Treatment of Men for “Low Testosterone”: A Systematic Review

Abstract

Testosterone products are recommended by some prescribers in response to a diagnosis or presumption of “low testosterone” (low-T) for cardiovascular health, sexual function, muscle weakness or wasting, mood and behavior, and cognition. We performed a systematic review of 156 eligible randomized controlled trials in which testosterone was compared to placebo for one or more of these conditions. We included studies in bibliographic databases between January 1, 1950 and April 9, 2016, and excluded studies involving bodybuilding, contraceptive effectiveness, or treatment of any condition in women or children. Studies with multiple relevant endpoints were included in all relevant tables. Testosterone supplementation did not show consistent benefit for cardiovascular risk, sexual function, mood and behavior, or cognition. Studies that examined clinical cardiovascular endpoints have not favored testosterone therapy over placebo. Testosterone is ineffective in treating erectile dysfunction and controlled trials did not show a consistent effect on libido. Testosterone supplementation consistently increased muscle strength but did not have beneficial effects on physical function. Most studies on mood-related endpoints found no beneficial effect of testosterone treatment on personality, psychological well-being, or mood. The prescription of testosterone supplementation for low-T for cardiovascular health, sexual function, physical function, mood, or cognitive function is without support from randomized clinical trials.

Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores

“…A recent review considered 48 studies assessing sexual function or libido as a primary or secondary endpoint of TTh [16]. The authors concluded that TTh did not show consistent benefit for sexual function.…”

“…The authors concluded that TTh did not show consistent benefit for sexual function. However, that review failed to distinguish between results in eugonadal and E U R O P E A N U R O L O G Y X X X ( 2 0 1 7 ) X X X -X X X hypogonadal men, men with or without baseline symptoms, and studies that used different instruments for assessment [16]. In addition, their interpretation of results was not based on any stated criteria or validated statistical method, and relied solely on their personal interpretation.…”

“…Although most studies, including meta-analyses and systematic reviews, have provided supporting evidence that T therapy does in fact improve sexual symptoms in men with TD [11][12][13][14][15], a recent systematic qualitative review on the effect of TTh on several outcomes in controlled trials concluded that TTh did not show consistent benefits for sexual function [16]. That conclusion was based on a subjective interpretation of study results, without considering overall patient population characteristics at baseline, including T levels.…”

Testosterone replacement therapy: improved sexual desire and erectile function in men with type 2 diabetes following a 30‐week randomized placebo‐controlled study

“…found conflicting data, and recently, Huo et al . reviewed 156 eligible studies concluding that use of TRT to improve sexual function was without support from clinical trials (Gianatti et al ., ; Huo et al ., ). Our study in men experiencing changes in sexual function following treatment offers further insight.…”

Letter to the Editor regarding ‘Treatment of Men for “Low Testosterone”: A Systematic Review’ by Huo et al.; Testosterone Replacement Therapy: Toward to the Robust Evidence and Facts

“…We read with interest the systematic review (SR) by Huo et al [1] on the role of testosterone replacement therapy (TRT) for treating men with low testosterone, which suggests that there is no beneficial effect in most men. While we cannot rule out that the author's conclusions will ultimately be proven to be true, we believe that it is premature to make this determination based on the current study.…”