Benefits of testosterone therapy
Once hypogonadism had been confirmed through a combination of clinical assessment and biochemical tests, the standard management of testosterone deficiency is the prescription of testosterone replacement therapy (TRT) which aims to restore normal testosterone levels and relieve clinical symptoms of hypogonadism.
The British Society of Sexual Medicine (BSSM) recognises a number of benefits conferred through TRT and several others have been identified through clinical trials. [1] It is recommended that TRT trials are at least 6 months in length and maximal benefits are seen post 12 months. [1]
TRT provides benefits to body mass composition including increased muscle mass and reduced BMI and waist size
Testosterone deficient individuals can experience reduced bone mass and density including osteoporosis, reduced muscle mass and strength and weight gain.
TRT has been shown to dose-dependently increase skeletal muscle mass, increase muscle strength and also increase self-reported mobility. It also has been shown to moderately improve aerobic capacity. [1] [2]
TRT improves sexual function, erectile function and sexual desire
Hypogonadism causes reduced sexual desire and sexual function including erectile dysfunction and fewer nocturnal erections.
Therapy improves sexual function and ability and subsequently provides greater sexual satisfaction. [1] [2]
TRT may confer benefits in cognitive function and mood
In men who do not have a depressive disorder but who have been diagnosed with hypogonadism, TRT has been shown to moderately improve depressive symptoms.[3] However, for those with major depressive disorder, TRT has not been shown to cause significant improvements in depression, when administered alone or in combination with an antidepressant. [2]
There are limited studies into the impact of TRT on cognitive memory, however some randomised controlled trials have shown some improvement in verbal memory and cognitive function. [2] [3]
TRT may reduce cardiovascular risk
There is a large body of conflicting evidence on whether TRT increases or decreases cardiovascular risk, however leading institutions [3] [6] have concluded in their guidelines that there is no evidence that TRT increases cardiovascular risk.
Importantly, low testosterone levels have been shown to have a direct link to the development of coronary heart disease and overall poorer cardiovascular health. [4]
Therapy has demonstrated benefits to at-risk individuals including showing benefits such as improved muscle strength in those with congestive heart failure and improvements in cardiovascular risk factors such as body composition, insulin resistance and improved lipid profile.[3] [5] [6]
TRT increases haemaglobin levels, reducing anaemia and its associated symptoms
Therapy has been shown to significantly increase haemaglobin levels from both unexplained or unknown causes. [1] The downstream effect of this is reduced fatigue and weakness in the individual and subsequent improvement to their quality of life.
References
1. Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523.
2. Bhasin S. J Clin Invest. 2021;131(4):e146607. https://doi.org/10.1172/JCI146607.
3. Juny & Shin. World J Mens Health. 2016; 34(3): 194–199.
4. Morris & Channer. Asian J Androl. 2012; 14(3): 428–435.
5. Jones & Kelly. Asian J Androl. 2018; 20(2):120-130. doi: 10.4103/aja.aja_6_18.
6. Salonia A, Bettocchi C, Carvalho J. EAU Guidelines on Sexual and Reproductive Health. 2020
BMI = body mass index, TRT = testosterone replacement therapy.