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Low serum testosterone levels are poor predictors of sexual dysfunction
Author(s) -
Marberger Michael,
Wilson Timothy H.,
Rittmaster Roger S.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09766.x
Subject(s) - dutasteride , medicine , testosterone (patch) , erectile dysfunction , sexual dysfunction , body mass index , prostate cancer , placebo , urology , population , prostate , endocrinology , gynecology , cancer , pathology , environmental health , alternative medicine
Study Type – Prognosis (RCT) Level of Evidence 1b What’s known on the subject? and What does the study add? Sexual dysfunction is a common problem in elderly men, especially if they also have LUTS. Serum testosterone likewise decreases with aging, and a common conclusion from this is that low serum testosterone levels are a main cause for this. This is by far the largest population‐based study correlating sexual dysfunction with serum testosterone levels. Whereas age, body mass index and the severity of LUTS were independent risk factors for sexual dysfunction, serum testosterone levels were not. Treating sexual dysfunction only based on a low serum testosterone level therefore appears unjustified. There is a trend towards sexual dysfunction with S. testosterone levels <200 ng/dl, but only 4% of the 8231 older men studied were in this range. OBJECTIVE • To identify predictors of sexual dysfunction using baseline data from the reduction by dutasteride of prostate cancer events (REDUCE) study. PATIENTS AND METHODS • REDUCE was a 4‐year randomized, double‐blind, placebo‐controlled study evaluating the efficacy and safety of once‐daily dutasteride 0.5 mg in over 8000 men aged 50–75 years with a prostate‐specific antigen (PSA) level of 2.5–10 ng/mL (50–60 years) or 3.0–10 ng/mL (>60 years) and a negative prostate biopsy within 6 months of enrolment. • Baseline values (mean serum testosterone, age, International Prostate Symptom Score [IPSS], total prostate volume [TPV], body mass index [BMI], and presence of diabetes/glucose intolerance) were compared in subjects with and without sexual dysfunction (sexual inactivity, impotence, decreased libido or a Problem Assessment Scale of the Sexual Function Index [PAS‐SFI] score <9). RESULTS • Multivariate logistic regression showed that baseline age and IPSS were significant predictors of all four sexual function criteria examined ( P < 0.0001). • BMI was a significant predictor of decreased libido, impotence and a PAS‐SFI score <9, while diabetes/glucose intolerance was a significant predictor of sexual inactivity, impotence and a PAS‐SFI score <9. • Testosterone and TPV were not significant predictors of any sexual function criterion examined. CONCLUSIONS • Age, IPSS, BMI and diabetes/glucose intolerance, but not serum testosterone or TPV, were significant independent predictors of sexual dysfunction in the REDUCE study population. • The lack of association between sexual dysfunction and serum testosterone questions the value of modestly reduced or low normal testosterone levels as criteria for choosing testosterone replacement in older men with sexual dysfunction.