Etiology of testosterone deficiency after radical prostatectomy

Testosterone deficiency (TD) may occur after radical prostatectomy (RP). Guidance on prevalence, mechanisms, and testosterone-replacement therapy (TRT) safety remains limited.

To summarize contemporary evidence on the etiology of post-RP TD.

A PRISMA-ScR scoping review identified English-language human studies reporting the etiology of post-RP TD. Fourteen of 186 screened articles met the inclusion criteria.

TD develops in 20% to 30% of men within 4 weeks and persists in 37.5% by day 90. Proposed mechanisms described in the literature include perioperative venous, ischemic, and neuroendocrine perturbations, though supporting evidence remains limited and largely indirect.

One-third of men experience transient or persistent TD post-RP owing to venous, ischemic, and endocrine factors; most normalize within a year. Routine androgen surveillance and prospective trials are warranted to refine the timing and long-term outcomes of administering exogenous testosterone post-RP.