Sexual function in men is a complex interplay of hormonal, psychological, and relational factors.
Hypogonadism, characterised by low testosterone levels, is a significant contributor to sexual dysfunction.
We examine the TRAVERSE sexual function sub-study, examining which patients benefit the most from testosterone replacement therapy (TRT).
Hypogonadism can be congenital or acquired, with symptoms often overlapping with normal ageing and chronic diseases, complicating diagnosis (Rastrelli et al., 2018). Testosterone is crucial for male sexual response, influencing libido, erectile function, and overall sexual activity. However, sexual disorders cannot be solely attributed to low testosterone levels, as various factors, including organic, relational, and psychological influences, contribute to sexual dysfunction (Corona et al., 2022).
The TRAVERSE sexual function sub-study
The TRAVERSE trial primarily focused on the cardiovascular safety of TRT in middle-aged and older men with hypogonadism. The sexual function sub-study involved 1161 men aged 45 to 80, randomly assigned to receive either testosterone gel or a placebo for two years (Pencina et al., 2023). It is important to note that all patients had pre-existing cardiovascular disease or were at risk. The study aimed to assess the impact of TRT on sexual activity, desire, and hypogonadal symptoms.
Key findings
- Sexual activity and desire: TRT significantly enhanced sexual activity,
with participants reporting nearly a 50% increase in sexual activity compared to baseline, and a 25% greater improvement than those receiving placebo. Improvements in sexual desire and hypogonadal symptoms were also notable, although there was no significant effect on erectile function (Pencina et al., 2023).
- Patient demographics: The study highlighted the prevalence of sexual symptoms in older men, emphasising the importance of addressing these issues as they often lead to seeking testosterone treatment. Many participants had chronic health conditions, such as cardiovascular disease and diabetes, which could influence their sexual health. This demonstrates that even in older patients with CVD or risk factors, TRT improves sexual function, which is in line with previous research. (Pencina et al., 2023).
- Safety and adverse effects: The TRAVERSE trial demonstrated that TRT does not significantly increase the risk of major cardiovascular events in men with hypogonadism (Lincoff et al., 2023).
Clinical implications
The findings from the TRAVERSE sexual function sub-study provide valuable insights for clinicians and patients considering testosterone treatment.
TRT can effectively improve sexual activity and hypogonadal symptoms in men with low testosterone, particularly in older men and those with prior cardiovascular disease (Pencina et al., 2023).
Conclusion
Testosterone plays a multifaceted role in male sexual health, and TRT can significantly enhance sexual activity and hypogonadal symptoms in men with low testosterone. The TRAVERSE sexual function sub-study underscores the importance of a comprehensive approach to diagnosing and treating sexual dysfunction in men, considering both hormonal and non-hormonal factors. Further long-term studies are warranted to explore the efficacy and safety of TRT in this demographic.
References available on request.
