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2 April 2012

Current state of knowledge on low testosterone in middle-aged and older men

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This article reviewed what is known about the consequences of low testosterone (also known as hypogonadism) in middle-aged and older men, with practical information on the benefits and risks of testosterone replacement. The authors examined evidence from a wide range of studies about low testosterone and its treatment to prepare their review.

28 June 2011

Testosterone undecanoate injection normalizes testosterone levels and improves sexual function in Korean men with hypogonadism and ED

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The efficacy and safety of testosterone undecanoate (Nebido®) in testosterone deficiency syndrome in Korean: a multicenter prospective study. Moon DG, Park MG, Lee SW, et al. J Sex Med 2010;7(6):2253-2260.

This prospective, multicentre study assessed the efficacy and safety of testosterone replacement therapy (TRT) with a long-acting intramuscular injection of testosterone undecanoate (Nebido®) in an Asian population.1 A total of 133 Korean patients (mean age 54, range 42–75 years) with erectile dysfunction (ED) and testosterone deficiency syndrome (serum testosterone <3.5 ng/mL [12 nmol/L]) were treated with testosterone undecanoate 1000 mg at baseline and again at 6 and 18 weeks. The primary efficacy endpoints were the changes in International Index of Erectile Function (IIEF) score from the initial visit to the final visit (24 weeks) and from the initial visit to each visit. Changes in the Aging Males' Symptoms (AMS) Scale and the Global Efficacy Question (GEQ) for improvement of erectile function were also evaluated.

Key Points


  • Testosterone replacement therapy (TRT) significantly increased serum total T and free T by week 12 in Korean men with ED and hypogonadism
  • TRT also significantly improved:

    • total IIEF score and all 5 domain scores
    • total AMS scale and all three domain scores of AMS
  • 77% of men reported improved erectile function
  • Improvements in lipid profile and some metabolic components were seen
  • Serum glucose levels tended to improve with treatment, reaching statistical significance in men with elevated initial glucose levels
  • TRT was effective, safe and well tolerated in hypogonadal Asian men.


5 May 2011

Meta-analysis supports association between metabolic syndrome and hypogonadism; testosterone replacement therapy may improve metabolic control and reduce central obesity

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Testosterone and metabolic syndrome: a meta-analysis study. Corona G, Monami M, Rastrelli G, et al. J Sex Med 2011;8(1):272-283.

A systematic review and meta-analysis of available prospective and cross-sectional studies comparing androgen levels in men with or without metabolic syndrome (MetS) was performed to analyse the relationship between androgen levels and MetS. Additionally, a separate meta-analysis of available randomized controlled trials reporting the metabolic effects of testosterone replacement therapy was performed. Overall, 21 quality studies were included; 13 cross-sectional, 3 longitudinal and 4 randomized controlled published trials, and 1 unpublished randomized controlled trial. Data for 2,254 men with and 6,407 men without MetS were included.

Key Points

  • Men with MetS had significantly lower levels of total plasma testosterone compared with healthy subjects
  • This was also true when men with or without erectile dysfunction were analysed separately and when different definitions of MetS were used
  • The presence of type 2 diabetes mellitus (T2DM) further enhanced the MetS-related decline in testosterone levels
  • Adjusted for age and body mass index, both T2DM and MetS independently predicted low testosterone (p<0.001 and p<0.05, respectively)
  • Data from longitudinal studies showed that baseline testosterone was significantly lower among patients with MetS than in controls (mean -2.17 nmol/L; p<0.0001)
  • Testosterone replacement therapy significantly reduced metabolic risk factors, including fasting plasma glucose, homeostasis model assessment index of insulin resistance (HOMA-IR), triglycerides and waist circumference, and increased HDL-cholesterol.

1 April 2011

Men with erectile dysfunction and low testosterone levels have an increased risk of dying from cardiovascular disease

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Citation: Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction. Corona G, Monami M, Boddi V, et al. J Sex Med 2010;7(4 Pt 1):1557-1564.

A consecutive series of 1687 patients attending an andrology clinic for erectile dysfunction (ED) was followed for a mean of 4.3 ± 2.6 years to investigate whether low testosterone levels predict incident fatal or nonfatal major adverse cardiovascular events (MACE) in men with ED. Patients in this prospective cohort study were interviewed using the structured interview on erectile dysfunction (SIEDY) and the ANDROTEST structured interview to measure aspects of ED and hypogonadal-related symptoms. Total testosterone was evaluated at baseline and information on MACE was obtained from registry database records.

Key Points

The nested case-control study showed:

  • At baseline, over 20% of men were hypogonadal, according to a widely accepted lower limit for normal total testosterone levels
  • Hypogonadism ranged from 5.2% to 13.8% and 22.4% depending on the threshold used (total testosterone less than 8, 10.4 and 12 nmol/L, respectively
  • During follow-up, 139 of the patients had a major cardiac event, such as ischaemic heart disease, cerebrovascular events (stroke or transient ischaemic attack) or peripheral artery disease
  • MACE were fatal in 15 men
  • Although low testosterone in itself was not associated with MACE, those patients with total testosterone levels below 10.4 nmol/L who had a major cardiac event were significantly more likely to die than those with higher testosterone levels
  • When adjusted for Chronic Diseases Score (an index of comorbidities) the risk of death was increased by a factor of seven (hazard ratio [HR] 7.1) in men with testosterone below 8 nmol/L
  • Of interest, fatal MACE were associated with a higher ANDROTEST score measuring hypogonadal-related symptoms and signs (HR = 1.2 for each ANDROTEST score increment; P = 0.05).

1 April 2011

Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone

Image: Human heart

There is increasing evidence that erectile dysfunction may be a warning sign of a number of disease conditions, such as high blood pressure, metabolic syndrome, diabetes mellitus, depression and coronary heart disease.

Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether those with low testosterone levels were more likely to suffer a major cardiovascular disease event, such as a heart attack or stroke.

Last updated: 2019