Identifying the outcomes important to men with hypogonadism: a qualitative evidence synthesis

Magaly Aceves Martins, Richard Quinton, Miriam Brazzelli, Moira Cruickshank, Paul Manson, Jemma Hudson, Nick Oliver, Rodolfo Andrés Hernández, Lorna Aucott, Frederick C W Wu, Waljit S. Dhillo, Siladitya Bhattacharya, Katie Gillies* (Corresponding Author), Channa N Jayasena* (Corresponding Author), NIHR Testosterone Efficacy & Safety (TestES) Consortium

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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OBJECTIVE: Men with male hypogonadism (MH) experience sexual dysfunction, which improves with testosterone replacement therapy (TRT). However, randomised controlled trials (RCTs) provide little consensus on functional and behavioural symptoms in hypogonadal men; these are often better captured by qualitative information from individual patient-experience.
METHODS: We systematically searched major electronic databases to identify qualitative data from men with hypogonadism, with or without TRT. Two independent authors performed the selection, extraction and thematic analysis of data. Quality of eligible studies was assessed using the Critical Appraisals Skills Programme (CASP) and Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADECERQual) tools.
RESULTS: We analysed data from five studies published in nine reports that assessed a total of 284 participants. Published data were only available within North America, with no ethnic minority or other underserved groups included. In addition to sexual dysfunction, men with MH experienced adverse changes in physical strength, perceptions of masculinity, cognitive function and quality of
life. The experience of MH appeared dependent on the source(s) of educational material.
DISCUSSION: We propose a patient-centred approach to clinician interactions rather than focusing on discreet MH symptoms. Current evidence about the experience of MH is limited to North America and predominantly white ethnicity, which may not be broadly applicable to other geographic regions.
Broadening our understanding of the MH experience may improve the targeting of information to patients. In addition, a multidisciplinary approach may better address symptoms neither attributable to MH nor alleviated by TRT
Original languageEnglish
Pages (from-to)625-641
Number of pages17
JournalJournal of Andrology
Issue number4
Early online date8 Feb 2022
Publication statusPublished - 20 Apr 2022

Bibliographical note

We are indebted to members of the patient panel for their feedback and comments.
This paper presents independent research funded by the National Institute for Health Research (NIHR) and supported by the NIHR Biomedical Research Centre at Imperial College Healthcare NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. This project was supported by an NIHR Health Technology Assessment grant (17/68/01). The Section of Endocrinology and Investigative Medicine, Imperial College London is funded by grants from the MRC, BBSRC, NIHR, an Integrative Mammalian Biology (IMB) Capacity Building Award, an FP7- HEALTH- 2009- 241592 EuroCHIP grant and is supported by the NIHR Biomedical Research Centre Funding Scheme. The following authors are also funded as follows: NIHR Research Professorship (WSD); NIHR Post-Doctoral
Fellowship (CNJ).


  • male hypogonadism
  • testosterone replacement therapy
  • qualitative systematic review


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