The article “What Are the Benefits and Harms of Testosterone Therapy for Male Sexual Dysfunction? – A Systematic Review” provides advice on the benefits and risks of testosterone treatment in adult men with sexual dysfunction. A study of the potential risks of approved testosterone treatment has been undertaken due to the increased risk of severe cardiovascular events in individuals undergoing this kind of therapy. The purpose of the study is to review the safety and efficacy of testosterone treatment in men with a decline in testosterone levels who suffer from sexual dysfunctions.
The study was based on current controlled trials and comparative studies. The considered indicators included sexual and physical functions, quality of life, energy and vitality, serious side effects, significant cardiovascular side effects, and other adverse events. The authors searched several databases for articles and systematic reviews. The studied databases included EMBASE, MEDLINE, Cochrane Systematic Reviews, WHO International Clinical Trials Registry Platform, and others (Dimitropoulos et al., 2019). They compared the benefits and risks of testosterone treatment in a sample of adult men over 18 who were either eugonadal or hypogonadal. A review of the evidence identified 25 randomized controlled trials that met the inclusion criteria. 17 RCTs studied hypogonadal men, 2 included eugonadal patients, 3 studied borderline eugonadal men, 2 had mixed participants, and 1 study did not mention the status (Dimitropoulos et al., 2019). A technical panel of experts was also convened to review the evidence and help clarify key issues.
Quality of life, erectile function, cognitive function, as well as risks, including serious side effects, severe cardiovascular side effects, deep vein thrombosis, pulmonary embolism, mortality, and prostate cancer were noted as critical outcomes assessed. Energy and vitality, physical function, depression, decreased fracture rates, libido, and lower urinary tract symptoms were classified as important (Dimitropoulos et al., 2019). All critical and important outcomes were considered in making recommendations. Data reported as standardized mean differences were interpreted as low, moderate, and high evidence.
Low-level evidence showed a slight improvement in AMS quality of life, but this may be due to improved sexual function, which is a subset of the AMS. Low-grade data showed small improvements in erectile function as well as marginal improvements in physical function. Low evidence also showed a slight increase in the incidence of cardiovascular side effects. Moderate evidence showed little improvement in global sexual function IIEF and AMS (Dimitropoulos et al., 2019). There is also no evidence of an increased risk of serious side effects or withdrawal symptoms associated with testosterone treatment.
Besides, in studies that looked at different forms of drugs, there was no consistent difference in risks with the use of transdermal testosterone formulas compared with intramuscular ones. Both intramuscular and transdermal testosterone formulas have been associated with improved sexual function. The results of the indirect comparison show no significant differences in clinical efficacy, benefits, or risks between the two forms; however, there are few direct comparison results. Due to the lower cost, patients often prefer intramuscular formulas to transdermal ones (Dimitropoulos et al., 2019). They can be considered preferable today since they are significantly cheaper in the absence of differences in benefits and risks.
Clinicians may debate the need to initiate testosterone treatment in hypogonadal men seeking to improve their sexual function. An increase in the erectile function index on the IIEF scale is regarded as a positive response to hormone replacement therapy. Changes in sexual function are the main criterion for the effectiveness of substitution therapy since erectile dysfunction is the main reason for patients’ treatment. A change in sexological status in response to androgen therapy can be noted within a few weeks, in contrast to other symptoms that require longer therapy. It is also important to reevaluate symptoms within 12 months of starting treatment and periodically thereafter (Dimitropoulos et al., 2019). However, testosterone treatment should be discontinued in men with age-related hypogonadism and sexual dysfunction who do not show improvement in sexual function.
This study relates to the class readings and assumes the increased scientific and practical interest in the treatment of sexual disorders in general. The urgency of diagnosis and treatment of hormonal disorders and sexual dysfunction in men is due to the increase in the average age of the population and high attention to the quality of human life. Many researchers have noted a close relationship between erectile dysfunction and androgen deficiency, which characterizes the importance of studying hormonal levels in men (Dimitropoulos et al., 2019). The issues of the relationship between androgens and male sexual function are reflected in the documents of international communities studying the characteristics of sexual disorders in combination with the problems of male aging (Dimitropoulos et al., 2019). Thus, serum testosterone testing is recommended as an international standard in the evaluation of men with erectile dysfunction. Treatment of the general population with an androgen deficiency is impossible without an accurate diagnosis.
The issue of early detection of this pathology still causes many discussions. Significant difficulties are caused by determining the reference values of the blood testosterone index, taking into account the individual characteristics of a person, as well as daily fluctuations of this value and its correlation with living conditions and exogenous factors (Dimitropoulos et al., 2019). In contrast to primary hypogonadism, with age-related changes, the decrease in testosterone production is relative, not absolute. Age-related androgen deficiency is not characterized by a pronounced decrease in the level of androgens and an increase in the concentration of luteinizing hormone (Dimitropoulos et al., 2019). The clinical symptoms of age-related androgen deficiency are non-specific and are similar to those of other somatic and psychological disorders that accompany the aging process. Thus, neither a laboratory study nor a clinical picture in a significant part of cases allows diagnosing age-related hypogonadism. Thus, a short trial treatment is recommended for the existing clinical picture of sexual dysfunction and borderline testosterone levels.
The reviewed article provides guidance based on the best available evidence regarding the benefits, harms, and costs of testosterone therapy in adult men with testosterone decline who suffer from sexual dysfunction. Most studies provide information on follow-up for a year or less, making it difficult to judge long-term benefits and risks. Without a noticeable improvement in symptoms, such treatment will incur additional costs and no definite benefit. For this reason, patients’ symptoms should be regularly assessed to understand the effectiveness of the therapy. The role of testosterone therapy in the treatment of sexual dysfunction in men is controversial. It is impossible to say for sure whether non-specific symptoms and manifestations, such as sexual dysfunction, are associated with low testosterone levels, or they are the result of other factors, such as chronic illness or taking concomitant medications. Overall, the evidence is insufficient to conclude testosterone treatment for sexual dysfunction due to high data uncertainty, low mortality rates, and the potential fragility of the results.
References
Dimitropoulos, K., Verze, P., Van den Broeck, T., Salonia, A., Yuan, C. Y., Hatzimouratidis, K., & Dohle, G. (2019). What are the benefits and harms of testosterone therapy for male sexual dysfunction? – A systematic review. International Journal of Impotence Research, 1-12.