Short-term testosterone therapy improves quality of life, sexual function for men
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Key takeaways:
- Men receiving testosterone therapy had greater improvements in sexual function and quality of life than those receiving placebo.
- Improvements in sexual function may be lower for older men and those with obesity.
Testosterone therapy improves sexual function and quality of life for men with a baseline serum testosterone of less than 12 nmol/L, though less improvement was observed for older men and those with obesity, data show.
“Our analysis of more than 3,000 individual men suggest that age, BMI and diabetes status do not significantly alter the short-to-medium term effectiveness of testosterone replacement therapy in improving sexual function or quality of life compared with placebo with a double-blinded randomized clinical trial setting,” Channa N. Jayasena, MA, PhD, MRCP, FRCPath, reader in reproductive endocrinology at Imperial College London and consultant in reproductive medicine and andrology at Imperial College Healthcare NHS Trust, and colleagues wrote in a study published in The Lancet Healthy Longevity. “However, due to more severe baseline symptoms, the absolute level of sexual function reached during testosterone might be lower in older men and men with obesity compared with younger men and those who are not obese.”
Researchers conducted a systematic review and meta-analysis of randomized placebo-controlled trials assessing the effects of testosterone therapy for at least 3 months among men aged 18 years and older with a total serum testosterone of less than 12 nmol/L at baseline. MEDLINE, Embase, Science Citation-Index and Cochrane Central Register of Controlled Trials were searched from 1992 until Aug. 27, 2018. Data from questionnaires analyzing quality of life, sexual function and psychological symptoms were extracted.
There were 17 studies involving 3,431 men included in the meta-analysis (median age, 67 years). Of the participants, 1,750 were randomly assigned to testosterone and 1,681 received placebo. Of the participants, 97.1% were aged 40 years and older. The median duration of testosterone therapy was 8 months and median duration of follow-up was 30 weeks.
The 15-item International Index of Erectile Function questionnaire assessed sexual function for 1,412 men across five studies. Men receiving testosterone had a higher total score, erectile function subscore and intercourse satisfaction subscore than those receiving placebo in one-stage analysis. After adjusting for baseline values, improvements in sexual function were greater during testosterone therapy when baseline serum testosterone was greater than 9.8 nmol/L or when BMI was lower than 30.6 kg/m2. Men older than 70 years receiving testosterone therapy had less of an increase in sexual function than men aged 70 years or younger.
The Aging Males’ Symptoms scale was administered to 938 men among seven studies to evaluate quality of life. Among these participants, men receiving testosterone therapy had a greater improvement in overall quality of life and all subscales than those receiving placebo. No differences in quality of life improvement were observed by age, baseline total or free testosterone or BMI.
The SF-12 was administered to 539 men across five studies to assess health-related quality of life. Men receiving testosterone had greater improvements in social function, role limitations due to emotional problems and mental health composite score than placebo.
The Beck Depression Inventory was completed by 246 men across three studies to analyze psychological symptoms. No differences in scores were observed for men receiving testosterone vs. placebo.
“This study provides useful new information for clinicians to counsel men without classic hypogonadism about the short-to-medium-term benefits of testosterone treatment,” the researchers wrote. “Testosterone should always be initiated within a holistic clinical care model, including assessment for potentially modifiable risk factors, such as obesity and smoking.”
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