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The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review.
Martin Kathrins1, Karen Doersch2, Tony Nimeh3
1Division of Urology, Brigham and Women's Hospital, Boston, MA.
Urology
|December 1, 2015
Summary
Testosterone-replacement therapy generally does not worsen lower urinary tract symptoms or increase prostate volume in men. This review found limited evidence to support contraindications for testosterone therapy in men with severe urinary symptoms.
Area of Science:
- Urology
- Endocrinology
- Men's Health
Background:
- Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are common in aging men.
- Testosterone-replacement therapy (TRT) is used to treat hypogonadism.
- The effect of TRT on LUTS and prostate health is a subject of ongoing research and clinical debate.
Purpose of the Study:
- To systematically review prospective trials on the clinical effects of TRT on LUTS and prostate volume.
- To evaluate the impact of TRT on International Prostate Symptom Score (IPSS), prostate volume, and urodynamic parameters.
Main Methods:
- Literature review of PubMed, Embase, and Cochrane Library (1994-2015).
- Inclusion of prospective trials of hypogonadal men with BPH or LUTS treated with TRT.
- Evaluation of abstracts for outcomes related to IPSS, prostate volume, and urodynamic parameters.
Main Results:
- Thirty-five trials were included from 3079 initial abstracts.
- Most trials showed no significant prostate growth with TRT.
- Studies indicated no change or improvement in LUTS for men with mild baseline symptoms.
- Trials involving men with metabolic syndrome showed uniform improvement in LUTS.
- A lack of relevant urodynamic studies was noted.
- Many trials excluded men with severe LUTS.
Conclusions:
- Limited evidence supports a causal link between TRT and worsening LUTS or increased prostate volume.
- Current evidence does not strongly support contraindicating TRT in men with severe LUTS.
- Future trials with more inclusive criteria are needed to clarify the role of TRT in men with LUTS.
