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. 2023 Jul;55(7):1649-1658.
doi: 10.1007/s11255-023-03602-4. Epub 2023 May 6.

Voiding function improves under long-term testosterone treatment (TTh) in hypogonadal men, independent of prostate size

Aksam Yassin  1   2   3 , Mustafa Alwani  1 , Raed M Al-Zoubi  4   5   6 , Omar M Aboumarzouk  1   7   8 , Raidh Talib  1 , Joanne Nettleship  9 , Daniel Kelly  9   10 , Bassam Albaba  2
Affiliations

Voiding function improves under long-term testosterone treatment (TTh) in hypogonadal men, independent of prostate size

Aksam Yassin et al. Int Urol Nephrol. 2023 Jul.

Abstract

Background: Functional hypogonadism is a condition in which some, but not all, older men have low testosterone levels. Rather than chronological age per se, the causality of hypogonadism includes obesity and impaired general health (e.g., metabolic syndrome). An association between testosterone deficiency and lower urinary tract symptoms (LUTS) has been reported, yet due to prostate safety concerns, men with severe LUTS (IPSS score > 19) have invariably been excluded from entering testosterone trials. Irrespective, exogenous testosterone has not been demonstrated to cause de novo or worsen mild to moderate LUTS.

Objective: This study investigated whether long-term testosterone therapy (TTh) could have a protective effect on improving the symptoms of LUTS in hypogonadal men. However, the exact mechanism by which testosterone exerts is beneficial effect remains uncertain.

Patients and methods: In this study 321 hypogonadal patients with an average age of 58.9 ± 9.52 years received testosterone undecanoate in 12-week intervals for 12 years. One hundred and forty-seven of these males had the testosterone treatment interrupted for a mean of 16.9 months before it was resumed. Total testosterone, International Prostate Symptom Scale (IPSS), post-voiding residual bladder volume and aging male symptoms (AMS) were measured over the study period.

Results: Prior to TTh interruption, it was observed that testosterone stimulation improved the men's IPSS, AMS and post-voiding residual bladder volume, while their prostate volume significantly increased. During the TTh interruption, there was a significant worsening in these parameters, although the increase in prostate volume continued. When TTh was resumed, these effects were reversed, implying that hypogonadism may require lifelong treatment.

Keywords: Benign prostate hyperplasia; Hypogonadism; LUTS; Prostate cancer; Testosterone.

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Conflict of interest statement

AY received partial compensation for data entry, honoraria and occasionally travel grants from Bayer AG and is a Member of the Advisory Board for Testosterone, Besin Health Care, Pharma. DMK has received honoraria and occasionally travel grants from Bayer AG.

Figures

Fig. 1
Fig. 1
Long-term effect of testosterone treatment on total testosterone (TT) levels (ng/dL) in hypogonadal males. *p < 0.0001 vs. baseline; #p < 0.0001 vs. previous year; all other p values compared to previous year
Fig. 2
Fig. 2
Long-term effect of testosterone treatment on International Prostate Symptom Score (IPSS) in hypogonadal males. *p < 0.0001 vs. baseline; #p < 0.0001 vs. previous year; all other p values compared to previous year
Fig. 3
Fig. 3
Long-term effect of testosterone treatment on post-voiding residual bladder volume (mL) in hypogonadal males. *p < 0.0001 vs. baseline; #p < 0.0001 vs. previous year; all other p values compared to previous year
Fig. 4
Fig. 4
Long-term effect of testosterone treatment on prostate volume (mL) in hypogonadal males. *p < 0.0001 vs. baseline; #p < 0.0001 vs. previous year; all other p values compared to previous year
Fig. 5
Fig. 5
Long-term effect of testosterone treatment on Aging Males’ Symptom Scale in hypogonadal males. *p < 0.0001 vs. baseline; #p < 0.0001 vs. previous year; all other p values compared to previous year
See this image and copyright information in PMC

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