Researchers Say Testosterone Replacement Therapy May Not Be Helpful for Erectile Dysfunction
By Denise Mann
WebMD Health News
Reviewed by Laura J. Martin, MD
Oct. 17, 2011 -- Many men may be taking supplements of the male sex hormone testosterone to boost their sex drive, but it may not be that helpful after all.
A new study of men 60 and older who had low or borderline low levels of testosterone showed that testosterone replacement therapy did not improve erectile dysfunction (ED) or their ability to achieve and maintain an erection, compared to a placebo gel.
Men who used either a low dose or a conventional dose of testosterone gel showed no improvements in their sexual function during the course of the year-long study, compared with men who used placebo gel.
The findings were presented at the annual meeting of the American Society for Reproductive Medicine in Orlando, Fla.
"It appears that testosterone supplementation will not improve ED, though it may have other benefits on sexual function that were not evaluated with this data," says study researcher Lauren W. Roth, MD, an obstetrician/gynecologist at the University of Colorado in Denver, in an email.
Sexual function is one of many reasons that many men are turning to testosterone therapy. With a laundry list of promises from a boost in sex drive and more energy to an increase in muscle mass and mental acuity, testosterone therapy can be tempting for many men who want to feel and look younger than they do.
But, according to some experts, the hormone may be more harmful than helpful for some men.
"I am quite concerned about the rampant use of testosterone replacement therapy for very soft indications," says Rebecca Sokol, MD. She is a professor of medicine and obstetrics and gynecology and the director of the andrology program at the Keck School of Medicine of the University of Southern California in Los Angeles. "It is very much a buyer beware situation."
"We have to be very cautious about who we do and do not start on testosterone," Sokol says.
Risks of Testosterone Supplements
There are risks attached to the use of testosterone, Sokol says. "This hormone may cause the prostate gland to increase in size, and there is also the theoretic risk that we can stimulate the growth of cancer cells in the prostate. We have been looking carefully to see if testosterone initiates prostate cancer and there is no data to indicate that it does at this point."
Testosterone may also increase levels of LDL "bad" cholesterol while decreasing levels of HDL "good" cholesterol, she says.
Men who are considering taking testosterone need to weigh the pros and cons carefully with their doctor.
"The patient really needs to be evaluated by a physician who is an expert in hormones and male reproduction," Sokol says. "The indication for treatment needs to be very clear and verified by evaluation and physical exam."
Checking for Low Levels of Testosterone
Part of the problem is that men are getting their testosterone from non-expert sources, including their buddies in the gym and online, says Joseph P. Alukal, MD. He is an assistant professor of urology and the director of male reproductive health at New York University's Langone Medical Center in New York City.
Testosterone replacement does have a role in treating some men with erectile dysfunction who also have low levels of the hormone, he says. "Testosterone is one of the treatments we have, but it's not the only one."
The first step is to measure a man's testosterone levels to see if they are low. This needs to be done on more than one occasion to make sure the results are accurate, he says.
If levels are low, and there are no other health problems that may be causing the problems with sexual functioning, testosterone replacement therapy is an option, Alukal tells WebMD.
In some men, ED can be a red flag for heart problems. In these cases, men will likely need to see a cardiologist, he says.
"Hormones are powerful," Alukal says. "They have tremendous benefits and significant risks, so to go on them requires proper monitoring by a physician who understands their risks and benefits and knows how to monitor men."
Doctors who prescribe testosterone should monitor the prostate gland closely, he says.
"We know that there is some relationship between testosterone and the growth of the prostate and the development of prostate cancer, but we don't fully understand the relationship," Alukal tells WebMD.