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

Corona, Giovanni; Rastrelli, Giulia; Morgentaler, Abraham; Sforza, Alessandra; Mannucci, Edoardo; Maggi, Mario

doi:10.1016/j.eururo.2017.03.032

Cited by 179 publications

(154 citation statements)

References 51 publications

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“…The increasing prevalence of TRT is likely to continue, as a result of the increasing geriatric population. Previous meta‐analyses of RCTs have reported that TRT positively influences health‐related quality of life, bone mineral density, body composition, sexual function and libido, and several measures of metabolic health in men . However, debate surrounds the potential utility of various TRT formulations in relation to promoting musculoskeletal integrity, muscular strength, and physical function in middle‐aged and older men .…”

Section: Discussionmentioning

confidence: 99%

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis

Skinner

Otzel

Bowser

et al. 2018

J cachexia sarcopenia muscle

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BackgroundInconsistent fat‐free mass (FFM) and muscle strength responses have been reported in randomized clinical trials (RCTs) administering testosterone replacement therapy (TRT) to middle‐aged and older men. Our objective was to conduct a meta‐analysis to determine whether TRT improves FFM and muscle strength in middle‐aged and older men and whether the muscular responses vary by TRT administration route.MethodsSystematic literature searches of MEDLINE/PubMed and the Cochrane Library were conducted from inception through 31 March 2017 to identify double‐blind RCTs that compared intramuscular or transdermal TRT vs. placebo and that reported assessments of FFM or upper‐extremity or lower‐extremity strength. Studies were identified, and data were extracted and validated by three investigators, with disagreement resolved by consensus. Using a random effects model, individual effect sizes (ESs) were determined from 31 RCTs reporting FFM (sample size: n = 1213 TRT, n = 1168 placebo) and 17 reporting upper‐extremity or lower‐extremity strength (n = 2572 TRT, n = 2523 placebo). Heterogeneity was examined, and sensitivity analyses were performed.ResultsWhen administration routes were collectively assessed, TRT was associated with increases in FFM [ES = 1.20 ± 0.15 (95% CI: 0.91, 1.49)], total body strength [ES = 0.90 ± 0.12 (0.67, 1.14)], lower‐extremity strength [ES = 0.77 ± 0.16 (0.45, 1.08)], and upper‐extremity strength [ES = 1.13 ± 0.18 (0.78, 1.47)] (P < 0.001 for all). When administration routes were evaluated separately, the ES magnitudes were larger and the per cent changes were 3–5 times greater for intramuscular TRT than for transdermal formulations vs. respective placebos, for all outcomes evaluated. Specifically, intramuscular TRT was associated with a 5.7% increase in FFM [ES = 1.49 ± 0.18 (1.13, 1.84)] and 10–13% increases in total body strength [ES = 1.39 ± 0.12 (1.15, 1.63)], lower‐extremity strength [ES = 1.39 ± 0.17 (1.07, 1.72)], and upper‐extremity strength [ES = 1.37 ± 0.17 (1.03, 1.70)] (P < 0.001 for all). In comparison, transdermal TRT was associated with only a 1.7% increase in FFM [ES = 0.98 ± 0.21 (0.58, 1.39)] and only 2–5% increases in total body [ES = 0.55 ± 0.17 (0.22, 0.88)] and upper‐extremity strength [ES = 0.97 ± 0.24 (0.50, 1.45)] (P < 0.001). Interestingly, transdermal TRT produced no change in lower‐extremity strength vs. placebo [ES = 0.26 ± 0.23 (−0.19, 0.70), P = 0.26]. Subanalyses of RCTs limiting enrolment to men ≥60 years of age produced similar results.ConclusionsIntramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle‐aged and older men, particularly in the lower extremities.

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Section: Discussionmentioning

confidence: 99%

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis

Skinner

Otzel

Bowser

et al. 2018

J cachexia sarcopenia muscle

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“…HG is characterized by low serum testosterone (TT) and sexual dysfunction (Kapoor et al, 2007;Hackett et al, 2009) with both these factors being independent determinants of mortality (Pye et al, 2014). Importantly, testosterone replacement therapy (TRT) has wide-ranging beneficial effects; for example, Hackett et al (2016aHackett et al ( , 2017a and Corona et al (2017) reported improvement in erectile function, sexual desire, and other sexual parameters. Importantly, testosterone replacement therapy (TRT) has wide-ranging beneficial effects; for example, Hackett et al (2016aHackett et al ( , 2017a and Corona et al (2017) reported improvement in erectile function, sexual desire, and other sexual parameters.…”

Section: Introductionmentioning

confidence: 99%

The association of sex hormone‐binding globulin with mortality is mediated by age and testosterone in men with type 2 diabetes

et al. 2018

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“…In early 2017, Corona et al performed meta-analysis of 14 RCTs that studied the effect of TTh on erectile function in men with late onset hypogonadism, and compared pre- and post-IIEF scores [25]. Overall, when compared to placebo, TTh provided only a modest improvement in IIEF-EF, as the mean difference between groups was 2.31 points.…”

Section: Testosterone Therapy Improves Symptoms Of Mild Erectile Dysfmentioning

confidence: 99%

“…The mean change in IIEF-EF, however, was greater when data were stratified by baseline testosterone level. In primary studies using a testosterone threshold <8 nM (231 ng/dL), IIEF-EF increased by 2.95 points, whereas in primary studies with testosterone threshold of <12 nM (346 ng/dL), only a 1.47 point increase in IIEF-EF was observed [25]. Given that a greater improvement in erectile function was observed in studies using a lower testosterone threshold, this supports the theory that once a threshold of “normal” testosterone level is achieved, higher testosterone levels do not further improve erectile function [26].…”

Section: Testosterone Therapy Improves Symptoms Of Mild Erectile Dysfmentioning

confidence: 99%

“…The Corona et al meta-analysis also assessed the impact of TTh on libido in hypogonadal men, finding that for 1,269 men across 14 randomized, placebo-controlled trials, the IIEF-SD significantly improved (p=0.001) [25]. These findings suggest that TTh may be more effective in improving sexual desire than in improving erectile function in men with moderate or severe ED.…”

Section: Testosterone Therapy and Libidomentioning

confidence: 99%

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Testosterone therapy improves erectile function and libido in hypogonadal men

Rizk

Kohn²,

Pastuszak³

et al. 2017

Current Opinion in Urology

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Purpose of Review Erectile dysfunction (ED) and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, co-administration with phosphodiesterase type 5 (PDE5) inhibitors, and libido. Recent Findings Recent publications suggest that TTh improves mild ED, though may be less useful in men with more severe ED. In men unresponsive to PDE5 inhibitors and with mild ED, TTh can further improve erectile function. Testosterone therapy has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized. Summary The available literature supports a role for TTh in men with low testosterone levels, ED, and low libido, with symptomatic improvement in these men.

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

Cited by 179 publications

References 51 publications

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis

The association of sex hormone‐binding globulin with mortality is mediated by age and testosterone in men with type 2 diabetes

Testosterone therapy improves erectile function and libido in hypogonadal men

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