Testosterone Replacement in Men with Sexual Dysfunction: An Abridged Version of the Cochrane Systematic Review

Purpose: To assess the effects of testosterone replacement therapy (TRT) compared to placebo or other medical treatments in men with sexual dysfunction.

Materials and methods: We performed a comprehensive search with no restrictions on publication language or status up to 29 August 2023. We only included randomized controlled trials (RCTs).

Results: We identified 43 studies with 11,419 randomized participants. We found that TRT likely results in little to no difference in erectile function assessed with the IIEF-EF (mean difference [MD]: 2.37, 95% confidence interval [CI]: 1.67 to 3.08; I²=0%; 6 RCTs, 2016 participants; moderate-certainty evidence) compared to placebo. TRT likely results in little to no change in sexual quality of life assessed with the Aging Males' Symptoms scale (MD: -2.31, 95% CI: -3.63 to -1.00; I²=0%; 5 RCTs, 1,030 participants; moderate-certainty evidence) compared to placebo. TRT also likely results in little to no difference in cardiovascular mortality (risk ratio: 0.83, 95% CI: 0.21 to 3.26; I²=0%; 10 RCTs, 3,525 participants; moderate-certainty evidence) compared to placebo. TRT also likely results in little to no difference in treatment withdrawal due to adverse events, prostate-related events, or lower urinary tract symptoms.

Conclusions: TRT for men with sexual dysfunction showed no difference in erectile function, sexual quality of life, or cardiovascular mortality compared to placebo. Furthermore, it also appears to no difference in treatment withdrawals due to adverse events, prostate-related events, or lower urinary tract symptoms.