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Effects of testosterone on sexual function in men: results of a meta‐analysis
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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“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]
In the citing paper
“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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Testosterone and Male Sexual Function
Galansky, L. B., Levy, J. A., & Burnett, A. L. “. (2022) · Urologic Clinics of North America · doi:10.1016/j.ucl.2022.07.006 · Cited by 11
Xu, Z., Chen, X., Zhou, H., Ren, C., Wang, Q., Pan, Y., Liu, L., & Liu, X. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1335146 · Cited by 11
“A prior meta-analysis involving 17 RCTs in men with LOH demonstrated that TRT was more likely to improve various aspects of sexual function, including morning erection, erectile function, sexual intercourse, sexual motivation, sexual satisfaction, sexual thoughts, and total erection (50).”
MethodLuberti, F. R., Reside, T.-L., Bonin, P. L., & Carré, J. M. (2021) · Hormones and Behavior · doi:10.1016/j.yhbeh.2021.105046 · Cited by 11
Oral testosterone therapy: past, present, and future
Miller, J. A., Nguyen, T. T., Loeb, C. A., Khera, M., & Yafi, F. A. (2023) · Sexual Medicine Reviews · doi:10.1093/sxmrev/qead003 · Cited by 13
Testosterone Replacement Therapy: What We Know Is Not Yet Enough
Isidori, A. M., & Lenzi, A. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)60960-9 · Cited by 11
Self-citationManagement of weight loss in obesity-associated male infertility: a spotlight on bariatric surgery
Abiad, F., Awwad, J. T., Abbas, H. A., Zebian, D., & Ghazeeri, G. S. (2017) · Human Fertility · doi:10.1080/14647273.2017.1317369 · Cited by 11
Preliminary evidence that androgen signaling is correlated with men's everyday language
Mascaro, J. S., Rentscher, K. E., Hackett, P. D., Lori, A., Darcher, A., Rilling, J. K., & Mehl, M. R. (2018) · American Journal of Human Biology · doi:10.1002/ajhb.23136 · Cited by 11
“…is more complex than is often portrayed, with the influence of T administration on libido and sexual activity often found only for hypogonadal men (Isidori et al., 2005), and with many studies failing to find a relationship between circulating T and self-reported sexual desire (reviewed in van…”
Effect of low androgen levels on IKca and SKca3 channels in rat penile corpus cavernosum
Zhao, H., Jiang, J., Xia, J., & Jiang, R. (2018) · Andrologia · doi:10.1111/and.13075 · Cited by 11
Dimitropoulos, K., Verze, P., den Broeck, T. V., Salonia, A., Yuan, C. Y., Konstantinos Hatzimouratidis, A., & Dohle, G. R. (2019) · International Journal of Impotence Research · doi:10.1038/s41443-019-0131-1 · Cited by 11
Hypogonadism and cancer survivorship
Faw, C. A., & Brannigan, R. E. (2020) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000583 · Cited by 11
“These trials corroborate two previous meta-analyses showing improved body composition and sexual function following testosterone therapy [95,96].”
ResultCosta, R. M., & Oliveira, R. F. (2015) · Neuropsychoanalysis · doi:10.1080/15294145.2015.1089184 · Cited by 11
“This question is particularly relevant, because there are many null findings in studies examining the associations between basal T levels and male desire (van Anders, 2012), and a greater number of cases in which T administration does not enhance sexual desire in eugonadal men (Bolona et al., 2007; Corona et al., 2014…”
BackgroundMethodResultYang, H. J., Kim, K. H., Kim, D. S., Lee, C. H., Jeon, Y. S., Shim, S. R., & Kim, J. H. (2023) · The World Journal of Men s Health · doi:10.5534/wjmh.220171 · Cited by 10
“Results of studies about effects of testosterone replacement on sexual function in elderly men are inconclusive [39,40].”
Documento básico de consenso sobre el síndrome de hipogonadismo de inicio tardío
Fernández, A. B., & Acosta, L. E. (2008) · Endocrinología y Nutrición · doi:10.1016/s1575-0922(08)70632-6 · Cited by 9
Testosterone threshold – does one size fit all?
Maganty, A., Shoag, J. E., & Ramasamy, R. (2015) · The Aging Male · doi:10.3109/13685538.2015.1004047 · Cited by 10
“ations between sexual symptoms and low testosterone in older men [9,14].”
BackgroundHypogonadism Makes Dyslipidemia in Klinefelter's Syndrome
Lee, H. S., Park, C. W., Lee, J. S., & Seo, J. T. (2017) · Journal of Korean Medical Science · doi:10.3346/jkms.2017.32.11.1848 · Cited by 10
“The most commonly reported sexual problem in KS patients is hypoactive sexual desire (12), which is seen to improve following testosterone replacement therapy (13).”
BackgroundPerspectives for metabolomics in testosterone replacement therapy
Haring, R. (2012) · Journal of Endocrinology · doi:10.1530/joe-12-0119 · Cited by 10
Lee, K. S., Lee, E. K., Kim, S. Y., Kim, T. H., & Kim, H. P. (2015) · Korean Journal of Food Science and Technology · doi:10.9721/kjfst.2015.47.4.492 · Cited by 10
Behavioral Neuroendocrinology of Reproduction in Mammals
Park, J., & Rissman, E. F. (2011) · Elsevier eBooks · doi:10.1016/b978-0-12-374928-4.10008-2 · Cited by 10
Rastrelli, G., Antonio, L., Carrier, S., Isidori, A. M., & Maggi, M. (2025) · Sexual Medicine Reviews · doi:10.1093/sxmrev/qeaf025 · Cited by 9
Self-citationThe Impact of Testosterone on Erectile Function
Schardein, J. N., & Hotaling, J. M. (2022) · Androgens Clinical Research and Therapeutics · doi:10.1089/andro.2021.0033 · Cited by 10
“79 The degree that erectile function was affected was inversely related to the baseline testosterone level, such that patients with lower levels of testosterone demonstrated more impressive results with testosterone replacement.”
The Intersection of Medicine and Urology
Miner, M. M., Heidelbaugh, J. J., Paulos, M., Seftel, A. D., Jameson, J., & Kaplan, S. A. (2018) · Medical Clinics of North America · doi:10.1016/j.mcna.2017.11.002 · Cited by 9
Investigating the basis of sexual dysfunction during late-onset hypogonadism
Tharakan, T., Miah, S., Jayasena, C. N., & Minhas, S. (2019) · F1000Research · doi:10.12688/f1000research.16561.1 · Cited by 9
“Isidori et al.38 noted a significant heterogenicity in effect sizes and risk of publication bias.”
BackgroundDiabetes Mellitus and Erectile Dysfunction
Nikolaidou, B., Nouris, C., Lazaridis, A. A., Sampanis, C., & Doumas, M. N. (2014) · Springer eBooks · doi:10.1007/978-3-319-08272-1_12 · Cited by 9
Role of androgens in modulating male and female sexual function
Traish, A. M. (2010) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci.2010.052 · Cited by 9
Metadata
- 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
- 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
- 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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