A recent review finds no evidence that testosterone replacement therapy (TRT) causes or worsens lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH).
Furthermore, although the Endocrine Society and other associations have suggested severe LUTS as a contraindication to TRT treatment, investigators found little evidence to support it after reviewing the limited research.
Martin Kathrins, MD, of University of Illinois at Chicago, and colleagues identified and examined 35 prospective trials of hypogonadal men with LUTS/BPH using TRT published from 1995–2015,. The investigators discovered that men with mild LUTS experienced either no change or an improvement in their symptoms following TRT. International Prostate Symptom Scores did not significantly worsen, nor did prostate size increase. Limited urodynamic studies also indicated that TRT helped rather than harmed bladder physiology.
Remarkably, patients with metabolic syndrome (MetS) experienced symptomatic improvement after TRT. TRT may reduce prostatic inflammation associated with MetS, the investigators suggested. Writing in a paper published online ahead of print in Urology, they explained that the therapy “may improve voiding symptoms while also improving the underlying metabolic and biometric abnormalities of MetS.”
Half of trials excluded men with severe LUTS due to concerns TRT might worsen symptoms. Androgens influence prostate development, so some investigators feared TRT would promote prostate enlargement. According to preliminary research discussed by the researchers, serum testosterone may not have a strong impact on levels of intra-prostatic testosterone or dihydrotestosterone.
The investigators acknowledged several study limitations, including the exclusion of retrospective trials, short trial durations, small numbers of patients, and lack of accounting for other medications. To better understand the safety of TRT, they recommend future clinical trials that involve patients with LUTS/BPH in the severe range, urodynamic testing, and more inclusive criteria.
- Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, and Seftel A. The Relationship Between Testosterone Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology S0090-4295(15)01053-3. doi:10.1016/j.urology.2015.11.006.