Association Between Testosterone Replacement Therapy and Prostatic Disorders in Elderly Hypogonadal Men.

Area of Science:

• Endocrinology
• Urology
• Geriatric Medicine

Background:

• Hypogonadal men often avoid testosterone replacement therapy (TRT) due to concerns about prostate complications.
• Existing data on TRT's prostate impact in older men is limited, necessitating further investigation.

Purpose of the Study:

• To investigate the association between TRT use and prostate outcomes (prostate cancer and benign prostatic hyperplasia) in older hypogonadal men.
• To analyze how TRT duration, administration route, and aromatase inhibitor (AI) coadministration influence these associations.

Main Methods:

• Large-scale retrospective cohort study using Medicare data (2007-2020) for men aged ≥65 with hypogonadism.
• 1:1 propensity score matching and Cox regression analysis stratified by age group.
• TRT use categorized by duration, route (parenteral/topical), and AI coadministration.

Main Results:

• TRT use was associated with a 16% reduced hazard of prostate cancer (PCa) across various durations and routes.
• TRT use showed a 13% increased hazard of benign prostatic hyperplasia (BPH), with higher risk for parenteral compared to topical routes.
• Long-term topical TRT was linked to a modest 9% increase in BPH hazard.

Conclusions:

• TRT is associated with decreased prostate cancer risk and a modest increase in benign prostatic hyperplasia risk in older hypogonadal men.
• The magnitude of these associations varies based on TRT duration, administration route, and AI coadministration.
• Findings support personalized TRT strategies for hypogonadal men, balancing potential benefits and risks.