TRT and Sex Drive: What a 2-Year Trial Found

Medically reviewed by Lauren Orta, FNP-C

In men with low T and low libido, testosterone gel raised sexual activity and desire versus placebo, and the effect held for 2 years. It did not improve erections.

TL;DR

• Men with confirmed low T and low libido who used testosterone gel had more sexual activity and more desire than men on placebo.
• The gain showed up by 6 months and was still there at 24 months.
• Erectile function did not improve more than placebo. Drive and erections are different problems.
• Studied: 1,161 men aged 45 to 80 with low T and heart disease or high heart risk.

What the study did

This was the Sexual Function Study inside TRAVERSE, the large testosterone trial best known for its heart-safety result. Of 5,204 men in the parent trial, 1,161 who reported low libido joined this substudy. Every man was 45 to 80, had two testosterone readings under 300 ng/dL, had symptoms of low T, and had heart disease or high cardiovascular risk.

Men were randomly assigned to a daily 1.62% testosterone gel (587 men) or a placebo gel (574 men), double-blind. The main outcome was change in a sexual activity score. Researchers also tracked desire, erectile function and general low-T symptoms. The work was published in the Journal of Clinical Endocrinology & Metabolism in 2024 (PubMed 37589949; DOI 10.1210/clinem/dgad484).

What it found

• More sexual activity: men on testosterone reported about 0.49 more sexual acts per day than placebo at 6 months (95% CI 0.19 to 0.79) and 0.47 more at 12 months (95% CI 0.11 to 0.83). Overall test P = .011.
• It lasted: the difference was maintained at 24 months. Few randomized trials have tracked this past 12 months.
• More desire, fewer low-T symptoms: testosterone improved sexual desire and hypogonadal symptom scores versus placebo.
• Not erections: erectile function did not improve more than placebo.

What it means for you

If your main complaint is that the drive is gone, and your labs confirm low T, this is some of the best evidence that treatment can bring it back, and keep it back. It came from a randomized, placebo-controlled trial, not a clinic's before-and-after photos.

If your main problem is erections, testosterone alone may not be the fix. Low T and erectile dysfunction overlap but aren't the same thing (more in ED vs low testosterone). Erection problems often come down to blood flow, which is why a provider may talk about options like daily tadalafil separately.

Want the bigger picture on libido? Read testosterone and libido, low libido in men and hormones, and how long TRT takes to work.

The fine print

• Men in the study were 45 to 80, had low libido and low T, and had heart disease or high heart risk. Results may differ for younger, healthier men.
• Outcomes were self-reported questionnaires.
• The trial used a daily gel. AZTRT's TRT program uses injections; the delivery method is different, though the hormone is the same.
• The parent trial (Lincoff et al., NEJM 2023) found no increase in major cardiac events versus placebo, but did see more atrial fibrillation, acute kidney injury and pulmonary embolism on testosterone. That's why monitoring matters.
• The study was funded by AbbVie and other testosterone makers, and some authors are AbbVie employees.

FAQ

Does TRT increase sex drive?

In the TRAVERSE Sexual Function Study, men with low T and low libido on testosterone gel reported more sexual activity and more desire than men on placebo, and the effect lasted 2 years.

Does TRT fix erectile dysfunction?

Not on its own in this trial. Erectile function did not improve more than placebo. ED often has blood-flow causes that need a separate plan.

How fast did the libido effect show up?

The difference versus placebo was measurable by the 6-month check and was maintained at 12 and 24 months.

Who was in the study?

1,161 men aged 45 to 80 with two testosterone readings under 300 ng/dL, symptoms of low T, low libido, and heart disease or high cardiovascular risk.

Next step

Low drive and low energy? Start with real labs and a real conversation. See how TRT works at AZTRT, or book a free consult. AZTRT serves men in Arizona through licensed telehealth providers.

Sources

1. Pencina KM et al. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab. 2024;109(2):569-580. PubMed · DOI
2. Lincoff AM et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389(2):107-117. PubMed · DOI

This article is for education, not medical advice. Treatment decisions are made with a licensed provider after an evaluation and labs. Results vary.