The Potential Therapeutic Effects of Testosterone on Sarcopenia: A Thorough Systematic Review

Sarcopenia is characterized by a progressive loss of skeletal muscle mass and function with aging, often resulting in functional decline and reduced independence. Although it primarily affects older adults, its development is multifactorial and may be influenced by various underlying factors. Testosterone, the primary endogenous male androgen, promotes skeletal muscle protein synthesis by activating pathways involved in muscle growth, cellular energy, and tissue repair. As testosterone levels decline with age, decreases in muscle strength and increases in frailty may occur, prompting investigation into testosterone replacement therapy (TRT) as a potential therapeutic intervention. This systematic review examines evidence from 15 studies comparing the effects of testosterone in patients with sarcopenia, with a focus on efficacy and functional improvements. Key outcomes include changes in lean body mass, strength performance, and physical function indicators. Our findings suggest that TRT can increase lean muscle mass and strength to a lesser extent, but improvements in mobility or daily function are inconsistent among population groups. Evidence regarding long-term safety and efficacy, as well as responses in the presence of other comorbidities, is limited. Current best practice recommendations emphasize exercise and a protein-rich diet as the primary approach for sarcopenia. This review aims to clarify the therapeutic role of testosterone in managing sarcopenia, highlight current limitations in the evidence base, and identify critical directions for future research.