Sexual health
Everything in the library studied for it, medical and holistic together. Within each kind, what was shown to help comes first, strongest evidence first. What was tested and not shown to help stays on the list.
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Medication
Doxycycline after sex to prevent sexually transmitted infections
Shown to cut chlamydia and syphilis by about three quarters with doxycycline after sex, mostly in men who have sex with men, with a smaller or no effect on gonorrhea.
Compared with standard care without doxycycline [15][16]; no prophylaxis [17]
The numbers and sources
- Effect
- In people on HIV prevention pills, a sexually transmitted infection was found at 10.7% of quarterly visits on doxycycline 200 mg within 72 hours of sex and 31.9% on standard care (RR 0.34), with similar results in people living with HIV (RR 0.38). Tetracycline-resistant gonorrhea occurred in 5 of 13 cases on doxycycline and 2 of 16 on standard care [15]. Pooled trials found lower chlamydia (RR 0.22) and syphilis (RR 0.24) and a smaller drop in gonorrhea (RR 0.79) [16]. Another meta-analysis found chlamydia (RR 0.35) and syphilis (RR 0.23) lower and no significant effect on gonorrhea (RR 0.90) [17].
- Population
- 501 men who have sex with men and transgender women [15]; 1,278 participants in 3 trials [16]; 1,727 participants in 4 trials, 73% men who have sex with men [17].
- Sources
- [15], [16], [17]
- Caveats
- Open-label trials. Long-term effects on resistance remain uncertain [16][17].
Erections and intercourse success
Shown to raise intercourse success to about 69% against 35% on placebo in men with erectile dysfunction, with no difference between sildenafil, vardenafil and tadalafil.
The numbers and sources
- How common
- Very common: more than 1 in 10 people.
- Effect
- Intercourse success was 69.0% on PDE5 inhibitors and 35.0% on placebo. Improved erections were reported by 67% to 89% on treatment and 27% to 35% on placebo. In head-to-head trials, sildenafil, vardenafil and tadalafil did not differ [1]. A network meta-analysis found sildenafil 50 mg had the greatest efficacy of starting doses and tadalafil 10 mg had the lowest overall adverse event rate [2].
- Population
- RCTs of men with erectile dysfunction, mostly 12 weeks or shorter [1]; 82 trials with 47,626 men for efficacy [2].
- Sources
- [1], [2]
- Caveats
- Many trials were of low methodological quality and short [1]. [1] was funded by the Agency for Healthcare Research and Quality.
Sexual side effects from other antidepressants
Shown to improve sexual function scores in people with antidepressant-related sexual problems at 150 mg twice daily in three trials, and not at 150 mg once daily.
The numbers and sources
- Effect
- In three studies in men and women, adding bupropion 150 mg twice daily improved sexual function rating scores against placebo (SMD 1.60, 95% CI 1.40 to 1.81). In two studies of 150 mg once daily, response rates did not differ from placebo (RR 0.62, 95% CI 0.09 to 4.41) [17].
- Population
- People with sexual dysfunction on antidepressants, within a Cochrane review of 23 trials and 1,886 participants [17].
- Sources
- [17]
- Caveats
- Not an approved use. Few trials, with the benefit seen only at the higher dose [17].
Premature ejaculation
Shown to improve self-rated premature ejaculation in men, about 202 more per 1,000 than placebo, in a use no label cited here lists.
The numbers and sources
- How common
- Very common: more than 1 in 10 people.
- Effect
- Men on an SSRI were more likely to rate their symptoms better or much better than men on placebo (RR 1.92, 95% CI 1.66 to 2.23), 202 more per 1,000 against 220 per 1,000 on placebo. Satisfaction with intercourse rose (RR 1.63, 95% CI 1.42 to 1.87). Time to ejaculation was 3.09 minutes longer (95% CI 1.94 to 4.25). Stopping treatment for adverse events was more frequent (RR 3.80, 95% CI 2.61 to 5.51), 30 more per 1,000 against 11 per 1,000 on placebo [18].
- Population
- 8,254 men with premature ejaculation in 31 randomized trials [18].
- Sources
- [18]
- Caveats
- Certainty was moderate for symptom ratings and low for time to ejaculation and for withdrawals. The abstract does not break results down by drug [18].
Sexual side effects from SSRIs
One trial found 58% of people with SSRI-related sexual problems improved on added buspirone over 4 weeks, against 30% on placebo.
The numbers and sources
- How common
- Very common: more than 1 in 10 people.
- Effect
- Among people on citalopram or paroxetine who reported decreased libido or problems with orgasm or ejaculation, about 58% improved in sexual function on added buspirone and 30% on added placebo. The difference was larger in women and appeared in the first week [9].
- Population
- 47 of 117 participants who reported sexual dysfunction at baseline, in a trial of buspirone 20 to 60 mg a day added to an SSRI [9].
- Sources
- [9]
- Caveats
- A secondary analysis of 47 people from a trial designed to test something else [9]. Not an approved use.
Premature ejaculation
Limited evidence: four tramadol trials in men found longer time to ejaculation than placebo, with high heterogeneity and more side effects.
The numbers and sources
- Effect
- Pooling 4 placebo-controlled trials, tramadol lengthened intravaginal ejaculatory latency time over 8 to 12 weeks (p = 0.0007), with high heterogeneity (I² 74%). Erectile dysfunction, constipation, nausea, headache, sleepiness, dry mouth, dizziness, itching and vomiting were more frequent than on placebo or behavioral therapy [15].
- Population
- 721 men with premature ejaculation in the 4 pooled trials, from 8 trials reviewed [15].
- Sources
- [15]
- Caveats
- Most trials were of unclear quality. Doses and durations varied, and none assessed addiction. Not an FDA-approved use [16].
Erectile dysfunction
Not shown to improve erectile dysfunction: 37% responded on trazodone against 20% on placebo across six small trials, a difference that was not statistically significant.
The numbers and sources
- Effect
- A positive treatment response occurred in 37% on trazodone and 20% on placebo (relative benefit increase 1.6, 95% CI 0.8 to 3.3). Three of six trials showed an apparent benefit, significant in two. Benefit appeared greater at 150 to 200 mg a day than at 50 mg, and in men whose erectile dysfunction was psychological in origin. Dry mouth (19%), sedation (16%), dizziness (16%) and fatigue (15%) were reported on trazodone [11].
- Population
- 396 men in 6 trials [11].
- Sources
- [11]
- Caveats
- The trials were small, brief, mixed in population and in some cases weak in method [11]. Not an approved use.
Hormone therapy
Sexual function in postmenopausal women
Shown to raise satisfying sexual events, desire, arousal and orgasm, and lower sexual distress, in postmenopausal women. Long-term data are limited.
The numbers and sources
- Effect
- Compared with placebo or a comparator, testosterone raised satisfying sexual event frequency by a mean of 0.85 (95% CI 0.52 to 1.18), desire by an SMD of 0.36 (95% CI 0.22 to 0.50), arousal by 0.28 (95% CI 0.21 to 0.35) and orgasm by 0.25 (95% CI 0.18 to 0.32), and lowered sexual distress by an SMD of -0.27 (95% CI -0.36 to -0.17) [6]. A 2026 systematic review reported improved desire with transdermal testosterone in postmenopausal trials, including one of more than 800 women. In two premenopausal trials of 31 to 261 women, libido, satisfying sexual events and satisfaction improved [7].
- Population
- 36 blinded RCTs with 8,480 participants, at least 12 weeks long, analyzed in postmenopausal women [6]; 33 studies, including 7 RCTs in postmenopausal and 2 in premenopausal women [7].
- Sources
- [6], [7]
- Caveats
- No effects were found on body composition, musculoskeletal measures or cognition, but few women contributed data to those outcomes [6]. The 2026 review was not pooled, and androgen levels and long-term safety were inconsistently reported [7]. Long-term data are limited.
Sexual function in menopause
Shown to improve sexual function slightly in menopausal women overall, though oral DHEA alone did not differ from placebo.
The numbers and sources
- Effect
- Compared with placebo, DHEA improved sexual function by an SMD of 0.31 (95% CI 0.07 to 0.55). Oral DHEA alone showed an SMD of 0.11 (95% CI -0.13 to 0.35), and one intravaginal trial 0.42 (95% CI 0.03 to 0.81) [5].
- Population
- Peri- and postmenopausal women, 5 trials with 261 women in the main analysis [5].
- Sources
- [5]
- Caveats
- The oral-only result did not differ from placebo. The overall evidence was rated moderate to low quality [5].
Painful sex and vaginal dryness after menopause
Shown to lower pain during sex and vaginal dryness in postmenopausal women using intravaginal DHEA. This applies to the vaginal form, not oral DHEA.
The numbers and sources
- Effect
- Pooled against placebo, intravaginal DHEA lowered dyspareunia scores by a mean difference of -0.40 (95% CI -0.66 to -0.15) and vaginal dryness by -0.23 (95% CI -0.35 to -0.11) [6]. In the largest single trial, daily intravaginal DHEA for 12 weeks reduced pain at sexual activity by 0.36 severity units over placebo and vaginal dryness by 0.27 units over placebo. Parabasal cells fell 27.7% and vaginal pH 0.66 units over placebo. Serum steroids stayed within normal postmenopausal values [7]. In an open-label trial against vaginal estradiol, 92% on DHEA and 82% on estradiol improved by at least 1 point in dyspareunia at 12 weeks (OR 2.87, 95% CI 1.00 to 8.25, p = 0.051). Vaginal pH, maturity index and clinical signs of atrophy improved more on estradiol [8].
- Population
- 1,611 postmenopausal women with vulvovaginal atrophy in 5 unique RCTs [6]; 482 postmenopausal women (325 on DHEA, 157 on placebo) in one phase 3 RCT [7]; 172 postmenopausal women, mean age 62.4, in the estradiol comparison [8].
- Sources
- [6], [7], [8]
- Caveats
- The phase 3 trial was run by the drug's developer, EndoCeutics. The estradiol comparison was open label. This is a local vaginal treatment and does not describe oral DHEA.
Sexual function in men with low testosterone
Shown to raise sexual desire, erectile function and satisfaction slightly in men with low testosterone, with effects small by usual standards.
The numbers and sources
- Effect
- Compared with placebo, testosterone raised sexual desire by an SMD of 0.17 (95% CI 0.01 to 0.34, 1,383 men), erectile function by 0.16 (95% CI 0.06 to 0.27, 1,344 men) and sexual satisfaction by 0.16 (95% CI 0.01 to 0.31, 676 men) [1].
- Population
- Adult men with morning testosterone of 300 ng/dL or less and at least one symptom, in 4 trials (1,779 men) lasting at least 12 weeks [1].
- Sources
- [1]
- Caveats
- Effect sizes under 0.2 are small by conventional thresholds. Four trials, all judged at low risk of bias.
Peptides and SARMs
Sexual desire in premenopausal women with low desire
Shown to raise sexual desire scores by about 0.35 points over placebo on a 1.2 to 6 scale in premenopausal women with low desire.
The numbers and sources
- Effect
- Over 24 weeks, the desire score rose 0.30 points more than placebo in one trial and 0.42 in the other, 0.35 points across both [1]. On that score, which runs from 1.2 to 6, mean change was 0.5 against 0.2 and 0.6 against 0.2 on placebo [2]. In a 12-week dose-finding trial, the total sexual function score rose 3.6 points against 1.9 on placebo [3].
- Population
- 1,247 premenopausal women with acquired, generalized hypoactive sexual desire disorder, mean age 39, 85.6% white, 96.6% at US sites [1]; 327 premenopausal women with female sexual dysfunction [3].
- Sources
- [1], [2], [3]
- Caveats
- The phase 3 trials were funded by Palatin Technologies and AMAG Pharmaceuticals [1]. The score is self-reported. The label limits use to premenopausal women [2].
Distress about low sexual desire
Shown to lower distress about low desire by about 0.33 points over placebo on a 0 to 4 scale in premenopausal women.
The numbers and sources
- Effect
- Distress related to low desire fell 0.37 points more than placebo in one trial and 0.29 in the other, 0.33 points across both [1]. On that item, which runs from 0 to 4, mean change was -0.7 on bremelanotide and -0.4 on placebo in both trials [2]. In the dose-finding trial, the total distress score changed by -11.1 against -6.8 [3].
- Population
- As above [1][3].
- Sources
- [1], [2], [3]
- Caveats
- Same trials and funding as the desire outcome.
Satisfying sexual events
One trial found satisfying sexual events rose 0.7 a month against 0.2 on placebo in premenopausal women with sexual dysfunction.
The numbers and sources
Supplements
Erectile function
Shown to raise erectile function scores about 3.5 points on a 30-point scale in men with mild to moderate dysfunction, below the minimal important difference.
The numbers and sources
- Effect
- In 9 studies of 587 men with mild to moderate erectile dysfunction, ginseng raised IIEF erectile function scores by 3.52 points (95% CI 1.79 to 5.25) on a 30-point scale, below the 4-point minimal important difference, and by 2.39 points (95% CI 0.89 to 3.88) on a 25-point scale. Self-reported ability to have intercourse improved (RR 2.55, 95% CI 1.76 to 3.69) [7].
- Population
- Men aged 20 to 70, followed up to 12 weeks [7].
- Sources
- [7]
- Caveats
- Certainty was low to moderate, and the Cochrane authors describe the effect on erectile function as trivial [7].
Erectile function
Shown to raise the odds of improvement about 3 times over placebo in men with mild to moderate erectile dysfunction, at 1,500 to 5,000 mg a day.
The numbers and sources
- Effect
- In 10 RCTs with 540 men with mild to moderate erectile dysfunction, 1,500 to 5,000 mg of arginine raised the odds of improvement over placebo or no treatment (OR 3.37, 95% CI 1.29 to 8.77, I² 44%). IIEF erectile function, orgasmic function and satisfaction scores improved, and sexual desire did not change [7].
- Population
- Men with mild to moderate erectile dysfunction [7].
- Sources
- [7]
- Caveats
- Doses and durations varied. The analysis included arginine combined with other substances alongside arginine alone [7].
Erection hardness
One small trial found erection hardness improved in 50% of men with mild erectile dysfunction on 1.5 g a day, against 8.3% on placebo.
The numbers and sources
- Effect
- In 24 men (mean age 56.5) with mild erectile dysfunction, 1.5 g a day for a month moved erection hardness from score 3 to 4 in 12 men (50%), against 2 men (8.3%) during a month of placebo. Intercourse rose from 1.53 to 2.3 times a month [13].
- Population
- 24 men with mild erectile dysfunction [13].
- Sources
- [13]
- Caveats
- Single-blind, not randomized in order, one month per phase, 24 men. No meta-analysis located.
Sexual function and desire
Small trials found better sexual function scores than placebo in some groups, including men with mild erectile dysfunction, with no effect in healthy cyclists.
The numbers and sources
- Effect
- A systematic review of 4 RCTs found positive effects on sexual desire or dysfunction in two, no effect in healthy cyclists in one, and better IIEF-5 scores in one trial in erectile dysfunction [1]. In 50 men with mild erectile dysfunction, 2,400 mg a day for 12 weeks raised IIEF-5 more than placebo (1.6 vs 0.5 points) [2]. In 45 women with antidepressant-induced sexual dysfunction, 3.0 g a day for 12 weeks gave higher remission rates than placebo, linked to postmenopausal status [3]. In 80 men with late-onset hypogonadism symptoms but normal testosterone, 12 weeks of gelatinized maca improved aging-symptom, erectile function and prostate symptom scores over placebo [4].
- Population
- Healthy adults, men with mild erectile dysfunction, women on SSRIs or SNRIs, older men [1][2][3][4].
- Sources
- [1], [2], [3], [4]
- Caveats
- The review judged the number of trials, sample sizes and quality too limited for firm conclusions [1].
Erectile function
Mixed results: a meta-analysis found erectile function scores about 3 points higher than placebo in men with erectile dysfunction, while one small trial found no change.
The numbers and sources
- Effect
- A meta-analysis of 8 studies found tribulus raised IIEF-5 by 3.23 points (95% CI 1.89 to 4.58) and IIEF-15 by 14.44 points (95% CI 5.75 to 23.14) more than placebo [6]. A systematic review found improvement in 3 of the 5 studies that measured erectile function, at 400 to 750 mg a day for 1 to 3 months, and rated the evidence low [7]. In 180 men with mild or moderate erectile dysfunction, Tribestan at six 250 mg tablets a day for 12 weeks raised the IIEF score 2.70 points more than placebo (95% CI 1.40 to 4.01), with gains in intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction [8]. In 30 men aged 40 or older, 800 mg a day for 30 days did not change IIEF-5 compared with placebo (p = 0.79) [3].
- Population
- Men with erectile dysfunction in RCTs [6][7]; men aged 18 to 65 in Bulgaria [8]; 30 men in Brazil [3].
- Sources
- [6], [7], [3], [8]
- Caveats
- Single trials disagree [3][8]. Half the studies in the 2025 review had low methodological quality by Jadad score [7]. The larger trial tested a branded extract made by Sopharma AD, and its funding is not stated in the abstract [8]. Doses and durations differed.
Sexual function and libido
Not shown to improve sexual function or quality of life in men with an enlarged prostate, in very low certainty evidence.
The numbers and sources
- Effect
- Across 6 RCTs, sexual function did not differ from placebo (Hedges' g -0.08, 95% CI -0.93 to 0.77, I² 96%). In the trials that used the IIEF questionnaire, the result was g -0.21 (95% CI -0.54 to 0.13, I² 29%). Quality of life did not improve either [8].
- Population
- Men with benign prostatic hyperplasia in 6 RCTs [8].
- Sources
- [8]
- Caveats
- Certainty was very low. The pooled analysis combined different sexual function questionnaires, and the prediction interval ran from -2.45 to 2.29 [8].
Erectile function
Limited evidence: pooled trials found no change in erectile function over placebo, though men with lower starting scores improved about 2 points.
The numbers and sources
- Effect
- Pooling 2 RCTs (139 participants), the change in IIEF-5 score at 12 weeks did not differ from placebo (WMD 0.91, 95% CI -1.50 to 3.33, I² 89.5%). Men with lower baseline scores improved by 2.15 points (95% CI 1.03 to 3.27) [3]. In a 6-month trial of 45 men with androgen deficiency, the largest improvement came with 200 mg a day combined with concurrent training [4]. A systematic review of 11 human studies found 7 reported an effect on male sexual health and 4 did not [5].
- Population
- Men with erectile dysfunction [3]; men averaging 47 years with androgen deficiency [4]; mixed designs [5].
- Sources
- [3], [4], [5]
- Caveats
- The trial in [4] had no supplement-only or training-only group.
Libido and sexual function
Not studied in people. In diabetic male rats, Cordyceps militaris improved mating behavior and testosterone, and Cordyceps sinensis raised testosterone in mice.
No study in people. This rests on animal studies, lab studies.
The numbers and sources
- Effect
- In male rats made diabetic with streptozotocin, 21 days of Cordyceps militaris improved sperm measures, serum testosterone and copulatory behavior compared with untreated diabetic rats [10]. Cordyceps sinensis and two of its extracted fractions raised testosterone production in isolated mouse Leydig cells and raised plasma testosterone in live mice [11].
- Population
- Wistar rats, healthy and diabetic [10]. Mice and mouse Leydig cells [11].
- Sources
- [10], [11]
- Caveats
- Animal and cell findings do not show an effect on desire or sexual function in people. No human trial of Cordyceps for libido was located in Europe PMC.
Libido
Not studied in people. The claim rests on raising testosterone, which rose in one 12-day trial and in rats but not in later trials in trained men.
No study in people. This rests on how it acts in the body, animal studies.
The numbers and sources
- Effect
- In 23 men given sodium D-aspartate for 12 days and in rats, LH and testosterone release rose [1]. Later trials in resistance-trained men found no rise in testosterone at 3 g a day for 28 days, and a fall at 6 g a day for 14 days [2][3]. Where testosterone is low, raising it does change desire: in 790 men aged 65 or older with low testosterone, a year of testosterone gel raised sexual desire, activity and erectile function against placebo [8]. No study measured libido in people taking D-aspartic acid.
- Population
- Men and rats [1]. Resistance-trained men [2][3]. 790 older men with low testosterone, given testosterone itself [8].
- Sources
- [1], [2], [3], [8]
- Caveats
- The testosterone trial tested the hormone, not D-aspartic acid, in men with low levels [8]. D-aspartic acid's effect on testosterone is itself inconsistent [1][2][3].
Erectile function
Not studied in people. Used traditionally for impotence, its extract and icariin block the PDE5 enzyme in the lab, and icariin protected penile tissue in diabetic rats.
No study in people. This rests on lab studies, animal studies, documented traditional use.
The numbers and sources
- Effect
- In a screen of plant extracts traditionally used for male impotence, Epimedium brevicornum extract inhibited human PDE5, the enzyme sildenafil blocks, by 80% at 50 µg/mL, and icariin had an IC50 of 5.9 µM, about 80 times weaker than sildenafil [9]. In diabetic rats, 3 months of icariin partially preserved the smooth muscle and blood vessel lining of the penis that diabetes damaged [10].
- Population
- Human recombinant enzyme in the lab [9]. Diabetic Sprague-Dawley rats [10].
- Sources
- [9], [10]
- Caveats
- Lab enzyme activity and rat tissue do not show an effect on erections in people. No controlled trial in men was located.
Libido
Not studied in people. Male mice given icariin for 21 days mated sooner and more often than untreated mice.
No study in people. This rests on animal studies, documented traditional use.
The numbers and sources
- Effect
- In 48 male mice, 21 days of icariin shortened the time to mounting and ejaculation and raised the number of both compared with controls, along with higher serum testosterone, nitric oxide and brain dopamine (all p < 0.05) [11]. The plant is among extracts traditionally used for male impotence [9].
- Population
- Male CD1 mice [11].
- Sources
- [11], [9]
- Caveats
- Mating behavior in mice is not human desire. No study of libido in people was located.
Practices
Erectile function
Mixed results: erectile function scores rose 88% in an uncontrolled study of 30 men, and a sham-controlled trial after prostate surgery found no difference.
The numbers and sources
- Effect
- In 30 men with erectile dysfunction for about 4 years, 40 daily sessions improved the erectile function score by 88% (p < 0.0001), and 80% reported a positive outcome [20]. In 109 men randomized after nerve-sparing prostatectomy to hyperbaric oxygen or air under pressure, no outcome differed between groups at 18 months [21].
- Population
- 30 men with a mean age of 59, no control group [20]. 109 men aged 40 to 65, 83 of whom completed follow-up [21].
- Sources
- [20], [21]
- Caveats
- The positive study had no control group. The two studies enrolled different kinds of patients.
Lab markers
Symptoms, physical function and diabetes in men
Linked to sexual symptoms, slower walking and diabetes in men with low calculated free testosterone, including men whose total testosterone was in range.
The numbers and sources
- Effect
- In 3,334 European men aged 40 to 79, the 277 with normal total testosterone and calculated free testosterone below 220 pmol/L were older and in poorer health and reported more sexual and physical symptoms than men with both in range, with lower hemoglobin and bone ultrasound values. The 96 men with low total testosterone and normal free testosterone were younger and more obese and lacked features of androgen deficiency [12]. In three cohorts, men below the 2.5th percentile of a young reference sample for total and free testosterone were more likely to have slow walking speed, difficulty climbing stairs or frailty, and diabetes, than men with normal levels [5]. In the European cohort, the chance of three sexual symptoms rose as free testosterone fell through 160 to 280 pmol/L (46 to 81 pg/mL) [6].
- Population
- 3,334 community-dwelling men aged 40 to 79 in the European Male Aging Study [12]. Men in the Framingham Heart Study, the European Male Aging Study and the Osteoporotic Fractures in Men Study [5]. 3,369 men aged 40 to 79 [6].
- Sources
- [12], [5], [6]
- Caveats
- Cross-sectional, so these studies cannot show which came first. Free testosterone was calculated, not measured, in all three. Two of the three analyses use the same European cohort.
Body fat and sexual function in a trial that lowered estradiol in men
One trial found that blocking estradiol production in men aged 20 to 50 increased body fat and contributed to lower sexual function, while lean mass and strength followed testosterone.
The numbers and sources
- Effect
- Men were given a drug that suppressed their own testosterone and estradiol, then placebo or one of four doses of testosterone gel for 16 weeks. A second group also took anastrozole, which blocks the conversion of testosterone to estradiol. The authors concluded that androgen deficiency accounted for the decreases in lean mass, muscle size and strength, that estrogen deficiency primarily accounted for the increases in body fat, and that both contributed to the decline in sexual function [12].
- Population
- 198 men aged 20 to 50 without anastrozole and 202 with it, treated for 16 weeks [12].
- Sources
- [12]
- Caveats
- One trial of 16 weeks in which hormone levels were set by drugs. The abstract gives no effect sizes for estradiol [12].
Sexual function in women
Mixed results: women's testosterone levels did not track sexual function in one survey, while testosterone treatment improved sexual function in trials of postmenopausal women.
The numbers and sources
- Effect
- In a community survey of 1,021 Australian women aged 18 to 75, no clinically significant relationship was found between a low score in any domain of sexual function and a low total or free testosterone, and the authors concluded that no single androgen level predicts low sexual function [25]. In a meta-analysis of 36 randomized trials, testosterone treatment in postmenopausal women increased satisfactory sexual events (mean difference 0.85, 95% CI 0.52 to 1.18) and sexual desire (standardized mean difference 0.36, 0.22 to 0.50). Acne and hair growth were more likely, and oral testosterone raised LDL cholesterol [26].
- Population
- 1,021 women drawn at random from the electoral roll in Victoria, Australia [25]. 8,480 participants in 36 trials of at least 12 weeks [26].
- Sources
- [25], [26]
- Caveats
- The survey is cross-sectional. The trials tested treatment in women with low sexual desire, not a blood level, and the authors call for study of long-term effects [26].
Outcomes in trials that raised testosterone
Limited evidence: the large testosterone treatment trials enrolled men by total testosterone, so they do not show what correcting a low free testosterone alone does.
The numbers and sources
- Effect
- A trial of 790 men aged 65 or older enrolled on a total testosterone below 275 ng/dL and found improved sexual function with no benefit for vitality or walking distance [15]. A trial of 5,246 men enrolled on two fasting total testosterone levels below 300 ng/dL and found no difference in major cardiac events (hazard ratio 0.96, 95% CI 0.78 to 1.17) [16]. The American Urological Association states that total and free testosterone are not interchangeable and that no clear data point to consistent thresholds between the two below which symptoms appear and above which treatment benefits occur [3].
- Population
- 790 men treated for 1 year [15]. 5,246 men aged 45 to 80, mean follow-up 33.0 months [16].
- Sources
- [15], [16], [3]
- Caveats
- A marker that tracks an outcome is not always one whose correction changes it. Neither trial reports results by free testosterone level in its abstract.
Sexual function, vitality and walking in a trial that raised testosterone in older men
One trial found raising low testosterone in men 65 and older improved sexual function moderately, with no benefit for vitality or walking distance.
The numbers and sources
- Effect
- In 790 men aged 65 or older with testosterone below 275 ng/dL and symptoms, testosterone gel for 1 year raised levels to the mid-normal range for men aged 19 to 40. Sexual activity increased (P below 0.001), as did sexual desire and erectile function. The share of men gaining at least 50 meters in the 6-minute walk did not differ significantly in the Physical Function Trial, and was 20.5% against 12.6% when men from all three trials were pooled. There was no significant benefit for vitality, and mood and depressive symptoms were slightly better [21].
- Population
- 790 men aged 65 or older, mean of two testosterone results below 275 ng/dL, treated for 1 year [21].
- Sources
- [21]
- Caveats
- One trial of 1 year. The authors state that it enrolled too few men to draw conclusions about the risks of treatment [21].
Body composition, physical performance and quality of life in trials that raised DHEA-S
Not shown to change body composition, physical performance, sexual function or quality of life in a meaningful way when DHEA-S was raised with DHEA in older adults.
The numbers and sources
- Effect
- In a 2-year trial in older adults with low DHEA-S, DHEA raised the level by a median of 3.4 µg/mL in men and 3.8 µg/mL in women, which is 340 and 380 µg/dL. It had no significant effect on body composition, and did not change peak oxygen consumption, muscle strength, insulin sensitivity or quality of life. Bone density rose at the femoral neck in men and at the ultradistal radius in women [8]. Across 25 trials in older men, DHEA reduced fat mass slightly (standardized mean difference -0.35, 95% CI -0.65 to -0.05), an effect that disappeared after adjusting for the rise in testosterone and estradiol, with no effect on blood lipids, blood sugar, bone, sexual function or quality of life [9]. A review of 8 trials called the effect on muscle strength and physical function inconclusive [10]. In postmenopausal women, 23 trials found no significant improvement in libido or sexual function (0.35, -0.02 to 0.73) and no significant effect on lipids, glucose, weight or bone density [11]. A Cochrane review found no improvement in quality of life (0.16, -0.03 to 0.34) and more androgenic side effects, mainly acne (odds ratio 3.77, 1.36 to 10.4) [12].
- Population
- 87 older men and 57 older women with low DHEA-S, treated for 2 years [8]. 1,353 older men in 25 trials, mean follow-up 36 weeks [9]. 661 adults aged 50 or older in 8 trials [10]. 1,188 postmenopausal women in 23 trials [11]. 1,273 women in 28 trials [12].
- Sources
- [8], [9], [10], [11], [12]
- Caveats
- A marker that tracks an outcome is not always one whose correction changes it. Low DHEA-S went with more deaths in cohorts. The trials measured body composition, function and quality of life, not deaths. The reviewers of the trials in women rated confidence in the evidence as low [11].
Sexual function in women
One survey found no link between a low free testosterone and low self-reported sexual function in women aged 18 to 75.
The numbers and sources
- Effect
- In a community survey, no clinically significant relationship was found between a low score in any domain of sexual function and a low serum total or free testosterone. A low dehydroepiandrosterone sulfate level did go with low scores in some domains, and the authors concluded that no single androgen level predicts low sexual function in women [13].
- Population
- 1,021 women drawn at random from the electoral roll in Victoria, Australia [13].
- Sources
- [13]
- Caveats
- One cross-sectional survey from 2002 and 2003. A comparison of methods in women found the direct immunoassay had high bias and a higher detection limit than dialysis [14].