Efficacy of Testosterone Replacement Therapy in Men WithHypogonadism: A Systematic Review and Meta-Analysis of ClinicalOutcomes, Body Composition, and Quality of Life

Background: Male hypogonadism is associated with sexual, physical, and psychological manifestations, and testosterone replacement therapy (TRT) is used to restore testosterone levels and relieve symptoms. Objective: To evaluate the efficacy of TRT in adult men with hypogonadism across erectile function, hypogonadal symptoms, fatigue, body composition, waist circumference, urinary symptoms, and quality of life. Methods: This systematic review and meta-analysis followed PRISMA guidance. PubMed/MEDLINE, Google Scholar, and ScienceDirect were searched. Fourteen studies involving 1,388 participants were included. Effect estimates were synthesized as standardized mean differences using random-effects models, and heterogeneity was assessed with I2, Cochrans Q, and t2. Results: TRT was associated with favorable pooled effects on erectile function, hypogonadal symptoms, fatigue, lean mass, fat mass, waist circumference, and quality of life. No consistent effect was observed for lower urinary tract symptoms. Heterogeneity was high for erectile function, hypogonadal symptoms, waist circumference, and urinary symptoms; moderate for body-composition outcomes; and low for fatigue and quality of life. Randomized trials generally yielded smaller effect estimates than observational studies. Conclusions: TRT was associated with improvement across several clinical and body-composition outcomes in hypogonadal men, although effect magnitude varied substantially by outcome and study design. The high heterogeneity for several outcomes and the larger estimates in observational studies warrant cautious interpretation and support the need for longer, high-quality randomized trials.