Supervisors info:
Νικόλαος Μαστοράκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεόδωρος Καλαμπόκας, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Όλγα Τριανταφυλλίδου, Ακαδημαϊκή Υπότροφος, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Low levels of testosterone and sexual desire loss are common characteristics of
hypogonadism, which is an endocrine disorder often occurring in men. Sexual dysfunction is an
uncomfortable condition that both hypogonadal and diabetic men experience nowadays, however
the diagnosis and treatment strategies are limited. Type II diabetes is a lifelong disorder of abnormal
glucose metabolism with devastating health effects on patients. Sex-related hormones, that normally
regulate the reproductive cycle, are found significantly reduced in conditions where the functional
activity of the gonads is decreased. An imbalance in the levels of these hormones is also associated
with metabolic abnormalities, such as hyperglycemia and insulin resistance. The effectiveness of
the existing therapies for sexual dysfunction treatment and the restoration of reproductive hormones
in hypogonadal men with type II diabetes remain unexplored.
Methods: We searched the Cochrane Library, Scopus, Science Direct and the Web Search engine
“Google Scholar” from January 2011 to July 2021. Randomized controlled trials (RCTs) were
included, comparing the treatment of sexual dysfunction and the restoration of sex-related hormones
in hypogonadal men with type II diabetes with testosterone replacement or administration of
vardenafil or clomiphene citrate, versus placebo treatment. Fixed effect meta-analysis was
performed to estimate pooled proportions with 95% confidence intervals (CI).
Results: The review includes nine RCTs regarding: a) Testosterone replacement therapy (five RCTs)
and administration of b) Vardenafil (one RCT) or c) Clomiphene citrate (three RCTs) for the
treatment of sexual dysfunction in diabetic men with hypogonadism. The aspects of sexual function
were evaluated by estimating the: a) Aging male’s symptoms’ (AMS) rating scale, b) Erectile
Function, c) Intercourse Satisfaction, d) Orgasmic Function, e) Sexual Desire, f) Overall Sexual
Satisfaction, g) levels of E2 (pg/mL), h) levels of FHS (mU/mL), i) levels of LH (mU/mL), j) levels
of SHBG (nmol/L) and k) levels of free testosterone (nmol/L). Our findings suggest that a)
testosterone replacement therapy or administration of vardenafil resulted in improved erectile
function (95% Cl -0.485 to -0.165; 6 RCTs; I2=94,8%, p=6.5e-05), b) testosterone supplementation
ameliorated intercourse satisfaction (95% Cl -0.4 to -0.064; 4 RCTs; I2=54,5%, p=0.006783),
orgasmic function (95% Cl -0.674 to -0.325; 4 RCTs; I2=94,6%, p=0) and sexual desire (95% Cl -
0.446 to -0.124; 5 RCTs; I2=94,3%, p=0.00509), but had no impact on AMS rating scale (95% Cl -
0.286 to 0.057; 4 RCTs; I2=93,1%, p = 0.191643) and overall satisfaction (95% Cl 0.03 to 0.402; 3
RCTs; I2=95%, p=0.023112) and c) administration of clomiphene citrate led in elevated levels of
E2 (95% Cl -1.531 to -0.756; 3 RCTs; I2=0%, p=0), LH (95% Cl -0.674 to -0.325; 3 RCTs; I2=0%,
p=0), FSH (95% Cl -1.372 to -0.612; 3 RCTs; I2=0%, p=0), SHBG (95% Cl -0.938 to -0.207; 3
RCTs; I2=0%, p=0.002151) and free testosterone (95% Cl -1.864 to -1.204; 3 RCTs; I2=83.1%, p=0),
compared to placebo treatment in hypogonadal men with type II diabetes.
Conclusions: Hypogonadal males with type II diabetes receiving either testosterone
supplementation, or the compounds vardenafil and clomiphene citrate, displayed improved sexual
function and elevated levels of sex-related hormones, versus placebo treatment.
Keywords:
Hypogonadism, Testosterone, Sexual dysfunction, Diabetes, Hormones
