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Updated: Jan 10, 2026

Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
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Testosterone and Lower Urinary Tract Symptoms: A Narrative Review.

Colin J O'Mahony1,2, M A Arshad3, S M Norton3,4

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Summary

Low testosterone levels can worsen lower urinary tract symptoms (LUTS) through inflammation and metabolic issues. Physiologic testosterone therapy is safe for LUTS when monitored, improving urinary function and quality of life.

Keywords:
Benign prostatic hyperplasiaHypogonadismInflammationLower urinary tract symptomsMetabolic syndromeTestosterone

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Area of Science:

  • Endocrinology
  • Urology
  • Metabolic Health

Background:

  • Lower urinary tract symptoms (LUTS) are common in men.
  • The role of testosterone in LUTS is complex, involving endocrine, metabolic, and inflammatory pathways.
  • Existing evidence suggests testosterone influences bladder, prostate, and pelvic floor function.

Purpose of the Study:

  • To review current evidence on the relationship between testosterone and LUTS in men.
  • To explore the endocrine, metabolic, and inflammatory mechanisms involved.
  • To discuss implications for clinical practice and patient management.

Main Methods:

  • Systematic review of recent experimental and clinical studies.
  • Analysis of androgen-receptor pathways and their effects on lower urinary tract tissues.
  • Evaluation of the impact of testosterone deficiency and therapy on LUTS and prostate outcomes.

Main Results:

  • Testosterone deficiency amplifies inflammation, oxidative stress, and vascular dysfunction, contributing to LUTS.
  • Metabolic syndrome, hypogonadism, and sleep disorders exacerbate LUTS severity.
  • Physiologic testosterone therapy, when appropriately monitored, does not worsen LUTS or prostate outcomes.
  • Testosterone deficiency contributes to LUTS via systemic mechanisms, not solely anatomical ones.

Conclusions:

  • Restoring physiologic testosterone balance and addressing metabolic and sleep factors can improve urinary function and quality of life in men with LUTS.
  • Future research should focus on phenotype-specific trials and integrated metabolic-endocrine-urological approaches for personalized care.
  • Testosterone therapy can be a safe and effective component of LUTS management in hypogonadal men.