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Testosterone therapy unsuccessful for ejaculatory dysfunction
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Testosterone replacement therapy did not improve sexual function in men with ejaculatory disorders and low testosterone levels, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
“This is the first clinical trial examining the treatment of a very common but poorly understood condition that affects men’s physical health as well as their interpersonal relationships,” Darius A. Paduch, MD, PhD, of New York-Presbyterian Hospital/Weill Cornell Medical Center and Weill Cornell Medical College, said in a press release. “Although the participants in this study did not experience any significant improvement in ejaculatory function, we hope our work will spur the development of additional clinical trials to find treatments for this condition.”
Darius A. Paduch
Paduch and colleagues randomly assigned 76 men aged at least 26 years with total testosterone levels less than 300 ng/dL and ejaculatory dysfunction to a 2% testosterone solution applied on the skin or a placebo to determine the effect on ejaculatory dysfunction.
Ejaculatory dysfunction was measured by the three-item score on the Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF).
Serum testosterone levels increased more in the testosterone solution group (274 ± 344 ng/dL) compared with the placebo group (18 ± 60 ng/dL; between treatment, P < .001). Free testosterone levels also increased more in the testosterone solution group (8.6 ± 10.2 ng/dL) compared with the placebo group (0.5 ± 1.8 ng/dL; between treatment, P < .001).
The testosterone group had a greater score change on the MSHQ-EjD-SF compared with placebo, although this was not statistically significant. Mean change in ejaculate volume, orgasmic function and frequencies of ejaculation and orgasm were not statistically different between the two groups.
“Our findings suggest physicians who are treating men with ejaculatory dysfunction need to look at other reasons for delayed ejaculation than hypogonadism,” study researcher Shehzad Basaria, MD, of Brigham and Women’s Hospital and Harvard Medical School, said in the release. “More research is needed to determine whether a longer course of testosterone therapy or other treatment options can benefit men with ejaculatory dysfunction.” – by Amber Cox
Disclosure: Paduch and Basaria report receiving trial support and personal fees from Eli Lilly. Basaria reports receiving grants from AbbVie. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Ronald Tamler, MD, PhD, MBA
The authors of the study deserve a lot of credit. Even though the trial was of modest size, with 66 subjects who completed 16 weeks, it was well done and answers a common question that most physicians with an interest in sexual medicine previously had to answer based on anecdotal data: Testosterone supplementation for hypogonadal men is not superior to placebo when it comes to treating ejaculatory disorders. It is also a badge of honor for the research team and for Eli Lilly that this negative study was published despite the involvement of and support by pharma (two co-authors work for the company). While these data allow providers to frame patients’ expectations, that does not diminish the role of testosterone supplementation for hypogonadal men — the benefits in other domains, such as libido, remain well-established.
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