Testosterone Optimization Therapy (TOT) has been observed to help prevent osteoporosis and frailty in aging men and women which are usually the number 1 cause of death for the elderly. In multiple studies involving aging men, low testosterone levels are associated with lower skeletal muscle mass, muscle strength, physical function, bone mineral density and higher risk of fractures and death. Low testosterone levels clearly cause bone disease in men, as testosterone is indisputably linked to bone health. Optimized blood testosterone levels increase bone density and impede the normal bone resorption issues that come with age (i.e., breakdown and destruction of bone tissue). Men who suffer from bone disease usually have suboptimal levels of testosterone, and this leads to frailty in old age 55.
The last thing any man wants is to end up with a deteriorated hip or spine that completely limits their range of motion later in life. No man wants to be a shadow of his former glory, stuck in a rocking chair and unable to move. If you want ideal bone health into your later years, you owe it to yourself to optimize your testosterone levels. More and more physicians are using a SERM (such as Clomid, Nolvadex or Toremifene) or even an AI (such as Arimidex) as the entirety of a “TOT” protocol. These medications will elevate luteinizing hormone (LH) and overall total testosterone levels, so it’s easy to see why such an approach would be taken.
From our experience and the most prominent research done to this date on AI’s in men, patients rarely report long-term benefits from these strategies. Due to scientific studies showing the negative consequences to bone mineral density from long-term overuse of AI medications, we adamantly recommend that AI’s are ONLY used for short periods of time. This is to get estrogen levels within an acceptable therapeutic range where hormonal balance is achieved, and side effects are alleviated. A much safer and effective strategy is to either reduce the testosterone dosage or alter the dosing schedule to deal with the symptoms of excess estrogen. 
ReNue Health Founder Dr. Robert Kominiarek sees patients in his practice with osteoporosis (breakdown of the bones) in the spine and hips after being on Arimidex for 6-12+ consecutive months (or longer). This is a terrible situation for a TOT patient, and one that physicians attempt to avoid at all costs. The dosing of these AI medications is highly variable as all men are biochemically different from one another. As aromatase inhibition is dose-dependent, it has been suggested that aromatase is less suppressed in the testes than in adipose and muscle tissue, which explains the incomplete effectiveness of aromatase inhibition in men. Again, that is why it is crucial to have a competent TOT prescribing doctor who can evaluate lab values and attend to symptoms, if and when they arise. Additionally, ongoing blood draws done regularly, and honest patient feedback are crucial for both the patient and the doctor to achieve (and maintain) an optimal hormonal balance. With some men, hormonal balance can take time to achieve. To read much more about the usage of therapeutic testosterone to fight frailty and osteoporosis in men, purchase The TOT Bible.
