The discordance between studies on the lipid effects of testosterone treatment did not appear to be route dependent. Six studies evaluated effects of testosterone treatment on CHF.18–23 In two papers from the same group,19, 20 it is not clear whether treatments were randomly assigned. Although 2 studies reported improvements in angina symptoms during or after testosterone treatment,7, 15 4 studies showed no effect of treatment on angina.1, 4, 8, 16 Most studies did not report any measure of angina symptoms. Six studies involved men in whom the study authors reported evidence of hypogonadism either clinically or based on plasma testosterone concentration 2–6; the remainder included men without regard to plasma testosterone concentration. In studies that investigated the effect of testosterone on patients with coronary artery disease (CAD), eligible men generally were identified based on stable angina, angiographic evidence of some degree of coronary artery occlusion, or a history of myocardial infarction (MI). The PsycNET search was conducted using the term "testosterone" modified by "addiction," "drug dependency," "therapy," "treatment," or "deficiency." The original PsycNET search was conducted for studies published between January 1, 1806 and November 26, 2013. These results were filtered using the key term "clinical trial." Titles and abstracts were reviewed to identify RCTs and eliminate irrelevant studies. Testosterone and methyltestosterone are marketed in the United States for men with congenital or acquired hypogonadism. Testosterone is ineffective in treating erectile dysfunction and controlled trials did not show a consistent effect on libido. Pituitary dysfunction may be a significant cause of testosterone deficiency. A survey of 120 patients who were treated for infertility at the University of Illinois-Chicago found that the incidence of testosterone deficiency was 45% in men with non-obstructive azoospermia, 42.9% in men with oligospermia, and 16.7% in men with obstructive azoospermia.159 There does appear to be a trend towards lower total testosterone and a diagnosis of ED. In studies of men with HIV, 2101, 107 of 5 studies reported an improvement in at least 1 measure of muscle strength; 3 showed no effect.41, 99, 103 Three of these 12 studies (all with Jadad scores of 4 or 5) reported improvements in fewer than 25% of the measurements.11, 53, 81 In studies of men without HIV, 11 of 24 studies (45.8%) reported an improvement in at least 1 measure of muscle strength. Of the 30 studies that assessed muscle strength as a primary or secondary endpoint, 13 studies (43%) reported an improvement in at least 1 measure of muscle strength.11, 18, 53, 81, 83, 84, 88, 93, 94, 101, 102, 104, 107 Eleven of 13 of these studies had a Jadad score of 4 or 5. One study, with a Jadad score of 3, showed no change in weight or estimates of body fat (triceps and scapula skinfold thickness). Two studies showed no changes in body weight or BMI,22, 104 but another showed an increase in body weight and BMI. Some studies did not measure muscle and fat mass specifically but used other body composition endpoints. Specifically, the AUA does not recommend routine PSA testing in men years of age unless they are at higher risk (e.g., positive family history, African American race), at which point decisions regarding PSA testing should be individualized. For patients who have an elevated PSA at baseline, a second PSA test is recommended to rule out a spurious elevation. In the IM testosterone group, there were no new cases of gynecomastia, and one patient with pre-existing gynecomastia had gynecomastia resolution.181 An evaluation for a prolactinoma in such patients is imperative because these benign tumors can be effectively managed using medications, such as bromocriptine or carbergoline. However, the literature at this time fails to define the LH level below which such adjunctive testing is warranted.
