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M
artits
AM
et
al
.
406
R
ev
A
ssoc
M
ed
B
ras
2014; 60(5):404-414
not seem to have an effect on the sexual function of eu-
gonadal males (
B
).
12
Long acting injectable testosterone
has demonstrated greater tolerability and more physio-
logical action (
B
),
15
while the oral form was not effective
in improving sexual symptoms (
A
).
17
Studies suggest a direct relationship between free
testosterone and vasodilation of the
corpora cavernosa
. As
such, testosterone therapy presents a synergic effect on
patients with ADAM that have responded partially to
phosphodiesterase inhibitors, significantly improving
erectile dysfunction in such patients (
B
).
12,13,18
Ultimately,
when erectile dysfunction does not respond to testoste-
rone treatment, the combination of phosphodiesterase
inhibitors should be considered (
B
).
2
Not only testosterone but also DHEA has been consi-
dered an important androgen for adequate sexual function,
although its effectiveness in improving sexual symptoms
and erectile dysfunction has not been demonstrated (
A
).
19
Recommendation
Testosterone replacement therapy is recommended for
improving libido and sexual function only in patients
with low testosterone levels. The use of testosterone is re-
commended for improving the libido and sexual func-
tion of patients with ADAM.
W
hat
is
the
role
of
androgen
replacement
therapy
(ART)
to
improve
mood
,
quality
of
life
and
cognitive
functions
?
The influence of testosterone replacement therapy on the
quality of life of older men has been widely evaluated. Al-
though the majority of studies do not have good eviden-
ce, an important improvement on quality of life after tes-
tosterone replacement has been suggested in both
hypogonadal and eugonadal men.
Comparing the quality of life of men with ADAM
that use testosterone with those that do not, the improve-
ment in the quality of life of the group using testosterone
could be relative, i.e. determined by the decline in quality
of life of the placebo group, suggesting a possible positi-
ve effect of testosterone on preventing the decline in qua-
lity of life with age (
A
).
3
Furthermore, the improvement
of physical function and control and somatic and sexual
symptoms with testosterone replacement improves the
quality of life of patients with ADAM, and may consti-
tute an important treatment strategy in old age (
A
)
4
(
B
).
5
The effects of testosterone replacement on cogniti-
ve functions, mood and sense of wellbeing in men with
ADAM are not yet clear. However, studies with excellent
evidence have demonstrated that regardless of the route
of administration, dose or treatment time, testosterone
replacement does not affect cognitive function, mood or
quality of life in men with ADAM (
A
)
20,21
(
B
).
22
Recommendation
Testosterone replacement improves mood and quality of
life in men with ADAM; however, there is no evidence of
a direct effect of testosterone over the above, or over cog-
nitive function. It is strongly recommended not to use
testosterone to specifically improve mood, quality of life
or cognitive functions in men with ADAM.
W
hat
is
the
influence
of
androgen
replacement
therapy
(ART)
on
the
metabolism
of
carbohydrates
and
lipids
?
Hyperinsulinemia and insulin resistance (IR) are antece-
dents of type 2
diabetes mellitus
(T2DM) and metabolic
syndrome, which in turn is characterized by IR associa-
ted with changes in lipid profile, among others. Type 2
diabetes is often associated with male hypogonadism, and
it has also been suggested that testosterone replacement
improves glycemic control as well as the body fat in pa-
tients with T2DM (
B
).
23
Replacement therapy with injectable testosterone has
been shown to be effective in improving insulin resistan-
ce and glycemic control with a significant reduction in
fasting blood glucose and glycated hemoglobin (HbA1c)
in hypogonadal men with type 2 diabetes (
A
)
7
or metabo-
lic syndrome (
C
).
16
Similar efficacy has also been obser-
ved in the metabolic syndrome parameters, with a signi-
ficant reduction in waist circumference, blood pressure,
total cholesterol, LDL and triglycerides and an increase
in HDL levels, albeit without changes in the dietary pat-
terns (
C
).
16
An additional effect to that described abo-
ve has been observed in the administration of long-ac-
ting testosterone. Patients with metabolic syndrome and
ADAM achieved a dramatic reduction in the levels of in-
sulin, leptin, HOMA-R and inflammatory markers such
as IL-1
b
, TNF
a
and PCR (
A
).
9
The association of testosterone with an aromatase
inhibitor leads to a significant increase in the testostero-
ne/estradiol ratio and thereby a significant reduction in
triglyceride levels in such patients. Therefore, this com-
bination may be particularly useful in patients with hy-
pertriglyceridemia. However, the safety of the use of this
association has not yet been established (
A
).
24
Ultimately, the effects of testosterone on carbohydra-
te and lipid metabolism are still uncertain. Testosterone
treatment in hypogonadal men with type 2 diabetes and/or