Within weeks since injury, testosterone level decreases, and thereafter may reach normal values within 4–6 months post-injury, which is fairly supported by our study that reported a significant increase in total testosterone and DHEA-S prior to discharge from first inpatient rehabilitation. Over a period of initial rehabilitation stay (between admission or within 16–40 post-injury to up to 10 days before discharge), total testosterone and DHEA-S levels increased significantly, while we observed no significant changes in other hormones (free testosterone, SHBG, or DHEA). A decline in androgen hormones and abnormalities of the hypothalamic-pituitary-gonadal (HPG) axis has been repeatedly reported in individuals with chronic spinal cord injury (SCI), with more than 40% of men having testosterone levels below normal age-specific cut-offs 1,2. Even if someone believes they have low testosterone, red-flag symptoms must be taken seriously and checked right away. Rapid or unexplained weight loss along with back pain may indicate inflammation, infection, or in rare cases, cancer. Some symptoms should never be ignored, even if someone also suspects low testosterone. For many people, back pain comes from structural or mechanical issues in the spine, joints, or nerves. Back pain isn’t a typical side effect of TRT, but indirect factors—such as increased exercise intensity or fluid shifts—can sometimes contribute. Fluid retention or increased activity levels without proper conditioning may contribute to discomfort in some individuals. It may support recovery by enhancing tissue repair and reducing muscle wasting, but results vary and it should not replace rehabilitation or physical therapy. TRT can increase muscle protein synthesis, which may improve core and back muscle strength—potentially offering better spinal support. In the end, the relationship between testosterone and back pain is real but complex. This may include physical therapy, stretching, core strengthening, weight management, and healthy sleep habits. Instead, TRT may work as a supportive therapy that improves the body’s foundation, which may help reduce symptoms or make other treatments more effective. In order to determine the role of CADM1, we evaluated the defects in sperm, testis architecrure, and CADM1 transcription and expression after SCI 12, 13 as well as the beneficial effects of sub-acute and chronic exogenous testosterone treatment on the aforementioned parameters in mice with SCI. On the other hand, time lapse testosterone treatment did not prevent a reduction in receptor immunoreactivity in both acute and chronic phases of SCI. There was an increase in the level of serum testosterone in SCI7-T7 group (5.8 ± 0.57) compared to SCI7 group(1.5 ± 0.28, P Exogenous testosterone administered immediately post-SCI non-significantly increased the testosterone level compared to the untreated SCI7 group. There were no significantdifferences between the sham and control groups.Seven days post SCI, the level of serum testosteronereduced significantly (PFig .3). Serum levels of testosterone were measured by Enzyme Linked Immune Sorbent Assay (ELISA) by using a commercial kit (Sigma-Aldrich. Co., Germany, Cat. No. SE120089) and expressed as ng/ml according to the manufacturer’s instructions. After the surgery, animals were injected with sterile saline (2 mL, s.c.) then placed in a warming chamber where their body temperatures were maintained at approximately 37°C until they became fully awake. The wound was closed by separately suturing muscles, skin and the fat pad. After the injury, we rinsed the cord with room temperature saline and removed any residual blood. The compression injury was induced according to the procedure described by Holtz et al. (19). Animals that underwent laminectomy with no cord compression and were killed 35 days post-injury (Sham35), and v. Intact animals that underwent no surgical intervention (control). Animals that received testosterone one week after SCI for a 35-day period and were killed 24 hours after last testosterone injection (SCI7-T35), iv. Since testosterone plays an important role in adhesion at the Sertoli-germ cell interface and in regulation of BTB integrity (16), here, we attempted to ascertain the role of CADM1 in SCI pathology and the possible role of exogenous testosterone in its regulation. LH then signals the testes to produce testosterone. Spinal cord injury affects multiple physiological systems beyond the nervous system. The endocrine system — the network of hormones regulating metabolism, muscle physiology and energy balance — is deeply interconnected with these processes. Yet recovery after injury is never purely neurological. Hypothyroidism (low thyroid hormone levels) can lead to reduced metabolic activity in the discs and surrounding tissues, contributing to degeneration and decreased repair capacity. Thyroid hormones (T3 and T4) regulate metabolism, including the metabolism of connective tissues and bones. We will also share detailed case studies from our clinic, Movability, to illustrate these concepts in real-world scenarios. Spinal disc health is a critical aspect of overall musculoskeletal well-being. Future research should address the pathophysiology of low testosterone and the outcomes of testosterone treatment. Guidelines are needed for when and how often testosterone monitoring should be conducted.
