Related Experiment Video
Updated: Dec 14, 2025
Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
Published on: May 30, 2025
Failure of testosterone replacement therapy to improve symptoms correlates with burden of systemic conditions
Nicholas J Farber1, Sarah C Vij1, Daniel A Shoskes1
1Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Background:
The symptoms of hypogonadism are non-specific and restoring testosterone (T) to physiologic levels may not lead to clinical improvement. In men with a high burden of systemic illness, it is difficult to assess whether hypogonadism is a primary contributing factor of their symptoms. Given that testosterone replacement therapy (TRT) is not without risk, it is important to understand which patients will benefit from treatment. Therefore, we hypothesize that men with a higher burden of systemic illness would be less likely to continue with TRT.
Methods:
We performed a retrospective review of our men's health registry for men who started TRT and adhered to follow up labs and visits within the first year. We restricted treatment to Testopel pellets due to reliable early T levels. Men were classified as yes/no for continued TRT based on whether they felt their presenting symptoms improved on therapy and they chose to continue TRT. The previously validated ACTIONS men's health phenotype was calculated as a composite systemic disease score grading severity [0-2] for each of anxiety, cardiovascular disease, low testosterone, diabetes, obesity, neurologic disease and obstructive sleep apnea (total score 0-14).
Results:
Sixty men were identified with a mean age of 59.5 (range, 33-81) years and mean starting total testosterone of 215 [48-332] ng/dL. Thirty-nine men (65%) felt symptomatic benefit and continued therapy for a median of 40.4 (20.5-76.4) months vs. 21 men without benefit treated for a median of 4.1 months (2.9-10.7, P<0.0001). Those who stopped TRT had a higher ACTIONS score than those who continued (8±2.5 vs. 4.1±1.6, P<0.0001). Age weakly correlated with total ACTIONS score (r=0.28, P=0.03) but age had no impact on continuing TRT and the relationship between continuing TRT and ACTIONS score held true regardless of age.
Conclusions:
Patients with a greater burden of systemic disease were less likely to have symptomatic improvement with TRT and more likely to stop therapy within a year. As several hypogonadal symptoms are non-specific, it is imperative that patients be counseled on the likelihood of success with TRT, particularly if they have multiple comorbidities. Ideal outcomes may come from multimodal therapy that includes lifestyle modification, and optimization of conditions such as diabetes, cardiovascular disease and sleep apnea.
Insights
Men with more health problems are less likely to benefit from testosterone replacement therapy (TRT) and may stop treatment sooner. Counseling on TRT success likelihood is crucial for patients with comorbidities.
Area of Science:
- Men's Health
- Endocrinology
- Systemic Illness Impact on Treatment
Background:
- Hypogonadism symptoms are often non-specific, making it hard to determine if testosterone (T) restoration improves clinical outcomes.
- Assessing the contribution of hypogonadism to symptoms in men with significant systemic illness is challenging.
- Testosterone replacement therapy (TRT) carries risks, necessitating identification of patients likely to benefit.
Purpose of the Study:
- To investigate the hypothesis that men with a higher burden of systemic illness are less likely to continue with TRT.
- To determine the relationship between systemic disease severity and continued adherence to TRT.
- To identify factors influencing patient-reported benefit and long-term TRT continuation.
Main Methods:
- Retrospective review of a men's health registry for patients initiating TRT with Testopel pellets.
- Classification of TRT continuation based on patient-reported symptom improvement and decision to continue therapy.
- Calculation of the ACTIONS men's health phenotype score (0-14) to quantify systemic disease burden.
Main Results:
- Sixty men (mean age 59.5 years) were analyzed; 65% continued TRT long-term.
- Men who stopped TRT had significantly higher ACTIONS scores (8±2.5) compared to those who continued (4.1±1.6).
- Age showed a weak correlation with ACTIONS score but did not impact TRT continuation, with the disease burden effect remaining consistent across age groups.
Conclusions:
- A greater burden of systemic disease is associated with reduced symptomatic improvement and higher likelihood of discontinuing TRT within a year.
- Counseling patients on TRT success probability is essential, especially for those with multiple comorbidities, given non-specific hypogonadal symptoms.
- Optimal outcomes may involve multimodal therapy, including lifestyle changes and management of conditions like diabetes, cardiovascular disease, and sleep apnea.
Related Concept Videos
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:29Therapeutic Drug Monitoring: Affecting Factors
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:25Chronic Obstructive Pulmonary Disease-III: Symptoms and Complications.
Symptoms of COPD can be classified as primary or systemic. Primary symptoms relate to reduced airflow, while systemic or extrapulmonary symptoms relate to COPD's broader impact on the body.
Primary Symptoms of COPD:
01:28Menopause