Testosterone Therapy and Bone Quality in Men With Diabetes and Hypogonadism

Inclusion Criteria: * Male veterans only * 35 to 70 years old * With an average fasting morning T level from 2 measurements of \<300 ng/dl taken at least a day apart * symptoms of hypogonadism as assessed using the androgen deficiency in aging male (ADAM) questionnaire * Participants should have * T2D * an A1C of \<11.5 % * a fasting blood sugar of 180 mg/dl * body mass index (BMI) \<40 kg/m2 * with DM of 15 years duration or less to target men who have relatively less complications from long-term DM Exclusion Criteria: * history of prostate or breast cancer * history of testicular disease * untreated severe sleep apnea * ongoing illness that could prevent the subject from completing the study * a hematocrit of \>50% * prostate-related findings as: * a palpable prostate nodule on digital rectal exam (DRE) * serum PSA of 4.0 ng/ml * International Prostate Symptom Score (IPSS) \>19 (severe) * on androgen therapy or selective androgen receptor modulators * on medications that affect bone metabolism such as: * estrogen * selective estrogen receptor modulator as: * raloxifene * aromatase inhibitors * GnRH analogs * glucocorticoids with prednisone equivalent of least 5 mg daily for 1 month * anabolic steroids * phenobarbital and Dilantin * use of bisphosphonates within two years of study entry, i.e.: * risedronate * alendronate * zoledronic acid * pamidronate * diseases that interfere with bone metabolism, as: * hyperpar…