INTRODUCTION AND OBJECTIVES: Testosterone replacement therapy (TRT) is commonly used to treat men with hypogonadism; however, there has been caution in using TRT in men with moderate to severe lower urinary tract symptoms (LUTS) for fear of worsening their symptoms.
The primary objective of this study was to examine the effect of TRT on LUTS in hypogonadal men.
METHODS: We retrospectively reviewed our outpatient database and identified patients with a diagnosis of hypogonadism who received TRT from 2002 to 2012. LUTS were assessed by use of the American Urological Association Symptom Index (AUASI) pre- and post- TRT. Testosterone and PSA were also continuously measured, and all patients were closely monitored for side effects to TRT. Patients who had progression of their LUTS to the point of requiring surgery were included in the study.
RESULTS: We identified 120 hypogonadal men who underwent TRT, the majority of whom had topical therapy or a combination of topical and pellet based therapy (57.5% and 20.8%, respectively). The mean baseline AUASI was 10.8 (±7.8) and our mean duration of TRT was 692 days (±773). The mean change in AUASI was -1.07 (±6.06). The mean baseline PSA was 1.6 (±1.9) and the mean change in PSA was 0.44 (±2.2). 8.1% of patients had a baseline PSA >4.0, and they had greater improvement in AUASI than those patients with baseline PSA < 4.0 (-1.9 vs. -1.0, pNS). 45.8% of patients had < 3-point change in AUASI in either direction. 38/120 (31.7%) had improvement in their AUASI ≥ 3 points while 27/120 (22.5%) had worsening of their AUASI ≥ 3 points. Patients with an improved AUASI had a mean PSA change of 0.3 (±3.4), while those who had worsening of their AUASI had a mean PSA change of 0.7 (±2.2)(pNS). Approximately 9/120 (7.5%) of these men initiated new medications for their LUTS during the course of the study. There was no significant change in their AUASI when compared to patients without any use of LUTS medications. Additionally, 4/120 (3.3%) of patients had progression of their LUTS and required transurethral resection of the prostate.
CONCLUSIONS: We demonstrate that initiating TRT in hypogonadal men has a low risk of worsening LUTS. In fact many men have an improvement in symptoms while PSA changes appear minor. Future research should focus on larger patient population studies to further examine this relationship.
Written by:
Pearl JA, Berhanu D, François N, Masson P, Zargaroff S, Cashy J, McVary KT. Are you the author?
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Reference: J Urol. 2013 Jun 10. pii: S0022-5347(13)04575-8.
doi: 10.1016/j.juro.2013.05.111
PubMed Abstract
PMID: 23764078
UroToday.com Androgen Deficiency Section
