, insulin sensitivity, and atherosclerosis progression","volume":"37","author":"Bhasin","year":"2003","journal-title":"Clin Infect Dis"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1152\/japplphysiol.00238.2016","article-title":"Testosterone inhibits expression of lipogenic genes in visceral fat by an estrogen-dependent mechanism","volume":"121","author":"Holland","year":"2016","journal-title":"J Appl Physiol (1985)"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"E327","DOI":"10.1152\/ajpendo.00402.2010","article-title":"Voluntary running, skeletal muscle gene expression, and signaling inversely regulated by orchidectomy and testosterone replacement","volume":"300","author":"Ibebunjo","year":"2011","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1038\/s41598-017-19104-0","article-title":"Testosterone boosts physical activity in male mice via dopaminergic pathways","volume":"8","author":"Jardi","year":"2018","journal-title":"Sci Rep"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"1390777","DOI":"10.3389\/fphys.2024.1390777","article-title":"Sex hormone supplementation improves breathing and restores respiratory neuroplasticity following C2 hemisection in rats","volume":"15","author":"Barok","year":"2024","journal-title":"Front Physiol"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.jocd.2021.03.010","article-title":"Predicting cardiometabolic risk from visceral abdominal adiposity in persons with chronic spinal cord injury","volume":"24","author":"Cirnigliaro","year":"2021","journal-title":"J Clin Densitom"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1080\/10790268.1997.11719458","article-title":"Fractures after myelopathy: the risk quantified","volume":"20","author":"Frisbie","year":"1997","journal-title":"J Spinal Cord Med"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1001\/jamainternmed.2016.9539","article-title":"Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: a controlled clinical trial","volume":"177","author":"Snyder","year":"2017","journal-title":"JAMA Intern Med"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1007\/s00198-016-3798-x","article-title":"Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options","volume":"28","author":"Cirnigliaro","year":"2017","journal-title":"Osteoporos Int"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1210\/clinem\/dgac028","article-title":"Relation of testosterone, dihydrotestosterone, and estradiol with changes in outcomes measures in the testosterone trials","volume":"107","author":"Stephens-Shields","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1056\/NEJMoa1000485","article-title":"Adverse events associated with testosterone administration","volume":"363","author":"Basaria","year":"2010","journal-title":"N Engl J Med"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1056\/NEJMoa2215025","article-title":"Cardiovascular safety of testosterone-replacement therapy","volume":"389","author":"Lincoff","year":"2023","journal-title":"N Engl J Med"},{"key":"ref85","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1007\/s40618-020-01243-3","article-title":"Testosterone, level of the lesion and age are independently associated with prostate volume in men with chronic spinal cord injury","volume":"43","author":"D\u2019Andrea","year":"2020","journal-title":"J Endocrinol Investig"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/s1166-7087(07)92363-5","article-title":"Benign prostatic hyperplasia and neurourology","volume":"17","author":"Chartier-Kastler","year":"2007","journal-title":"Prog Urol"},{"key":"ref87","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1038\/s41394-022-00499-6","article-title":"Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease intermittent catheterization in case of concomitant benign prostatic hyperplasia","volume":"8","author":"Sampogna","year":"2022","journal-title":"Spinal Cord Ser Cases"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1210\/jc.2018-00229","article-title":"Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline","volume":"103","author":"Bhasin","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"ref89","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/cen.14633","article-title":"Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism","volume":"96","author":"Jayasena","year":"2022","journal-title":"Clin Endocrinol"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3390\/ijms19061701","article-title":"Activity-based physical rehabilitation with adjuvant testosterone to promote neuromuscular recovery after spinal cord injury","volume":"19","author":"Otzel","year":"2018","journal-title":"Int J Mol Sci"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1479264\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T05:13:35Z","timestamp":1733894015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1479264\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,11]]},"references-count":90,"alternative-id":["10.3389\/fneur.2024.1479264"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1479264","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,11]]},"article-number":"1479264"}}