Testosterone supplementation and sexual function: a metaanalysis study

ABSTRACTObjective. The role of testosterone supplementation (TS) as a treatment for male sexual dysfunction remains questionable. The aim of the present study is to metaanalyse the effect of TS on male sexual function and its synergism with the use of phosphodiesterase type 5 (PDE5i). Methods. An extensive Medline Embase and Cochrane search was performed. All randomized controlled trials (RCTs) comparing the effect of TS vs. placebo or the effect of TS as add on to PDE5ì s on sexual function were included. Results. Out of 1702 retrieved articles, 41 were included in the study. TS is able to significantly ameliorate erectile function and to improve other aspects of male sexual response in hypogonadal patients. However, the presence of possible publication bias was detected. After applying “trim and fill” method, the positive effect of TS on erectile function and libido components retained significance only in RCTs partially or completed supported from pharmaceutical companies (Confidence Interval [0.04-0.53] and [0.12;0.52], respectively). In addition, we also report that TS could be associated with an improvement in PDE5i outcome. These results were not confirmed in placebo-controlled studies. The majority of them, however, included mixed eugonadal/hypogonadal subjects. Conclusions. TS plays positive effects on male sexual function in hypogonadal subjects. The role of TS is uncertain in men who are not clearly hypogonadal. The apparent difference between industry-supported and independent studies could depend on trial design more than on publication bias. New RCTs exploring the effect of TS in selected cases of PDE5i failure who persistently retain low T levels are advisable.