Long-term testosterone improves erectile function, reduces mortality in men with hypogonadism and diabetes

Long-term testosterone therapy appears to improve erectile function and reduce mortality in men with hypogonadism and type 2 diabetes mellitus, according to a recent study presented at the 2021 Sexual Medicine Society of North America Fall Scientific Meeting.¹

A total 361 men with hypogonadism (defined as total testosterone ≤350 ng/mL and at least moderate symptoms as assessed by the Aging Males’ Symptoms scale) in a single urology office had type 2 diabetes mellitus. Of these men, 183 received testosterone undecanoate injections of 1000 mg/12 weeks following an initial 6-week interval, with 178 patients opting to not receive TU injections serving as controls. International Index of Erectile Function-Erectile Function (IIEF-EF) domain score was assessed at each visit. Mortality was recorded based on reports from the patients’ general practitioners.

“Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction and adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups,” wrote the authors, led by Farid Saad, MD, of Bayer AG and Gulf Medical University School of Medicine, Ajman, United Arab Emirates.

Mean follow-up was 8.2±3.2 years (median, 8 years) in the treatment group and 9.2±2.8 years (median, 10 years) in the control group. Total observation time was 1508 years in the treatment group vs 1641 years in the control group. Age at baseline was 60.7±5.5 years in the treatment group and 63.0±4.9 years for the controls (P < .0001). Phosphodiesterase 5 inhibitor usage at baseline was 27.3% in the treatment group vs 34.3% of the control group (P = .1527). At first visit, erectile dysfunction (ED) was reported by 64.5% of the treatment group vs 54.5% in the control group. In patients who did not report ED, the condition was diagnosed using the IIEF-EF in 30.6% of patients in the treatment group vs 44.4% in the control group, and 4.9% of patients in the treatment group and 1.1% in the control group had no ED.

Regarding erectile function, in year 12 for the treatment group, IIEF-EF increased by 12.1±0.4 (least squares means ± standard errors), whereas IIEF-EF decreased by 14.2±0.4 in the control group. Estimated adjusted difference between the 2 groups was 26.3.

Over the observation period, 15 patients (8.2%) in the treatment group died compared with 61 patients (34.3%) in the control group (P < .0001).

“Our mortality data confirm the results by Hackett et al²…,who observed the lowest mortality in a subgroup of men receiving continuous long-term [testosterone therapy],” the investigators concluded.

References

1. Saad F, Haider A, Haider KS, Doros G, Traish A. Long-term testosterone therapy improves erectile function and reduces mortality in men with hypogonadism and type 2 diabetes – updated results from a registry study. Paper presented at 2021 Sexual Medicine Society of North America Fall Scientific Meeting; October 21-24, 2021; Scottsdale, Arizona. Abstract 001

2. Hackett G, Cole N, Mulay A, Strange RC, Ramachandran S. Long-term testosterone therapy in type 2 diabetes is associated with reduced mortality without improvement in conventional cardiovascular risk factors. BJU Int. 2019;123(3):519-529. doi:10.1111/bju.14536