Longitudinal Improvements in Quality of Life Following Testosterone Replacement Therapy in Men with Biochemical and Symptomatic Testosterone Deficiency: a 12 Month Retrospective Observational Study in a Remote Digital Healthcare Setting in the United Kingdom

Men with borderline or low-normal total testosterone often experience androgen-deficiency symptoms. While testosterone replacement therapy (TRT) benefits overt hypogonadism, its long-term effect on quality of life (QoL) in borderline cases, particularly via remote digital care, remains unclear. We retrospectively studied 1065 men (mean age 42.9±8.8 years) with total testosterone <15 nmol/L and clinical symptoms, managed through UK digital healthcare providers. QoL was assessed over 12 months using the quantitative Androgen Deficiency in the Ageing Male (qADAM) scale (range 10-50; ≥5-point increase considered clinically meaningful). Changes in qADAM were analySed with paired t-tests; subgroup differences (e.g., BMI) used one-way ANOVA, and correlations (testosterone, free testosterone, SHBG) were evaluated via Pearson’s tests. Mean qADAM increased by 6.64 points (95% CI: 6.16, 7.11; p<0.0001), with significant improvements across libido, energy, and other domains. Obese men (BMI≥30) had larger gains (+8.03 points) than normal-weight men, and those ≥100 kg improved by 8.22 points. While total testosterone rose by 31.25 nmol/L (p<0.0001), correlations between testosterone changes and qADAM were modest. In this real-world digital setting, TRT yielded clinically meaningful, multidomain QoL benefits for men with borderline testosterone levels. Future prospective research incorporating broader demographics and confounders will help optimize individualized TRT strategies.