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Cited by 492Hormonal and reproductive studiesSexual function and dysfunction studiesSperm and Testicular Function

Effects of testosterone on sexual function in men: results of a meta‐analysis

Isidori, Andrea M., Giannetta, Elisa, Gianfrilli, Daniele, Greco, Emanuela A., Bonifacio, Vincenzo, Aversa, Antonio, Isidori, Aldo, Fabbri, Andrea +1 more·2005·Clinical Endocrinology
DOI 10.1111/j.1365-2265.2005.02350.x
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Abstract

Summary: Objectives The role of androgen decline in the sexual activity of adult males is controversial. To clarify whether sexual function would benefit from testosterone (T) treatment in men with partially or severely reduced serum T levels, we conducted a systematic review and meta‐analysis of placebo‐controlled studies published in the past 30 years. The aim of this study was to assess and compare the effects of T on the different domains of sexual life. Data source A comprehensive search of all published randomized clinical trials was performed in MEDLINE, the Cochrane Library, EMBASE and Current Contents databases. Review methods Guided by prespecified criteria, software‐assisted data abstraction and quality assessed by two independent reviewers, a total of 17 randomized placebo‐controlled trials were found to be eligible. For each domain of sexual function we calculated the standardized mean difference relative to T and reported the results of pooled estimates of T treatment using the random effect model of meta‐analysis. Heterogeneity, reproducibility and consistency of the findings across studies were explored using sensitivity and meta‐regression analysis. Results Overall, 656 subjects were evaluated: 284 were randomized to T, 284 to placebo (P) and 88 treated in cross‐over. The median study length was 3 months (range 1–36 months). Our meta‐analysis showed that in men with an average T level at baseline below 12 nmol/l, T treatment moderately improved the number of nocturnal erections, sexual thoughts and motivation, number of successful intercourses, scores of erectile function and overall sexual satisfaction, whereas T had no effect on erectile function in eugonadal men compared to placebo. Heterogeneity was explored by grouping studies according to the characteristics of the study population. A cut‐off value of 10 nmol/l for the mean T of the study population failed to predict the effect of treatment, whereas the presence of risk factors for vasculogenic erectile dysfunction (ED), comorbidities and shorter evaluation periods were associated with greater treatment effects in the studies performed in hypogonadal, but not in eugonadal, men. Meta‐regression analysis showed that the effects of T on erectile function, but not libido, were inversely related to the mean baseline T concentration. The meta‐analysis of available studies indicates that T treatment might be useful for improving vasculogenic ED in selected subjects with low or low‐normal T levels. The evidence for a beneficial effect of T treatment on erectile function should be tempered with the caveats that the effect tends to decline over time, is progressively smaller with increasing baseline T levels, and long‐term safety data are not available. The present meta‐analysis highlights the need, and pitfalls, for large‐scale, long‐term, randomized controlled trials to formally investigate the efficacy of T replacement in symptomatic middle‐aged and elderly men with reduced T levels and ED.

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  • Testosterone levels are linked to a variety of conditions and diseases, such as cardiovascular disease, type-2 diabetes, the metabolic syndrome, erectile dysfunction, depression, obesity, stroke and osteoporosis.

    “Several studies have previously reported that testosterone levels are linked to a variety of conditions and diseases, such as cardiovascular disease, type-2 diabetes, the metabolic syndrome, erectile dysfunction, depression, obesity, stroke and osteoporosis. 1-7”

    From Cigarette smoking has a positive and independent effect on testosterone levels (2013) · cites this paper as [4]

  • Testosterone therapy may be justifiable in men receiving opioids who may suffer from opioid-induced suppression of testosterone levels and associated sexual dysfunction, osteoporosis, and/or muscle atrophy.

    “Testosterone therapy may be justifiable in patients with some of these conditions, such as men receiving opioids, who may suffer from opioid-induced suppression of testosterone levels 32 and sexual dysfunction, 33 osteoporosis, and/or muscle atrophy.34”

    From Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study (2017) · cites this paper as [33]

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Authors
Isidori, A. M., Giannetta, E., Gianfrilli, D., Greco, E. A., Bonifacio, V., Aversa, A., Isidori, A., Fabbri, A., & Lenzi, A.
Affiliations
  • Sapienza University of Rome (IT)
  • University of Rome Tor Vergata (IT)
Corresponding author
Isidori, Andrea M.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2005-09-03
Volume
63
Issue
4
Pages
381-394
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/j.1365-2265.2005.02350.x
OpenAlex
W2138141643
Cited by
492
References
99
Citations by year
2026: 4 · 2025: 10 · 2024: 12 · 2023: 22 · 2022: 17 · 2021: 12 · 2020: 16 · 2019: 15 · 2018: 26 · 2017: 22 · 2016: 27 · 2015: 25 · 2014: 37 · 2013: 41 · 2012: 31
FWCI
3.03
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
Keywords
testosterone replacement therapy, male sexual function, hypogonadism, androgen deficiency, erectile function, vasculogenic erectile dysfunction, sexual desire, nocturnal erections, sexual satisfaction, eugonadal men, treatment effects over time, comorbidities, risk factors for erectile dysfunction, meta-regression, heterogeneity
MeSH terms
Adult, Aged, Aging, Data Interpretation, Statistical, Humans, Male, Middle Aged, Placebos, Sexual Dysfunction, Physiological, Testosterone, Randomized Controlled Trials as Topic, Treatment Outcome

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