CLINICAL QUESTION

Is testosterone replacement therapy (TRT) safe and effective for the management of sexual dysfunction in men whose testosterone levels are unknown?

EVIDENCE-BASED ANSWER

TRT provides little to no benefit in men with sexual dysfunction in whom testosterone levels are unknown.¹ (Strength of Recommendation: A, consistent, good-quality, patient-oriented evidence.)

PRACTICE POINTERS

Erectile dysfunction (ED) and low libido may result in an inability to experience pleasure during sexual activity. The overall prevalence rates of ED and low libido in men are 22% and 15% to 25%, respectively, and both increase with age.² Sexual dysfunction can negatively impact work productivity, health-related quality of life, self-esteem, and mood.^3,4 The US Food and Drug Administration has approved TRT only for men with testosterone deficiency, a stance supported by the American Urological Association (AUA).^5,6 However, TRT has been widely used in practice to treat sexual dysfunction, regardless of serum testosterone level.⁷