Long-acting testosterone improves sexual function in men with type 2 diabetes

By Will Boggs MD

NEW YORK (Reuters Health) - Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism, researchers from England report.

"It is not possible to make a decision unless testosterone is measured in all men with erectile dysfunction (ED)," Dr. Geoffrey Hackett from Heart of England Foundation NHS Trust in Coldfield told Reuters Health. "In type 2 diabetes, 75% of men have ED, and for those without ED, it is largely a matter of time."

How to manage these men has been the subject of some controversy, and there is no consensus as to which symptoms are important or how the benefit of testosterone replacement therapy (TRT) should be assessed.

Dr. Hackett and colleagues in the BLAST study evaluated the effects of testosterone undecanoate (1000 mg injected at baseline, week 6 and week 18) on the magnitude, time to onset, and clinical significance of changes in sexual function scores of men with type 2 diabetes.

Their 30-week, double-blind, placebo-controlled study involved 109 men with mild hypogonadism, i.e., total testosterone (TT) 8.1-12 nmol/L or free testosterone (FT) 0.181-0.25 nmol/L, and 82 men with severe hypogonadism (TT no higher than 8.0 nmol/L or FT no higher than 0.18 nmol/L).

Erectile function improved significantly only among men with severe hypogonadism treated with testosterone. Intercourse satisfaction and sexual desire also improved in these men at six, 18, and 30 weeks.

There was no consistent pattern of significant change in sexual symptoms in the other treatment groups, according to the April 28th online report in BJU International.

Only among men with severe hypogonadism treated with testosterone were improvements in erectile function, intercourse satisfaction, and sexual desire significantly greater compared with placebo.

Men with mild hypogonadism treated with testosterone did have improvements in sexual desire at 18 and 30 weeks, however.

Hematocrit increased within the normal range (from 43.5% at baseline to 45.6% after 30 weeks), but only in the severe hypogonadism group treated with testosterone. PSA also increased from 1.2 µg/L to 1.5 µg/L at 30 weeks in these men.

"The study endorses the view of the Endocrine Society that the burden of hypogonadism-related sexual dysfunction in men is evident at TT (less than or equal to) 8 nmol/L," the researchers conclude. "Our findings also suggest that therapeutic trials of TRT, especially with testosterone undecanoate, should be >30 weeks, not 3 months as suggested by some guidelines."

"It takes more than 6 months to see benefits, and improvement continues beyond that," Dr. Hackett said. "Too many trials of testosterone do not check that adequate levels are obtained and are not given for long enough. Physicians need to understand this and explain the facts to the patient."

Dr. Alex W. Pastuszak from Baylor College of Medicine, Houston, Texas, who has extensively studied testosterone replacement therapy, told Reuters Health, "Perhaps the most surprising finding was the lack of efficacy of testosterone undecanoate in men with 'mild' hypogonadism, though this may be due in part to the effects of diabetes, as well as the potential use of only FT to group some of the patients. This may also be due to the incomplete effects of testosterone on sexual function in some men."

"This is a selected population of men with diabetes, with a focus on sexual function, so the results are not completely generalizable," Dr. Pastuszak said. "Furthermore, improvements in sexual desire were seen in both groups, consistent with a benefit regardless of severity of hypogonadism. Importantly, the authors did not look at the groups as a function of glucose control or diabetes medications, and one might expect that men with more severe diabetes may be less likely to respond to hormone therapy."

SOURCE: http://bit.ly/23FNxzm

BJU Int 2016.

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