1008 1030
patients, TTh alone could be considered in milder forms of
ED, whereas in the more severe forms the add-on of other
treatments, such as a PDE5i, might be appropriate.
TTh was less effective in improving EFD-score in patients
with obesity and diabetes. This finding is not surprising as it
is consistent with the reduced efficacy seen for all available
treatments for ED in patients with diabetes. This is likely
due to the presence of multiple diabetes-associated
complications, such as peripheral neuropathy and vasculo-
pathy, including macroangiopathy, microangiopathy, and
[(Fig._6)TD$FIG]
Overall erectile function domain
TT < 12 nM
TT < 8 nM
Libido domain
Intercourse satisfaction domain
Orgasmdomain
Paduch et al 2015 excluded
Overallsatisfaction
TotalIIEF-15 score
1806
0.001
2.29
1.30
1.80
774
0.001
2.03
0.9
1.47
1438
0.001
4.03
1.86
2.95
1269
0.001
0.28
0.12
0.20
1269
0.001
1.37
0.78
1.07
1300
0.010
0.48
0.06
0.27
1224
0.001
0.71
0.22
0.47
1269
0.001
0.46
0.20
0.33
607
0.001
5.20
2.18
3.60
-3.00
-2.00
-1.00
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
IIEF domains
IIEF score mean differences
A
B
–3 –2 –1 0 1 2 3 4 5 6 7
Diff. in mean LL, 95% CI UL, 95% CI
p
N
Placebo
TTh
-3.00
-2.00
-1.00
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
IIEF domains
IIEF score mean differences
Diff. in mean LL, 95% CI UL, 95% CI
p
N
Overall erectile function domain
TT < 12 nM
TT < 8 nM
Libido domain
Intercourse satisfaction domain
Orgasmdomain
Paduch et al2015 excluded
Overallsatisfaction
TotalIIEF-15 score
1806
0.001
3.22
1.41
2.31
774
0.001
2.03
0.9
1.47
1438
0.001
4.03
1.86
2.95
1269
0.001
0.54
0.12
0.33
1269
0.001
1.44
0.77
1.10
1300
0.030
1.21
0.05
0.63
1224
0.010
1.55
0.23
0.89
1269
0.010
0.64
0.08
0.36
607
0.001
9.20
1.72
5.46
Placebo
TTh
–3 –2 –1 0 1 2 3 4 5 6 7
Fig. 6 – Mean (with 95% confidence interval [CI]) of testosterone treatment (TTh) versus placebo on International Index of Erectile Function (IIEF)
domains as derived by applying (A) fixed or (B) random models.
Diff = differences; LL = lower limits; TT = total testosterone; UP = upper limits.
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
1008