High prevalence of low testosterone in men undergoing urologic surgery: Results of a prospective study

To assess the prevalence of low serum testosterone in men undergoing urologic surgery and the associations between low testosterone, frailty, and postoperative outcomes.

A prospective study of adult men undergoing urologic surgery between October 2022 and October 2024 was conducted. Morning serum testosterone levels were measured, and baseline sociodemographic characteristics and comorbid medical conditions were collected. The clinical Risk Analysis Index for measuring frailty in surgical populations was calculated. Postoperative outcomes were assessed up to 90 days after surgery.

We enrolled 125 patients with a mean age of 64.4 years and a median body mass index of 28.1 (interquartile range 25.6-31.8) kg/m². The median total testosterone of all patients was 305 (interquartile range 252-361) ng/dL. There were 56 (45%) men who had a testosterone level <300 ng/dL. Men with hypertension and obesity were significantly more likely to have low testosterone; for hypertension, the odds ratio (OR) was 2.30 (p<0.001); for obesity, the OR was 5.64 (p<0.001); and for men with both obesity and hypertension, the OR was 12.97 (p=0.043). There was no significant difference in median clinical Risk Analysis Index score between men with low testosterone and men with normal testosterone (36.0 vs. 36.0, p=0.8). There was no association between low testosterone and postoperative readmissions within 90 days.

Our study of patients undergoing urologic surgery found a high prevalence of low testosterone (45%). Urologists should consider evaluating all surgical patients for symptomatic hypogonadism. Further research on the postoperative implications of low testosterone and on the role of testosterone replacement therapy in the perioperative setting is needed.