The authors acknowledge the various limitations of their study, including use of a variety of assays to determine testosterone levels and a variety of cut-off values for determining low testosterone; the risk of bias; and the limited follow-up. They call for longer-term high-quality studies to more fully assess the risk of rare adverse events.
The authors note that although some individual RCTs showed a positive effect of testosterone replacement therapy (TRT) on depression and erectile function compared with placebo, in the network meta-analysis no individual TRTs showed a positive effect compared with placebo. This phenomenon has been noted previously and results in a more conservative estimate of effect.