Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials.
OBJECTIVE
To conduct a systematic review and meta-analysis of randomized placebo-controlled trials to measure the effect of testosterone use on sexual function in men with sexual dysfunction and varying testosterone levels.


METHODS
Librarian-designed search strategies were used to search the MEDLINE (1966 to October 2004), EMBASE (1988 to October 2004), and Cochrane CENTRAL (inception to October 2004) databases. The MEDLINE search was rerun in March 2005. We also reviewed reference lists from included studies and content expert files. We selected randomized placebo-controlled trials of testosterone vs placebo that enrolled men with sexual dysfunction and measured satisfaction with erectile function and libido and overall sexual satisfaction.


RESULTS
We included 17 trials (N = 862 participants) in this review. Trials that enrolled participants with low testosterone levels showed (1) a moderate nonsignificant and inconsistent effect of testosterone use on satisfaction with erectile function (random-effects pooled effect size, 0.80; 95% confidence interval [CI], -0.10 to 1.60), (2) a large effect on libido (pooled effect size, 1.31; 95% CI, 0.40 to 2.25), and (3) no significant effect on overall sexual satisfaction. Trials that enrolled patients with low-normal and normal testosterone levels at baseline showed testosterone that caused (1) a small effect on satisfaction with erectile function (pooled effect size, 0.34; 95% CI, 0.03 to 0.65), (2) moderate nonsignificant effect on libido (pooled effect size, 0.41; 95% CI, -0.01 to 0.83), and (3) no significant effect on overall sexual satisfaction.


CONCLUSIONS
Testosterone use in men is associated with small improvements in satisfaction with erectile function and moderate improvements in libido. Unexplained inconsistent results across trials, wide CIs, and possible reporting bias weaken these inferences.
Boloña
Enrique R
ER
Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Uraga
Maria V
MV
Haddad
Rudy M
RM
Tracz
Michal J
MJ
Sideras
Kostandinos
K
Kennedy
Cassie C
CC
Caples
Sean M
SM
Erwin
Patricia J
PJ
Montori
Victor M
VM
D000728:Androgens / Q000627:therapeutic use*; D007172:Erectile Dysfunction / Q000188:drug therapy*; D020249:Hormone Replacement Therapy; D006801:Humans; D007989:Libido / Q000187:drug effects; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012725:Sexual Behavior / Q000187:drug effects; D013739:Testosterone / Q000172:deficiency* / Q000627:therapeutic use*
D000728:Androgens; D013739:Testosterone