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Testosterone therapy shows promise for boys and young men with Prader-Willi syndrome. A Dutch study found that testosterone helped maintain bone mineral density and increase lean mass over five years — and, crucially, didn't worsen behavior in most patients. Researchers say behavioral concerns alone shouldn't be a reason to delay treatment.
Testosterone therapy may be a safe and effective option for teenage boys and young men with Prader-Willi syndrome (PWS), according to a new observational study from the Netherlands published in Clinical Endocrinology. PWS causes hypothalamic dysfunction that often leads to hypogonadism, putting patients at risk for poor bone development and unfavorable body composition. Historically, concerns about testosterone worsening behavioral symptoms — like temper tantrums, obsessive compulsions, and psychotic episodes — have made clinicians hesitant to prescribe it.
The study followed 59 males older than 14 years with PWS, 44 of whom used testosterone therapy. Over five years, testosterone users showed stabilized lumbar spine bone mineral density (BMD), increased lean mass, and reduced fat mass — with no significant overall behavioral changes. Only three patients discontinued treatment due to behavioral issues.
Key Takeaways:
Why it matters: For a condition as complex as PWS, these findings offer clinicians reassurance that testosterone replacement therapy can improve physical health outcomes without significantly amplifying behavioral challenges — suggesting that behavioral concerns alone should not serve as a blanket barrier to treatment.
