In the meta-analysis that underpins much of the modern guidance, testosterone therapy improved several sexual-function endpoints in postmenopausal women, including satisfying sexual events, desire, arousal, orgasm, pleasure, and self-image. The research paper provides a thorough summary of the selection criteria and covers testosterone's effects on depression, vascular endothelium, muscle strength, bone health, and sexual function (Figure 1). The research encompasses testosterone's effects on sexual function, bone health, muscle strength, depression, and vascular endothelium (Figure 1) and presents a detailed overview of the selection criteria.
Pearl et al. (52) performed a retrospective study including 120 patients and reported that IPSS decreased by an average of 7.42 for patients with severe IPSS after treatment of TRT. A systematic review including 6 RCTs reported that the improvements of sexuality and erectile function were significant after treatment of TRT compared with placebo (48). The systematic review and meta-analysis included 28 RCTs (3253 patients) published since 1990. Notably, the subgroup analysis exclusively for RCTs published after 2010 demonstrated a significant enhancement in erectile function with TRT (Supplementary Figure 1).
The evidence is much narrower than many clinic pages suggest. This article is based on scientific evidence, written by experts and fact checked by experts. Fenugreek may also reduce cholesterol levels, lower inflammation, and help with appetite control, but more research is needed in these areas. In humans, fenugreek may cause mild side effects, although it appears relatively safe at the correct dosage. Although most of these side effects haven’t been confirmed in humans, and the dosages used are unusually high, some scientists are concerned about the use of fenugreek supplements. Given its effect on blood sugar, fenugreek should be used with caution if you’re taking diabetes medication or other supplements that lower blood sugar levels. However, as with most supplements, less serious side effects like diarrhea and indigestion have been reported anecdotally.
Konaka revealed that the difference in changes of PSA levels between two groups was not obvious with an increase in the duration of testosterone administration to 52 weeks (39). However, the elevation of PSA levels was within the normal range and the time of administration of testosterone was only 6 months. Santella showed that TRT would not increase the risk of prostate cancer in men with LOH (61). However, in clinical practice, the PSA level does not necessarily increase with rising testosterone levels when elevated to eugonadal levels (58). The conclusive findings indicate that TRT does not promote prostate growth in patients with hypogonadism. Importantly, all 23 RCTs included patients both with and without prostate enlargement at baseline. A meta-analysis performed by Cui (54) suggested that TRT showed no significant changes in IPSS, PV and Qmax compared with placebo.
The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods (24). Two reviewers independently assessed the quality of randomization methods, allocation concealment, baseline imbalances, whether blinding was done adequately and who was blinded, monitoring of adherence to the medication use, and whether analysis was done by intention-to-treat. To assess the quality of the included study, we used Cochrane Collaboration's Risk of Bias assessment tool (23). When the data were not available in the published articles or a further clarification was needed, we contacted the authors by e-mail. Relevant studies were screened and selected using DistillerSR (Evidence Partners Inc), which is a web-based software specifically designed to conduct systematic reviews. Experts from The Endocrine Society were contacted to verify the final list and identify any missing studies.
The PSA levels were normal for all patients at baseline, and no patient underwent a prostate biopsy at the start of the study. The strongest evidence supports improved sexual desire and related sexual-function outcomes in postmenopausal women with HSDD. Oral testosterone is generally not recommended because of unfavorable lipid effects, and long-term safety data remain more limited than many patients realize. But current consensus documents say the evidence is insufficient to recommend testosterone therapy for cognition, general wellbeing, depressed mood, musculoskeletal health, or disease prevention. The benefits of trt for women may include better sexual desire and related sexual-function measures in selected postmenopausal women. If the question is where testosterone therapy may actually help women, the clearest answer is sexual desire in appropriately selected postmenopausal women with HSDD.

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