這篇文章探討了睪固酮替代療法（Testosterone Replacement Therapy, TRT）對低睪固酮症男性的性功能和低睪固酮症狀的影響。研究以隨機對照試驗形式進行，評估TRT在改善性功能、性欲及低睪固酮症狀方面的效果。

文章指出，性功能障礙是中老年男性常見問題，睪固酮水平隨年齡增長而下降，導致性欲低落和勃起功能障礙，本研究共有5204名45至80歲的男性參與研究，他們的睪固酮濃度低於300 ng/dL，並具有性欲低落及心血管疾病或風險增加的情況。研究對象隨機分配接受1.62%的睪固酮凝膠或安慰劑凝膠，每天使用。

研究結果顯示，TRT在改善性活動方面顯著優於安慰劑，且這一效果在24個月內持續存在。此外，TRT在改善低睪固酮症狀和性欲方面也優於安慰劑，但在改善勃起功能方面效果有限。這表明TRT能提高中老年男性的性活動和性欲，但對勃起功能的改善效果有限。

從專業角度來看，這項研究提供了有價值的數據支持，證實了TRT在改善中老年男性性功能和低睪固酮症狀方面的潛在益處。然而，TRT在改善勃起功能方面效果有限，臨床醫生需綜合考量患者具體症狀和需求。除了確保TRT的療效持續及安全性外，也要考慮根據個別患者的需求加入不同的治療方法。

值得注意的是，TRT的效果和安全性需在臨床實踐中謹慎評估，特別是心血管風險增加的男性群體。研究設計及多中心參與提高了結果的可靠性和廣泛適用性。不過一新發表在Progress in Cardiovascular Disease的文章統合分析三十個隨機對照試驗的文章所得出的結論是：對於性腺功能減退症的患者，睪固酮替代療法不會增加心血管疾病的風險和全因死亡率。

總的來說，這篇研究為TRT在改善男性性功能和低睪固酮症狀方面提供了有力的證據，為臨床實踐提供了重要參考。同時，研究強調在使用TRT過程中需謹慎監測和長期追蹤，以確保治療的安全性和有效性。未來需要更多針對不同人群的研究，以全面了解TRT的適用範圍和最佳使用方法。

Context
Few long-term randomized trials have evaluated the efficacy of testosterone replacement therapy (TRT) in improving sexual function and hypogonadal symptoms in men with hypogonadism and whether effects are sustained beyond 12 months.

Objective
The Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) study evaluated the effect of TRT on major adverse cardiovascular events in middle-aged and older men with hypogonadism. The Sexual Function Study, nested within the parent trial, determined testosterone’s efficacy in improving sexual activity, hypogonadal symptoms, libido, and erectile function among men reporting low libido.

Methods
Among 5204 men, 45-80 years, with 2 testosterone concentrations <300 ng/dL, hypogonadal symptoms, and cardiovascular disease (CVD) or increased CVD risk enrolled in the TRAVERSE trial, 1161 with low libido were enrolled in the Sexual Function Study (587 randomized to receive 1.62% testosterone gel and 574 to placebo gel for the duration of their participation in the study). Primary outcome was change from baseline in sexual activity score. Secondary outcomes included hypogonadal symptoms, erectile function, and sexual desire.

Results
TRT was associated with significantly greater improvement in sexual activity than placebo (estimated mean [95% CI] between-group difference 0.49 [0.19,0.79] and 0.47 [0.11, 0.83] acts per day at 6 and 12 months, respectively; omnibus test P = .011); treatment effect was maintained at 24 months. TRT improved hypogonadal symptoms and sexual desire, but not erectile function, compared with placebo.

Conclusion
In middle-aged and older men with hypogonadism and low libido, TRT for 2 years improved sexual activity, hypogonadal symptoms, and sexual desire, but not erectile function.