Hypogonadal men with moderate-to-severe lower urinary tract symptoms have a more severe cardiometabolic risk profile and benefit more from testosterone therapy than men with mild lower urinary tract symptoms

Abstract

Purpose: To analyze data from an observational, prospective, cumulative registry study in 805 hypogonadal men stratified by mild or moderate-to-severe lower urinary tract symptoms (LUTS) according to International Prostate Symptom Score.

Materials and methods: A total of 412 men underwent testosterone therapy (TTh) with injectable testosterone undecanoate, 393 men served as untreated controls. Measures of urinary function, anthropometric and metabolic parameters were performed at least twice per year.

Results: Data from 615 men with mild LUTS (253 treated, 362 untreated) and 190 with moderate-to-severe LUTS (159 treated, 31 untreated) were available. During a follow-up period of 8 years a significant improvement of LUTS was noted for all TTh-patients whereas the control-groups showed deterioration or fluctuation around initial values. Despite advancing age, TTh fully prevented worsening of symptoms. In parallel, a considerable improvement of anthropometric parameters, lipids and glycemic control, blood pressure, C-reactive protein, and quality of life was found. Moderate-to-severe LUTS was associated with worse cardiometabolic risk profile at baseline as well as worse cardiovascular outcomes during follow-up in comparison to mild LUTS. Effect size of TTh was more pronounced in men with moderate-to-severe than with mild LUTS.

Conclusions: Correcting hypogonadism by TTh is highly effective and safe for improving LUTS in hypogonadal men. TTh may also improve cardiometabolic risk and major adverse cardiovascular events.

Keywords: Cardiovascular diseases; Lower urinary tract symptoms; Metabolic syndrome; Quality of life; Testosterone.

Fig. 1. Urinary function: (A) IPSS and (B) post-voiding residual volume in men with mild IPSS under TTh and untreated controls, and in men with moderate-to-severe IPSS under TTh and untreated controls. IPSS, International Prostate Symptom Score; TTh, testosterone therapy.

Fig. 2. Prostate parameters: (A) Prostate volume and (B) prostate specific antigen in men with mild IPSS under TTh and untreated controls, and in men with moderate-to-severe IPSS under TTh and untreated controls. IPSS, International Prostate Symptom Score; TTh, testosterone therapy.

Fig. 3. Anthropometric measures: (A) Body weight, (B) body mass index, (C) percent weight loss, and (D) waist circumference in men with mild IPSS under TTh and untreated controls, and in men with moderate-to-severe IPSS under TTh and untreated controls. IPSS, International Prostate Symptom Score; TTh, testosterone therapy.

Fig. 4. C-reactive protein (mg/dL) in men with mild IPSS under TTh and untreated controls, and in men with moderate-to-severe IPSS under TTh and untreated controls. IPSS, International Prostate Symptom Score; TTh, testosterone therapy.

Fig. 5. Quality of life: Aging Males' Symptoms scale in men with mild IPSS under TTh and untreated controls, and in men with moderate-to-severe IPSS under TTh and untreated controls. IPSS, International Prostate Symptom Score; TTh, testosterone therapy.