Testosterone Therapy: a Panacea for Sexual Dysfunction in Men?
Purpose of Review
In this article, we review the most recent articles examining the use of testosterone for the treatment of erectile dysfunction, reduced sexual desire, and ejaculatory dysfunction.
The treatment of erectile dysfunction with testosterone therapy has long been investigated as a cure for sexual dysfunction. Men who are testosterone deficient can expect to benefit from testosterone therapy to address erectile dysfunction and libido, while ejaculatory function is unlikely to improve.
The literature supports the use of testosterone therapy in testosterone-deficient men with sexual dysfunction. We recommend advising patients about the benefits of testosterone therapy while ensuring that it will address their individual concerns, without delaying adjunct treatments for sexual dysfunction.
KeywordsTestosterone Erectile dysfunction Hypogonadism Libido Sexual dysfunction
Aging male symptom
Brief Male Sexual Function Index
International Index of Erectile Function
Men’s Sexual Health Questionnaire Ejaculatory Dysfunction
Phosphodiesterase type 5
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Baltimore Longitudinal Study of A. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86(2):724–31. https://doi.org/10.1210/jcem.86.2.7219. CrossRefPubMedGoogle Scholar
- 4.•• Araujo AB, O'Donnell AB, Brambilla DJ, Simpson WB, Longcope C, Matsumoto AM, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2004;89(12):5920–6. https://doi.org/10.1210/jc.2003-031719. This was the first large-scale observational study to establish the relationship between testosterone deficiency and aging. CrossRefPubMedGoogle Scholar
- 8.•• Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018:jc.2018-00229-jc.2018-. doi: https://doi.org/10.1210/jc.2018-00229. This publication includes the most recent Endocrine Society guidelines for testosterone therapy.
- 15.• Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–35. https://doi.org/10.1056/NEJMoa0911101. This is the largest cohort study evaluating symptoms most predictive of testosterone deficiency. CrossRefPubMedGoogle Scholar
- 16.Karazindiyanoglu S, Cayan S. The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism. Aging Male : Off J Int Soc Stud Aging Male. 2008;11(3):146–9. https://doi.org/10.1080/13685530802290438. CrossRefGoogle Scholar
- 18.McMahon CG, Shusterman N, Cohen B. Pharmacokinetics, clinical efficacy, safety profile, and patient-reported outcomes in patients receiving subcutaneous testosterone pellets 900 mg for treatment of symptoms associated with androgen deficiency. J Sex Med. 2017;14(7):883–90. https://doi.org/10.1016/j.jsxm.2017.04.734.CrossRefPubMedGoogle Scholar
- 20.Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). J Sex Med. 2011;8(11):3204–13. https://doi.org/10.1111/j.1743-6109.2011.02436.x.CrossRefPubMedGoogle Scholar
- 21.Haider KS, Haider A, Doros G, Traish A. Long-term testosterone therapy improves urinary and sexual function, and quality of life in men with hypogonadism: results from a propensity matched subgroup of a controlled registry study. J Urol. 2018;199(1):257–65. https://doi.org/10.1016/j.juro.2017.07.039.CrossRefPubMedGoogle Scholar
- 22.Permpongkosol S, Khupulsup K, Leelaphiwat S, Pavavattananusorn S, Thongpradit S, Petchthong T. Effects of 8-year treatment of long-acting testosterone undecanoate on metabolic parameters, urinary symptoms, bone mineral density, and sexual function in men with late-onset hypogonadism. J Sex Med. 2016;13(8):1199–211. https://doi.org/10.1016/j.jsxm.2016.06.003.CrossRefPubMedGoogle Scholar
- 23.•• Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611–24. https://doi.org/10.1056/NEJMoa1506119. This is the largest long-term randomized placebo-controlled clinical trial that has been published evaluating the effect of testosterone therapy on sexual, physical and psychosocial outcomes.
- 25.• Rosen RC, Wu F, Behre HM, Porst H, Meuleman EJH, Maggi M et al. Quality of life and sexual function benefits of long-term testosterone treatment: longitudinal results from the Registry of Hypogonadism in Men (RHYME). The journal of sexual medicine. 2017;14(9):1104–15. doi: https://doi.org/10.1016/j.jsxm.2017.07.004. This is the largest and most recent observational study investigating the effect of testosterone therapy on erectile function.
- 26.• Corona G, Rastrelli G, Morgentaler A, Sforza A, Mannucci E, Maggi M. Meta-analysis of results of testosterone therapy on sexual function based on International Index of Erectile Function Scores. Eur Urol. 2017;72(6):1000–11. https://doi.org/10.1016/j.eururo.2017.03.032. This is the most recent meta-analysis of the effects of testosterone therapy on erectile function. CrossRefPubMedGoogle Scholar
- 27.•• Elliott J, Kelly SE, Millar AC, Peterson J, Chen L, Johnston A, et al. Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis. BMJ Open. 2017;7(11):e015284. https://doi.org/10.1136/bmjopen-2016-015284. This is the most comprehensive meta-analysis evaluating the effect of testosterone therapy on various clinical outcomes and adverse events. PubMedPubMedCentralCrossRefGoogle Scholar
- 31.• Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol. 2004;172(2):658–63. https://doi.org/10.1097/01.ju.0000132389.97804.d7. This is the first randomized clinical trial showing testosterone therapy improves response to PDE5 inhibitors in men with erectile dysfunction. CrossRefPubMedGoogle Scholar
- 34.Arver S, Dobs AS, Meikle AW, Allen RP, Sanders SW, Mazer NA. Improvement of sexual function in testosterone deficient men treated for 1 year with a permeation enhanced testosterone transdermal system. J Urol. 1996;155(5):1604–8. https://doi.org/10.1016/S0022-5347(01)66141-X.CrossRefPubMedGoogle Scholar
- 35.Carani C, Bancroft J, Granata A, Del Rio G, Marrama P. Testosterone and erectile function, nocturnal penile tumescence and rigidity, and erectile response to visual erotic stimuli in hypogonadal and eugonadal men. Psychoneuroendocrinology. 17(6):647–54. https://doi.org/10.1016/0306-4530(92)90023-Z.
- 38.Redouté J, Stoléru S, Pugeat M, Costes N, Lavenne F, Le Bars D, et al. Brain processing of visual sexual stimuli in treated and untreated hypogonadal patients. Psychoneuroendocrinology. 30(5):461–82. https://doi.org/10.1016/j.psyneuen.2004.12.003.
- 39.• Brock G, Heiselman D, Maggi M, Kim SW, Rodriguez Vallejo JM, Behre HM, et al. Effect of testosterone solution 2% on testosterone concentration, sex drive and energy in hypogonadal men: results of a placebo controlled study. J Urol. 2016;195(3):699–705. https://doi.org/10.1016/j.juro.2015.10.083. This is the largest and most recent randomized placebo-controlled clinical trial investigating the effects of testosterone therapy on libido and energy level. CrossRefPubMedGoogle Scholar
- 40.• Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100(8):2956–62. https://doi.org/10.1210/jc.2014-4434. This is the only randomized placebo-controlled study evaluating the effect of testosterone therapy on ejaculatory function. CrossRefPubMedGoogle Scholar
- 41.•• Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA et al. Evaluation and management of testosterone deficiency: AUA Guideline. J Urol. 2018. doi: https://doi.org/10.1016/j.juro.2018.03.115. This includes the most recent American Urological Association guidelines supporting the treatment of testosterone deficiency.