[Patient with TDS and lower urinary tract symptoms (LUTS)]

Area of Science:

• Urology
• Andrology
• Endocrinology

Background:

• Benign prostatic hyperplasia (BPH), lower urinary tract symptoms (LUTS), and erectile dysfunction (ED) are common in aging men.
• Testosterone deficiency (hypogonadism) is increasingly recognized as a potential contributing factor to these conditions.

Observation:

• A 61-year-old male presented with mixed LUTS, obesity, hypertension, and low total testosterone (238 ng/dL).
• His International Prostate Symptom Score (IPSS) was 12, and the International Index of Erectile Function (IIEF-5) score was 22, indicating moderate LUTS and mild ED.
• Prostate evaluation revealed an enlarged prostate (39 cm³), and uroflowmetry showed impaired voiding parameters.

Findings:

• The patient's presentation suggests a multifactorial etiology for LUTS, with testosterone deficiency as a potential contributor.
• Current guidelines support combination therapy for LUTS, including PDE5 inhibitors, but testosterone's role remains debated.
• While controversial, testosterone administration could potentially improve metabolic syndrome and enhance the efficacy of PDE5 inhibitors for LUTS.

Implications:

• Testosterone supplementation therapy (TST) appears safe and does not worsen BPH progression.
• TST may offer benefits for LUTS, sexual function, and overall well-being in hypogonadal men with BPH.
• Further large-scale studies are necessary to definitively establish the role of TST in managing LUTS associated with BPH and testosterone deficiency.