Testosterone therapy significantly improves sexual desire in older men with prediabetes
Key takeaways:
- Men receiving testosterone in the T4DM trial were more likely to have improved sexual desire than the placebo group.
- The percentage of men with better erectile dysfunction scores was similar between the groups.
Testosterone therapy plus lifestyle intervention was tied to a larger improvement in sexual desire than lifestyle intervention alone among older men with impaired glucose tolerance, according to a secondary analysis of the T4DM trial.
As Healio previously reported, the T4DM trial randomly assigned 1,007 men aged 50 to 74 years with a waist circumference of 95 cm or more and with IGT or newly diagnosed type 2 diabetes to 1,000 mg testosterone undecanoate (Reandron, Bayer) every 3 months or placebo for 2 years. Men receiving testosterone had a greater decline in 2-hour glucose than those in the placebo group and were less likely to have type 2 diabetes at the end of the study.
New data from the trial published in The Journal of Clinical Endocrinology & Metabolism found testosterone therapy improved sexual desire but had less of an effect on erectile dysfunction. Gary Wittert, MBBCh, MD, FRACP, professor of medicine and director of the Freemasons Centre for Male Health and Wellbeing at the University of Adelaide in Australia, said the study is the first to examine clinically significant improvements in both sexual function domains.
“Clinically significant improvements for both erectile function and sexual desire were more likely to occur in men with lower baseline scores,” Wittert told Healio. “Younger men were more likely to have a clinically significant improvement in erectile function, and older men for sexual desire.”
Sexual function in the T4DM trial was assessed using the International Index of Erectile Function 15-item questionnaire. A clinically significant improvement in erectile dysfunction was defined as a 4-point increase in score, and clinically significant improvement for sexual desire was defined as a 2-point or greater increase from baseline. Any decrease in either score from baseline was defined as deterioration of symptoms.
There were 932 T4DM participants included in the analysis, of whom 471 received testosterone and 461 received placebo.
Testosterone therapy was associated with a mean 2.5-point greater increase in erectile dysfunction score and a 0.68-point higher increase for sexual desire score compared with placebo (P < .001 for both). Testosterone therapy was also tied to a 0.87-point greater increase in orgasmic satisfaction score, a 1.5-point higher increase in intercourse satisfaction score and a 0.7-point greater increase in overall satisfaction score (P < .001 for all).
A higher percentage of men receiving testosterone had a clinically significant improvement in sexual desire vs. placebo (32% vs. 22%; P < .001). More men in the placebo group had deterioration of sexual desire compared with those receiving testosterone (36% vs. 25%; P < .001). Testosterone’s effect on sexual desire was larger among older men compared with younger men (P = .04), and those with lower baseline score for sexual desire were more likely to have a clinically significant improvement.
The proportion of men with clinically significant improvement in erectile dysfunction was similar between the testosterone and placebo groups (testosterone, 23%; placebo, 20%; P = .067). Erectile function deterioration was observed in 29% of the testosterone group vs. 37% of the placebo group. Clinically significant improvement in erectile dysfunction were more likely among those with lower baseline scores (P < .001) and younger men (P = .009).
Wittert said it was surprising to see the proportion of men receiving testosterone who had a lower sexual desire and erectile dysfunction score during follow-up vs. baseline. The reason why sexual function deteriorates or improves in response to testosterone treatment requires further research, he added.
“Treatment with testosterone for men without pathological hypogonadism will not inevitably benefit sexual function, and some men may deteriorate despite treatment with testosterone,” Wittert said.
For more information:
Gary Wittert, MBBch, MD, FRACP, can be reached at gary.wittert@adelaide.edu.au; X (Twitter): @ProfDocHealth
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