Testosterone deficiency (TD) may induce a series of clinical symptoms. Studies have shown that testosterone supplementation may prevent these unfavourable symptoms and improve patients’ quality of life. Given the conflicting findings across studies, this systematic review aims to evaluate the effects and risks associated with testosterone supplementation in middle-aged or aging males with TD. Electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane. Library were searched to December 2019. The risk of bias of individual included studies and the quality of the aggregate evidence were assessed using the GRADE approach. Our primary outcome was bone mineral density (BMD). Meta-analyses were performed. This systematic review was reported according to the PRISMA statement. A total of 52 randomized controlled trials (RCTs) were included. When compared with placebo, testosterone supplementation did not increase total BMD (short-term: 1081 participants, MD − 0.01 g/cm2, 95% CI − 0.02 g/cm2 to 0.01 g/cm2; long-term: 156 participants, MD 0.04 g/cm2, 95% CI − 0.07 g/cm2 to 0.14 g/cm2), lumbar spine, hip, or femur neck BMD. Furthermore, testosterone supplementation did not decrease the risk of falling or fracture. Lastly, it was found that testosterone supplementation did not increase the risk of cardiovascular events (1374 participants, RR 1.28, 95% CI 0.62 to 2.64), all-cause mortality (729 participants, RR 0.55, 95% CI 0.29 to 1.04), or prostatic events. However, testosterone supplementation may improve sexual function and quality of life (1328 participants, MD -1.32, 95% CI − 2.11 to − 0.52). The effect of testosterone supplementation on BMD and the risk of falls or fracture remains inconclusive. However, supplementation may benefit patients in the areas of sexual function and quality of life without increasing the risk of cardiovascular events, all-cause mortality, or prostatic events. RCTs with a longer follow-up period are still required. We registered our protocol in PROSPERO (CRD42018109738).

中文翻译：

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睾丸激素对睾丸激素缺乏症男性骨骼健康的影响：系统评价和荟萃分析

睾丸激素缺乏症（TD）可能会引起一系列临床症状。研究表明，补充睾丸激素可以预防这些不良症状并改善患者的生活质量。鉴于各研究之间存在矛盾的结果，本系统综述旨在评估与补充睾丸激素对中年或老年TD男性的影响和风险。搜索电子数据库（MEDLINE，EMBASE，PubMed和Cochrane。图书馆至2019年12月。使用GRADE方法评估个体纳入研究的偏倚风险和综合证据的质量。我们的主要结果是骨矿物质密度（BMD） ）。进行了荟萃分析，根据PRISMA声明进行了系统评价，共纳入52项随机对照试验（RCT）。与安慰剂相比，补充睾丸激素并没有增加总BMD（短期：1081名参与者，MD-0.01 g / cm2，95％CI-0.02 g / cm2至0.01 g / cm2；长期：156名参与者，MD 0.04 g / cm2，95％CI-0.07 g / cm2至0.14 g / cm2），腰椎，臀部或股骨颈BMD。此外，补充睾丸激素并不能降低跌倒或骨折的风险。最后，发现补充睾丸激素并没有增加心血管事件的风险（1374名参与者，RR 1.28，95％CI 0.62至2.64），全因死亡率（729名参与者，RR 0.55，95％CI 0.29至1.04），或前列腺事件。但是，补充睾丸激素可能会改善性功能和生活质量（1328名参与者，MD -1.32，95％CI-2.11至-0.52）。补充睾丸激素对BMD的影响以及跌倒或骨折的风险尚无定论。但是，补充可能会在性功能和生活质量方面使患者受益，而不会增加心血管事件，全因死亡率或前列腺事件的风险。仍然需要随访时间较长的RCT。我们在PROSPERO（CRD42018109738）中注册了我们的协议。