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Effect of testosterone supplementation on sexual functioning in aging men: a 6-month randomized controlled trial

Abstract

Serum testosterone levels decline significantly with aging and this has been associated with reduced sexual function. We have conducted a double-blind, randomized, placebo-controlled trial to investigate the effect of testosterone supplementation on sexual function in 237 elderly men with a testosterone level <13.7 nmol l−1. Participants were randomly assigned to receive oral testosterone undecanoate or a placebo for 6 months. A total of 207 men completed the study. After treatment, there were no differences in scores on sexual function between the groups. Subanalysis showed that although a baseline testosterone level in the lowest tertile was associated with significantly lower scores for sexual fantasies, desire of sexual contact and frequency of sexual contact, supplementation of testosterone did not result in improvement on any of these items in this group. In conclusion, the findings do not support the view that testosterone undecanoate supplementation for 6 months to elderly men with low-normal testosterone concentrations favorably affects sexual function.

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References

  1. Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ . A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: 762–774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Althof SE . Quality of life and erectile dysfunction. Urology 2002; 59: 803–810.

    Article  PubMed  Google Scholar 

  3. Gore J, Rajfer J . The role of serum testosterone testing: routine hormone analysis is an essential part of the initial screening of men with erectile dysfunction. Rev Urol 2004; 6: 207–210.

    PubMed  PubMed Central  Google Scholar 

  4. Spark RF, White RA, Connolly PB . Impotence is not always psychogenic. Newer insights into hypothalamic–pituitary–gonadal dysfunction. JAMA 1980; 243: 750–755.

    Article  CAS  PubMed  Google Scholar 

  5. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR . Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001; 86: 724–731.

    Article  CAS  PubMed  Google Scholar 

  6. Travison TG, Morley JE, Araujo AB, O'donnell AB, McKinlay JB . The relationship between libido and testosterone levels in aging men. J Clin Endocrinol Metab 2006; 91: 2509–2513.

    Article  CAS  PubMed  Google Scholar 

  7. Tsitouras PD, Martin CE, Harman SM . Relationship of serum testosterone to sexual activity in healthy elderly men. J Gerontol 1982; 37: 288–293.

    Article  CAS  PubMed  Google Scholar 

  8. Kupelian V, Shabsigh R, Travison TG, Page ST, Araujo AB, McKinlay JB . Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study. J Urol 2006; 176: 2584–2588.

    Article  CAS  PubMed  Google Scholar 

  9. Kaufman JM, Vermeulen A . The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 2005; 26: 833–876.

    Article  CAS  PubMed  Google Scholar 

  10. Bolona ER, Uraga MV, Haddad RM, Tracz MJ, Sideras K, Kennedy CC et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc 2007; 82: 20–28.

    Article  CAS  PubMed  Google Scholar 

  11. Isidori AM, Giannetta E, Gianfrilli D, Greco EA, Bonifacio V, Aversa A et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005; 63: 381–394.

    Article  CAS  Google Scholar 

  12. Nakhai Pour HR, Emmelot-Vonk MH, Sukel-Helleman M, Verhaar HJ, Grobbee DE, van der Schouw YT . Double blind randomized placebo-controlled trial on the effects of testosterone supplementation in elderly men with moderate to low testosterone levels: design and baseline characteristics [ISRCTN23688581]. Trials 2006; 7: 24.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, Aleman A, Lock TM, Bosch JL et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA 2008; 299: 39–52.

    CAS  PubMed  Google Scholar 

  14. Vermeulen A, Verdonck L, Kaufman JM . A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999; 84: 3666–3672.

    Article  CAS  PubMed  Google Scholar 

  15. Vroege JA . Eleven Questions on Sexual Functioning (ESF). An Extension of the Questionnaire for Screening Sexual Dynsfunctions (QSF). Department of Psychiatry, University Medical Centre Leiden: The Netherlands, 1998.

    Google Scholar 

  16. Aversa A, Isidori AM, Spera G, Lenzi A, Fabbri A . Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol (Oxf) 2003; 58: 632–638.

    Article  CAS  Google Scholar 

  17. Cavallini G, Caracciolo S, Vitali G, Modenini F, Biagiotti G . Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology 2004; 63: 641–646.

    Article  CAS  PubMed  Google Scholar 

  18. Steidle C, Schwartz S, Jacoby K, Sebree T, Smith T, Bachand R . AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003; 88: 2673–2681.

    Article  CAS  PubMed  Google Scholar 

  19. Liverman CT, Blazer DG (eds). Committee on Assessing the Need for Clinical Trials of Testosterone. Replacement Therapy: Testosterone and Aging: Clinical Research Directions. The National Academies Press: Washington, DC, 2004.

    Google Scholar 

  20. Haren MT, Wittert GA, Chapman IM, Coates P, Morley JE . Effect of oral testosterone undecanoate on visuospatial cognition, mood and quality of life in elderly men with low-normal gonadal status. Maturitas 2005; 50: 124–133.

    Article  CAS  PubMed  Google Scholar 

  21. Wittert GA, Chapman IM, Haren MT, Mackintosh S, Coates P, Morley JE . Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. J Gerontol A Biol Sci Med Sci 2003; 58: 618–625.

    Article  PubMed  Google Scholar 

  22. Schnabel PG, Bagchus W, Lass H, Thomsen T, Geurts TB . The effect of food composition on serum testosterone levels after oral administration of Andriol Testocaps. Clin Endocrinol (Oxf) 2007; 66: 579–585.

    CAS  Google Scholar 

  23. Houwing NS, Maris F, Schnabel PG, Bagchus WM . Pharmacokinetic study in women of three different doses of a new formulation of oral testosterone undecanoate, Andriol Testocaps. Pharmacotherapy 2003; 23: 1257–1265.

    Article  CAS  PubMed  Google Scholar 

  24. Carani C, Zini D, Baldini A, Della CL, Ghizzani A, Marrama P . Effects of androgen treatment in impotent men with normal and low levels of free testosterone. Arch Sex Behav 1990; 19: 223–234.

    Article  CAS  PubMed  Google Scholar 

  25. Bancroft J, Wu FC . Changes in erectile responsiveness during androgen replacement therapy. Arch Sex Behav 1983; 12: 59–66.

    Article  CAS  PubMed  Google Scholar 

  26. Skakkebaek NE, Bancroft J, Davidson DW, Warner P . Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clin Endocrinol (Oxf) 1981; 14: 49–61.

    Article  CAS  Google Scholar 

  27. Aydin S, Odabas O, Ercan M, Kara H, Agargun MY . Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction. Br J Urol 1996; 77: 256–260.

    Article  CAS  PubMed  Google Scholar 

  28. Benkert O, Witt W, Adam W, Leitz A . Effects of testosterone undecanoate on sexual potency and the hypothalamic–pituitary–gonadal axis of impotent males. Arch Sex Behav 1979; 8: 471–479.

    Article  CAS  PubMed  Google Scholar 

  29. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB . Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 2003; 139: 161–168.

    Article  PubMed  Google Scholar 

  30. Nieschlag E, Swerdloff R, Behre HM, Gooren LJ, Kaufman JM, Legros JJ et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. J Androl 2006; 27: 135–137.

    Article  CAS  PubMed  Google Scholar 

  31. Christiansen K . Behavioural correlates of testosterone. In: Nieschlag E BHe (eds). Testosterone: Action, Deficiency and Substitution. Berlin: Springer, 1998; 107–142.

    Chapter  Google Scholar 

  32. Kelleher S, Conway AJ, Handelsman DJ . Blood testosterone threshold for androgen deficiency symptoms. J Clin Endocrinol Metab 2004; 89: 3813–3817.

    Article  CAS  PubMed  Google Scholar 

  33. Zitzmann M, Faber S, Nieschlag E . Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab 2006; 91: 4335–4343.

    Article  CAS  PubMed  Google Scholar 

  34. Vroege JA . Questionnaire for Screening Sexual Dysfunctions (QSD). 4th version: Validation Studies. Department of Psychiatry, University Medical Centre Leiden/Department of Medical Sexuology, University Medical Centre Utrecht: The Netherlands, 1996.

    Google Scholar 

  35. Vroege JA . Questionnaire for Screening Sexual Dysfunction (QSD). Usefulness in Clinical Practice (RNG-studies, nr 4). Eburon, Delft: The Netherlands, 2003.

    Google Scholar 

  36. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    Article  CAS  PubMed  Google Scholar 

  37. Svartberg J, Aasebo U, Hjalmarsen A, Sundsfjord J, Jorde R . Testosterone treatment improves body composition and sexual function in men with COPD, in a 6-month randomized controlled trial. Respir Med 2004; 98: 906–913.

    Article  CAS  PubMed  Google Scholar 

  38. Dobs AS, Hoover DR, Chen MC, Allen R . Pharmacokinetic characteristics, efficacy, and safety of buccal testosterone in hypogonadal males: a pilot study. J Clin Endocrinol Metab 1998; 83: 33–39.

    CAS  PubMed  Google Scholar 

  39. Rhoden EL, Teloken C, Sogari PR, Souto CA . The relationship of serum testosterone to erectile function in normal aging men. J Urol 2002; 167: 1745–1748.

    Article  CAS  PubMed  Google Scholar 

  40. Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM, Snyder PJ et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 2085–2098.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Trial medication was provided by Organon N.V. (Oss, The Netherlands). Organon NV did either control or influence the contents of the research or this paper, nor played any part in the decision to submit this manuscript for publication. The study was financially supported by Grant 014-91-063 from the Netherlands Organisation for Health Research and Development.

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Correspondence to M H Emmelot-Vonk.

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Emmelot-Vonk, M., Verhaar, H., Nakhai-Pour, H. et al. Effect of testosterone supplementation on sexual functioning in aging men: a 6-month randomized controlled trial. Int J Impot Res 21, 129–138 (2009). https://doi.org/10.1038/ijir.2009.5

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