Review Questions Benefits of Testosterone Supplementation

Although it has been suggested that testosterone could improve men’s cardiovascular health, sexual function, strength, mood, and cognition, these claims do not have adequate clinical trial support, according to a new systematic review.

“Testosterone has known risks, such heart attacks, strokes, and pulmonary embolism, and no clear benefits in men with intact testicles and no genetic abnormalities,” said study author Adriane Fugh-Berman, MD, associate professor in the Department of Pharmacology and Physiology, Georgetown University Medical Center, in Washington, DC.
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Researchers performed a systematic review of 226 eligible randomized controlled trials in which testosterone was compared with placebo for 1 or more of these conditions: cardiovascular health, sexual function, muscle weakness or wasting, mood and behavior, and cognition. They included studies in bibliographic databases from January 1, 1950, to April 9, 2016, and excluded studies involving bodybuilding, contraceptive effectiveness, or treatment of any condition in women or children.

Testosterone supplementation did not show consistent benefit for cardiovascular risk, sexual function, mood and behavior, or cognition. Studies that examined clinical cardiovascular endpoints have not favored testosterone therapy over placebo. Testosterone is ineffective in treating erectile dysfunction, and controlled trials did not show a consistent effect on libido. Testosterone supplementation consistently increased muscle strength but did not have beneficial effects on physical function. Most studies on mood-related endpoints found no beneficial effect of testosterone treatment on personality, psychological well-being, or mood.

“The prescription of testosterone supplementation for low-T for cardiovascular health, sexual function, physical function, mood, or cognitive function is without support from randomized clinical trials,” the researchers wrote.

Dr Fugh-Berman has a simple message for primary care providers: “Don’t prescribe testosterone. Don’t screen for low testosterone, either.”

—Mike Bederka

Reference:

Huo S, Scialli AR, McGarvey S, et al. Treatment of men for “low testosterone”: a systematic review [published online September 21, 2016]. PLoS One. doi: http://dx.doi.org/10.1371/journal.pone.0162480.