#376 Testosterone supplementation for men: Let’s (andro-)pause for a moment (Update)
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- 16 systematic reviews from last five years1-16 and main randomized, placebo-controlled trials (RCTs). Statistically significant unless indicated.
- Sexual function: Most comprehensive systematic review1 (men ≥40 years with normal/low testosterone and sexual dysfunction). Highest quality RCTs:
- Sexual function scale (range 6-30, higher=normal function): 6 RCTs, 2016 patients
- Mean difference: 2.4 at ≤12 months, not clinically different.
- Others similar.2-4
- Sexual function scale (range 6-30, higher=normal function): 6 RCTs, 2016 patients
- Strength: Most comprehensive review5 (11 RCTs, 814 men, 66-77 years old, normal/low testosterone). Over 3-12 months, highest quality RCTs:
- Lean body mass: 1.6 kg higher with testosterone. Other reviews similar.6-10
- Hand grip strength, physical performance tests: No difference.5
- Leg strength: Inconsistent.5
- Fatigue: One systematic review with limitations.11 Largest RCT: 464 patients, age 65+, low testosterone and self-reported “low vitality”:17
- Proportion with clinical improvement on fatigue score: No difference.
- Cognition: Three systematic reviews with limited reporting.11-13
- Two largest RCTs: No difference.18,19
- Quality of life: Best systematic review (7 RCTs, 1043 participants, most: testosterone <12nmol/L).11
- Symptom scale: Not clinically different.
- Others similar.1,2,3,6
- Harms: Largest RCT on cardiovascular effects of testosterone 1.62% gel in 5204 men, 55% with cardiovascular disease or at high risk.20 Baseline testosterone=8nmol/L. At 33 months:
- All-cause mortality, major cardiovascular events, prostate cancer, invasive prostatic procedures: No difference.
- Atrial fibrillation: 3.5% versus 2.4% (placebo), number needed to harm=93.
- Pulmonary embolism: 0.9% versus 0.5% (placebo) (no statistics provided).
- Systematic reviews:1,14 Similar.
- Low testosterone: < 10nmol/L.21
- Guidelines:21,22
- Asymptomatic: Not recommended.22
- Age-related low testosterone and sexual dysfunction: May discuss testosterone.22
- Best initial screening: Total testosterone (morning draw: 7-11am).21
- Best formulation is uncertain: Direct comparisons of different formulations lacking.1