Meta-analysis finds no benefit from testosterone therapy

[Jinzang]

Don't get mad at me. I just report them, not believe them.

Treatment of Men for “Low Testosterone”: A Systematic Review

Testosterone products are recommended by some prescribers in response to a diagnosis or presumption of “low testosterone” (low-T) for cardiovascular health, sexual function, muscle weakness or wasting, mood and behavior, and cognition. We performed a systematic review of 156 eligible randomized controlled trials in which testosterone was compared to placebo for one or more of these conditions. We included studies in bibliographic databases between January 1, 1950 and April 9, 2016, and excluded studies involving bodybuilding, contraceptive effectiveness, or treatment of any condition in women or children. Studies with multiple relevant endpoints were included in all relevant tables. 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.

Full text of the study is available at

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162480

 

[Sean Mosher]

I didn't see anything regarding dosing, frequency, blood work results, etc...
Kind of hard to take something this vague seriously.

 

[Jinzang]

I don't want to go into the design of the study, because, as I see it, there's a larger problem. Many of the health problems of older men are the result of decades of poor lifestyle choices: poor diet, lack of exercise, and too much stress. In particular, ED is often a blood flow problem. If you give testosterone to a sick, unfit, stressed out man, you are going to get a horny, sick, unfit, stressed out man. Without controlling for lifestyle factors any study of the benefits of TRT are going to be hard to see. The reductionist, look at a single factor at a time, approach of many medical studies is not going to find the truth. I'd advise any man to fix their lifestyle either before or at the same time as they start TRT. Personally, I tried fxing up my lefstyle first, but it wasn't enough, and decided to try TRT. And I have been very pleased with the results.

 

[ERO]

I completely agree that this was a poorly done study. That said, I have to agree with this sentence: "Testosterone is ineffective in treating erectile dysfunction and controlled trials did not show a consistent effect on libido." Think about it - almost all of us on TRT still need pde5 inhibitors, N.O. supplements, Tri-Mix or some combination in order to get reliable erections. Libido is hit and miss as well for a lot of us.

 

[Nelson Vergel]

PLOS is not respected as JAMA and others since anyone who is willing to pay gets published.

 

[Jinzang]

This article has Dr. Morgentaler's response to the study:

“All they've done is list a large number of testosterone studies, without understanding important issues in the field, and then drawn their own conclusions without any scientific basis,” says Morgentaler.

 

[HarryCat]

This article has Dr. Morgentaler's response to the study:

“All they've done is list a large number of testosterone studies, without understanding important issues in the field, and then drawn their own conclusions without any scientific basis,” says Morgentaler.

The photo accompanying that article is just plain weird. What are they trying to show by that? Seems heavily biased to me.

 

[ecdysone]

In scope, it's not a bad study, unfortunately the criteria for inclusion was a bit weak: studies from the 1950's were included and in some cases there was "no regard to plasma testosterone level." The author's conclusions are also highly suspect... for example, in the CAD study which examined the effect of IV infusion on cardiac parameters, 2 out of 3 were favorable. With the Sexual Function studies, more that half didn't take into consideration whether testosterone was depressed; in one subset of the studies 23 out of 47 found a "beneficial effect" of administering testosterone.

Overall, a great many of the studies did indeed show beneficial effects of giving testosterone - so no idea how the authors reached their conclusions.