Testosterone replacement in men with sexual dysfunction.

Area of Science:

• Endocrinology
• Urology
• Clinical Pharmacology

Background:

• Clinical guidelines recommend testosterone replacement therapy (TRT) for men with sexual dysfunction and testosterone deficiency.
• However, TRT is often promoted for men without diagnosed testosterone deficiency, necessitating a review of its efficacy and safety in this population.
• Existing trials frequently lack clear reporting on participants' testosterone levels and symptomology.

Approach:

• A comprehensive literature search was conducted across major databases (CENTRAL, MEDLINE, EMBASE) and clinical trial registries up to August 2023.
• Included were randomized controlled trials (RCTs) of men aged 40+ with sexual dysfunction, excluding those with primary or secondary hypogonadism.
• Data were analyzed using a random-effects model, focusing on erectile function, sexual quality of life, and cardiovascular mortality, distinguishing between short-term and long-term outcomes.

Key Points:

• Short-term (up to 12 months) TRT likely results in little to no difference in erectile function (MD 2.37, 95% CI 1.67 to 3.08) or sexual quality of life (MD -2.31, 95% CI -3.63 to -1.00) compared to placebo.
• TRT also likely shows little to no difference in cardiovascular mortality (RR 0.83, 95% CI 0.21 to 3.26) and adverse events, including prostate and urinary issues.
• Long-term data are limited, with very low certainty of evidence regarding TRT's effect on erectile function, and no data available for sexual quality of life or cardiovascular mortality.

Conclusions:

• Short-term TRT demonstrates minimal to no significant benefit for erectile function, sexual quality of life, or cardiovascular mortality in men presenting with sexual dysfunction but without confirmed testosterone deficiency.
• The evidence for long-term effects is highly uncertain, underscoring the need for cautious application of TRT.
• These findings are crucial for informing clinical guidelines and decision-making regarding TRT for sexual dysfunction.