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Lessons From the Testosterone Trials.

Peter J Snyder1, Shalender Bhasin2, Glenn R Cunningham3

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Summary
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Testosterone therapy in older men with low levels improved sexual function, bone density, and anemia. While not enhancing energy or cognition, it showed mixed results in physical function and increased coronary artery plaque.

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Area of Science:

  • Endocrinology
  • Geriatrics
  • Men's Health

Background:

  • Low testosterone levels are common in older men.
  • The efficacy of testosterone replacement therapy (TRT) in this population requires further elucidation.
  • The Testosterone Trials (TTrials) aimed to comprehensively assess TRT's effects.

Purpose of the Study:

  • To determine the efficacy of TRT in older men with low testosterone.
  • To evaluate TRT's impact across various domains including sexual function, physical function, vitality, cognition, anemia, bone health, and cardiovascular health.

Main Methods:

  • A coordinated series of seven placebo-controlled, double-blind trials.
  • Involved 788 men aged 72 years on average with low testosterone.
  • TRT normalized testosterone levels from baseline to mid-normal young adult levels within 3 months, maintained through 12 months.

Main Results:

  • Significant improvements observed in sexual activity, desire, and erectile function.
  • Increased walking distance in all participants, though not specifically in slow walkers.
  • Slight improvements in mood and depressive symptoms, but no change in energy levels.
  • Increased hemoglobin in anemic men and improved bone mineral density and strength.
  • Increased coronary artery noncalcified plaque volume; no increase in cardiovascular or prostate adverse events compared to placebo.

Conclusions:

  • Testosterone therapy demonstrates benefits in sexual function, bone health, and anemia for older men with low testosterone.
  • Effects on physical function, vitality, and cognition were limited or not observed.
  • Further long-term, large-scale studies are needed to definitively assess cardiovascular and prostate risks.