EURURO Vol. 72 No. 6

Platinum Priority – Andrology

Editorial by Taylor P. Kohn and Ranjith Ramasamy on pp. 1012–1013 of this issue

Meta-analysis of Results of Testosterone Therapy on Sexual

Function Based on International Index of Erectile Function Scores

Giovanni Corona

a ,

Giulia Rastrelli

b ,

Abraham Morgentaler

c ,

Alessandra Sforza

a ,

Edoardo Mannucci

b , d ,

Mario Maggi

b , *

Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy;

Andrology and Sexual Medicine Unit,

Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy;

Men’s Health Boston, Harvard Medical School, Boston,

MA, USA;

Diabetes Agency, Careggi Hospital, Florence, Italy

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 1 0 0 0 – 1 0 1 1

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Article info

Article history:

Accepted March 21, 2017

Associate Editor:

Christian Gratzke

Keywords:

Erection

Ejaculation

Erectile dysfunction

Libido

International Index of Erectile

Function

Testosterone

Sexual function

Orgasm

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Abstract

Context:

The interpretation of available clinical evidence related to the effect of testosterone

(T) treatment (TTh) on sexual function has been inconsistent, in part due to the use of different

and self-reported measures to assess outcomes. The International Index of Erectile Function

(IIEF) is the most frequently used validated tool to assess male sexual function.

Objective:

To perform a meta-analysis of available data evaluating the effect of TTh on male

sexual function using IIEF as the primary outcome.

Evidence acquisition:

An extensive Medline, Embase, and Cochrane search was performed

including all placebo-controlled randomized clinical trials enrolling men comparing the effect

of TTh on sexual function.

Evidence synthesis:

Out of 137 retrieved articles, 14 were included in the study enrolling

2298 participants, with a mean follow-up of 40.1 wk and mean age of 60.2 6.5 yr. Using IIEF-

erectile function domain (IIEF-EFD) as the outcome, we found that TTh significantly improved

erectile function compared with placebo (mean difference = 2.31 [1.41;3.22] IIEF-EFD score,

0.0001). Patients with more severe hypogonadism (total T

8 nmol/l) reported greater

changes in final IIEF-EFD score when compared with those with a milder T deficiency (total

12 nmol/l; 1.47 [0.90;2.03] and 2.95 [1.86;4.03] for total T

12 nmol/l and

8 nmol/l,

respectively, Q = 5.61,

= 0.02). The magnitude of the effect was lower in the presence of

metabolic derangements, such as diabetes and obesity. Other aspects of sexual function, as

evaluated by IIEF subdomains, were also improved with TTh including libido, intercourse

satisfaction, orgasm, and overall sexual satisfaction.

Conclusions:

TTh significantly improves erectile function and other sexual parameters as

measured by IIEF in hypogonadal men. These results argue that sexual dysfunction should be

considered a hallmark manifestation of T deficiency, since those symptoms can be signifi-

cantly improved with normalization of serum T. In addition, these results suggest that TTh

alone may be considered a reasonable treatment for hypogonadal men with milder degrees of

erectile dysfunction, whereas the addition of other treatments, such as phosphodiesterase

type 5 inhibitors, may be more appropriate for men with more severe erectile dysfunction.

Patient summary:

We investigated the effect of testosterone treatment on sexual function by

performing a meta-analysis of all available studies that used the most frequently used

assessment tool, the International Index of Erectile Function. We found that testosterone

treatment significantly improves erectile dysfunction, as well as other aspects of sexual

function, in men with testosterone deficiency. This treatment may be all that is required for

hypogonadal men with milder erectile dysfunction; however, additional treatments may be

necessary in more severe cases.

2017 Published by Elsevier B.V. on behalf of European Association of Urology.

* Corresponding author. Andrology and Sexual Medicine Unit, Department of Experimental and

Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.

Tel. +39-55-4271415; Fax: +39-55-4271413.

E-mail address:

m.maggi@dfc.unifi.it

(M. Maggi).

http://dx.doi.org/10.1016/j.eururo.2017.03.032

0302-2838/

2017 Published by Elsevier B.V. on behalf of European Association of Urology.