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July 22, 2015
Testosterone Replacement Doesn’t Significantly Improve Ejaculatory Disorders
New York—Resolving low testosterone levels in men with ejaculatory disorders failed to improve their sexual function, according to a new study. Background information in the report, published online ahead of print recently in the Journal of Clinical Endocrinology & Metabolism, notes that the Endocrine Society estimates that between 10% and 18% of men have issues with inability to ejaculate, decreased volume of ejaculation, decreased force of ejaculation, and delayed time to ejaculation. Study authors, led by researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center and Weill Cornell Medical College in New York, point out that this is a distinct neurobiological problem from erectile dysfunction, and that the FDA has approved no therapies to treat it. “This is the first clinical trial examining the treatment of a very common but poorly understood condition that affects men's physical health as well as their interpersonal relationships,” said lead author Darius A. Paduch, MD, PhD. “Although the participants in this study did not experience any significant improvement in ejaculatory function, we hope our work will spur the development of additional clinical trials to find treatments for this condition.” For the multicenter, double-blind, randomized, placebo-controlled trial, 76 men with ejaculatory dysfunction—all 26 or older and with total testosterone levels of less than 300 ng/dL found on two separate tests—were assigned to receive either a 2% testosterone solution applied on the skin or a placebo. Testosterone levels were measured periodically in the participants to determine how well the hormone replacement therapy was working. Ejaculatory function was gauged through semen samples as well as sexual health questionnaires and logs completed by the study subjects. The men on testosterone replacement therapy had somewhat higher scores on the Men’s Sexual Health Questionnaire on ejaculatory dysfunction than the control group, but the difference was too small to be statistically significant, according to the study. The researchers also found no or little improvement in ejaculate volume or orgasmic function in the 66 men who completed the 16-week industry-funded study. Paduch noted that, among the participants who used the topical testosterone solution on their skin, about 70% showed an increase in the levels of testosterone above 300 ng/dL, and that subgroup showed a statistically significant improvement in ejaculatory function when compared to men whose testosterone did not reach levels as high. “Our findings suggest physicians who are treating men with ejaculatory dysfunction need to look at other reasons for delayed ejaculation than hypogonadism,” added co-author Shehzad Basaria, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston. “More research is needed to determine whether a longer course of testosterone therapy or other treatment options can benefit men with ejaculatory dysfunction.” Endocrine Society guidelines recommend prescribing testosterone only to men who have unequivocally low levels of the hormone and decreased libido, erectile dysfunction or other symptoms of hypogonadism, a condition that results from low testosterone.
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