Funnel plot of the studies represented in the meta-analysis. A funnel plot was constructed to assess publication bias in the meta-analysis of PSA with a stent indwelling, including all 24 studies. In all 28 RCTs, patients were subjected to vigilant and regular monitoring, with a protocol in place to cease treatment promptly upon the detection of signs indicative of prostate cancer or other serious complications. Two researchers extracted data independently such as first author, year, country, therapy, participants, duration, administration, method, characteristics of patients and dosage. Only RCTs were included in the meta-analysis after all studies were browsed by two independent reviewers. However, some studies revealed that symptoms related to LOH may not be correlated with serum total testosterone levels (9, 10).
Additionally, testosterone is essential for muscle mass regulation, as it promotes protein synthesis and muscle hypertrophy by binding to androgen receptors in muscle cells . Each domain was rated as having a "low," "moderate," or "high" risk of bias; the other 2 authors (AR and GB) made the compilation and screening as well as reviewing the selected studies. Publications that utilized descriptive, observational, or experimental designs involving human subjects and assessed the effects of testosterone were included based on the established criteria (Figure 1). This influence is important for maintaining vascular health and has implications for cardiovascular function . Testosterone levels naturally decline with age, which can lead to sarcopenia (age-related muscle loss) and decreased muscle strength. This anabolic effect enhances muscle growth and repair, making testosterone essential for maintaining muscle mass 15,16-17. Testosterone is undoubtedly the primary testicular hormone affecting bone metabolism.
DHT has a more potent androgenic effect and is crucial for the development of male secondary sexual characteristics and the maintenance of prostate health . Of the myriad hormones that orchestrate bodily functions, testosterone stands out due to its profound and multifaceted impact on health . Given the potential benefits of testosterone therapy, ongoing research and clinical exploration are highly recommended to deepen our understanding of its full range of effects and to refine therapeutic strategies. Recent landmark trials have demonstrated that testosterone therapy offers modest benefits, particularly for older men with low testosterone levels and symptoms of hypogonadism. However, these findings are limited by the small sample sizes and the relatively few studies available on this topic, warranting further research to better understand the full scope of testosterone's effects. This study aims to explore the critical and multifaceted role of testosterone in the physiology of healthy individuals. In addition to these physical features, testosterone is vital for reproductive health as libido, erectile function, and spermatogenesis, the process of sperm production; its impact extends across multiple bodily systems, highlighting its importance for physical traits and overall health and fertility.
The selection, screening, and assessment of the chosen studies were assisted by the remaining authors, AR and AFR. However, the use of a carefully planned randomized controlled trial (RCT) is advised in order to bolster the evidence even further and offer more conclusive findings. We provide a table that summarizes all the data gathered on the comparison of different factors linked to the ones previously discussed in order to improve comprehension of the data. The increase in sex steroid production during puberty speeds up bone mineral accumulation and causes sex-specific variations in bone growth; after mid-puberty, the male population experiences a greater increase in periosteal bone growth than the female population, who shows more pronounced endocortical bone formation . The hypothalamic-pituitary-gonadal (HPG) axis, a crucial part of the endocrine system, controls the production of testosterone. The synthesis and regulation of testosterone, a vital steroid hormone, are highly complicated procedures that involve intricate interactions among multiple endocrine glands, including the hypothalamus, pituitary gland, and gonads, as well as feedback mechanisms that maintain homeostasis within the body. Dysregulation of this feedback mechanism can lead to a variety of pathophysiological conditions, particularly testosterone deficiency; such disruptions may occur due to aging, disease processes, or lifestyle factors, underscoring the importance of accurate diagnosis and appropriate therapeutic interventions .
Additionally, differences in the measurements of testosterone levels contributed to potential heterogeneity in the results. The number of RCTs reporting PVR or Maximum Flow Rate (Qmax) included in the analysis, along with the sample sizes of these studies, were relatively small, potentially limiting the generalizability of our findings. Notably, we unveiled comprehensive insights into the alterations in LUTS, PSA, erectile function, and additionally, PVR – an aspect often overlooked in prior meta-analyses. In our meta-analysis, exclusive focus was placed on RCTs, each of which exhibited high methodological quality. Therefore, incorporating a diet that fosters testosterone production and includes plant-based elements could be beneficial for LOH patients. Lu’s report also reported that the intake of plant-based diet could be beneficial to erectile function in men over 45 yeas old and without impacting total testosterone level (66, 67).