Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study

Abstract

Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.

Keywords: neurocognitive function; obstructive sleep apnea; sexual desire; testosterone supplementation.

Figure 1

Changes in sexual desire over time. Data are the mean change from baseline and standard error of the mean at each time point for men treated with testosterone (black line with triangles) or placebo (grey line with circles). The overall between group difference is indicated by the p value, determined by mixed model analysis.

Figure 2

Between-group difference in sexual function. Data are between-group difference (testosterone minus placebo) and 95% confidence intervals of the change from baseline averaged across time in sexual function domains. Significant differences are indicated by **.

Figure 3

Quality of life changes with testosterone for those with high (>8 nmol/L) and low (<8 nmol/L) baseline testosterone concentrations. Data are the mean change from baseline and standard error of the mean for men treated with testosterone (squares) and placebo (circles) in men with baseline testosterone below (solid lines) and above (dashed lines) 8 nmol/L. Data are shown for feeling down (upper right panel), vitality (lower left panel) and nervousness (lower right panel). The p-values for the overall interaction term are shown at the bottom of each panel, and for between-group differences on the right-hand side of each panel. The solid bar indicates significant differences between testosterone and placebo in those with baseline testosterone concentrations below 8 nmol/L are shown with the solid vertical line, and above 8 nmol/L with the dotted lines.