Efficacy of testosterone replacement therapy for treating metabolic disturbances in late-onset hypogonadism: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 34089171 · doi:10.1007/s11255-021-02876-w
What was done
A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 1964 and November 2019 was performed across PubMed/Medline, Embase, and Cochrane databases following PRISMA guidelines. The study evaluated the effect of testosterone replacement therapy (TRT) versus placebo on metabolic, lipid, and anthropometric markers in men with late-onset hypogonadism. Across 1,562 screened articles, 17 were selected for qualitative analysis and 16 RCTs (n = 1,373 total; 709 TRT, 664 placebo) were included in the quantitative meta-analysis.
What was found
Compared with placebo, TRT resulted in statistically significant reductions in glycemic and metabolic markers: - HbA1c: Mean Difference (MD) = -0.172 (95% CI: -0.329 to -0.015) - HOMA-IR: MD = -0.514 (95% CI: -0.863 to -0.165) - Serum insulin: MD = -12.622 (95% CI: -19.660 to -5.585) - Leptin: MD = -2.381 (95% CI: -2.952 to -1.810) For lipid and anthropometric profiles: - Total cholesterol decreased significantly: MD = -0.433 (95% CI: -0.761 to -0.105) - HDL cholesterol decreased significantly: MD = -0.069 (95% CI: -0.121 to -0.018) - Waist circumference decreased significantly: MD = -0.1640 (95% CI: -2.857 to -0.423)
Why it matters
In men with late-onset hypogonadism, TRT improves glycemic control, insulin resistance, and total cholesterol, but it is accompanied by a slight decrease in HDL cholesterol.
Limits
The total sample size was modest (1,373 participants across 16 trials, averaging ~86 participants per trial). The abstract does not report measurement units, specific TRT formulations or dosages, intervention durations, baseline metabolic comorbidities, or clinical cardiovascular safety outcomes.
Cited by
- supports Exogenous testosterone and androgen administration lowers and suppresses HDL cholesterol levels.