title: Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study.
abstract: Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: K L
authors.initials: KL
authors.lastname: Melehan
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Hoyos
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Yee
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: K K
authors.initials: KK
authors.lastname: Wong
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Department of Respiratory Medicine, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: Buchanan
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: R R
authors.initials: RR
authors.lastname: Grunstein
authors.affiliation: NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA, USA.
authors.forename: P Y
authors.initials: PY
authors.lastname: Liu
mesh_terms: D000328:Adult; D003071:Cognition / Q000187:drug effects; D004311:Double-Blind Method; D007172:Erectile Dysfunction / Q000188:drug therapy*; D005227:Fatty Acids / Q000627:therapeutic use; D006801:Humans; D007989:Libido / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D010410:Penile Erection / Q000187:drug effects*; D011788:Quality of Life; D012725:Sexual Behavior / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D013739:Testosterone / Q000097:blood* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005227:Fatty Acids; C016173:undecanoic acid; D013739:Testosterone
keywords: neurocognitive function; obstructive sleep apnea; sexual desire; testosterone supplementation