Key messages from scientific research that's ready to be acted on
Got It, Hide thisDiem SJ, Greer NL, MacDonald R, et al. Efficacy and Safety of Testosterone Treatment in Men: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med. 2020;172:105-18.
In men who have low testosterone levels without a related medical condition, what are the benefits and harms of treatment with testosterone?
Some men have a condition called hypogonadism, where the body does not produce enough testosterone. Testosterone treatment is approved for men who have low testosterone levels due to conditions like disorders of the hypothalamus, pituitary gland, or testes. Often, men who have nonspecific symptoms like low energy, lower sexual function, or low serum testosterone levels are treated with testosterone. This review looked at whether treatment with testosterone was helpful and safe in men who did not have a medical condition to explain low testosterone levels.
The researchers did a systematic review of studies available up to May 2019. They found 38 randomized controlled trials. The average age of the men in the studies was 66 years.
The key features of the studies were:
Compared with placebo, treatment with testosterone
In men who have low testosterone levels without a related medical condition, testosterone treatment may improve sexual function and quality of life but does not reduce fatigue.
Outcomes | Number of trials (and men) | Effect of testosterone |
Overall sexual function | Improved sexual function measures by a small amount* | |
Erectile function | 7 trials (1299 men) | Improved erectile function measures by a small amount* |
Physical function | 5 trials (1029 men) | No difference in effect |
Vitality or fatigue | 3 trials (665 men) | No difference in effect |
Quality of life | 7 trials (1043 men) | Improved quality of life measures by a small amount* |
Adverse cardiovascular events† | 14 trials (2415 men) | No difference in effect |
Serious adverse events | 8 trials (2268 men) | No difference in effect |
Prostate cancer‡ | 10 trials (2143 men) | No difference in effect |
*Amount of improvement was small (standardized mean difference between groups was ≥0.27 and <0.35 on different measurement scales).
†Most trials did not include men with a history of heart disease or stroke.
‡Most trials did not include men who had a history of prostate cancer or a high prostate specific antigen level.