Testosterone and sexual dysfunction in men: perception vs. reality


Sexual dysfunction begins and ends with Testosterone.  Or does it?


Is sexual dysfunction and Testosterone in men evidence-based reality?




Is this sexual dysfunction and Testosterone in men based on perception without evidence?


The saying goes perception is reality.  What separates reality from perception is the evidence.  Perception can equal reality only without the knowledge of the evidence or the knowledge of biased evidence.  This connection or disconnection to reality of the evidence applies to physicians as much as it does to non-physicians i.e. patients.  In fact, the weight of responsibility falls squarely on the shoulders of physicians and medical providers to ensure that reality is based on evidence, not perception.

Testosterone, libido, and ED in men is the perfect example of perception based reality versus evidence-based reality.  So much of what is passed today as medical evidence is nothing more than marketing with a bow of scientific evidence for good looks.  The perception is that low Testosterone 100% equals low libido and ED in men.  The perception is that Testosterone therapy is the answer for all men with low libido and ED.  The perception is that Testosterone therapy will restore a man’s sex drive and performance to that of his youth. This perception of Testosterone and sexual function has even moved into the area of sexual dysfunction in women.

Here, perception does not equal evidence-based reality.

When it comes to sexual dysfunction and Testosterone, marketing has created an alternate reality devoid of scientific evidence.  How can a man with a total Testosterone of 626 ng/dl (optimal) have ED and low libido?  How can a women have a total Testosterone level of 488 ng/dl (normal is 30-60) and have low libido?  The answer can only be that the reality is based on perception and not on the evidence.

Marketing feeds the perception that Testosterone therapy in men is an aphrodisiac, but what does the evidence say?  As it relates to Testosterone, libido, and ED in men, the evidence may surprise you.  The findings of a recently published systemic review  that looked at randomized controlled trials from 1950 to 2016 found:

  • “of 47 studies that assessed sexual function or satisfaction…24 studies did not show testosterone-associated improvements in any sexual function endpoint.”


  • “Of 31 studies that evaluated erectile function, 15 found no improvements with testosterone therapy”


  • “Twelve studies included men with ED; 8 found no benefit of testosterone over placebo”


  • “Of 23 studies that specially reported changes in libido…eight found no effect”


  • “Five studies found no difference between testosterone and placebo on total scores (libido and sexual function), and 4 studies found a benefit of testosterone.”


What does the evidence reveal about Testosterone and ED/libido in men?  At best, Testosterone is associated with the cause and resolution of sexual function/dysfunction in only 50% of the cases in men.  Restated, approximately 50% of men with low libido and ED will find no improvement in ED and low libido symptoms.  Contrast that evidence-based reality with that of the marketing-based presumption that Testosterone is the ultimate aphrodisiac.  There is actually very little evidence for that line of thinking.  Testosterone is not an aphrodisiac.  It is this confusion between the evidence and the marketing that have set unrealistic expectations of Testosterone therapy for both male patients and for their treating physicians.  The result leads to excessive Testosterone replacement, in effect doping instead of Testosterone replacement, to reach a perception-based end point that has no evidence basis in reality.

In the case of Testosterone therapy and ED/libido in men, the marketing-based perception is not reality.  The evidence-based reality for Testosterone therapy and ED/libido in men is that 50% of men will find no change in libido and/or sexual performance.  That is the evidence.

The next post will look at the perception reality vs evidence-based reality of Testosterone and sexual dysfunction in women.

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