Low serum testosterone levels are poor predictors of sexual dysfunction

BJU Int. 2011 Jul;108(2):256-62. doi: 10.1111/j.1464-410X.2010.09766.x. Epub 2010 Oct 18.


Objective: • To identify predictors of sexual dysfunction using baseline data from the reduction by dutasteride of prostate cancer events (REDUCE) study.

Patients and methods: • REDUCE was a 4-year randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of once-daily dutasteride 0.5 mg in over 8000 men aged 50-75 years with a prostate-specific antigen (PSA) level of 2.5-10 ng/mL (50-60 years) or 3.0-10 ng/mL (>60 years) and a negative prostate biopsy within 6 months of enrolment. • Baseline values (mean serum testosterone, age, International Prostate Symptom Score [IPSS], total prostate volume [TPV], body mass index [BMI], and presence of diabetes/glucose intolerance) were compared in subjects with and without sexual dysfunction (sexual inactivity, impotence, decreased libido or a Problem Assessment Scale of the Sexual Function Index [PAS-SFI] score <9).

Results: • Multivariate logistic regression showed that baseline age and IPSS were significant predictors of all four sexual function criteria examined (P < 0.0001). • BMI was a significant predictor of decreased libido, impotence and a PAS-SFI score <9, while diabetes/glucose intolerance was a significant predictor of sexual inactivity, impotence and a PAS-SFI score <9. • Testosterone and TPV were not significant predictors of any sexual function criterion examined.

Conclusions: • Age, IPSS, BMI and diabetes/glucose intolerance, but not serum testosterone or TPV, were significant independent predictors of sexual dysfunction in the REDUCE study population. • The lack of association between sexual dysfunction and serum testosterone questions the value of modestly reduced or low normal testosterone levels as criteria for choosing testosterone replacement in older men with sexual dysfunction.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 5-alpha Reductase Inhibitors / adverse effects
  • 5-alpha Reductase Inhibitors / therapeutic use*
  • Aged
  • Azasteroids / adverse effects
  • Azasteroids / therapeutic use*
  • Biomarkers / blood
  • Body Mass Index
  • Dutasteride
  • Epidemiologic Methods
  • Humans
  • Libido
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / complications
  • Prostatic Neoplasms / drug therapy
  • Prostatism / complications
  • Prostatism / drug therapy*
  • Sexual Dysfunction, Physiological / diagnosis*
  • Testosterone / administration & dosage
  • Testosterone / blood*


  • 5-alpha Reductase Inhibitors
  • Azasteroids
  • Biomarkers
  • Testosterone
  • Prostate-Specific Antigen
  • Dutasteride