However, TT's role in the development or progression of benign prostatic hyperplasia (BPH)—another highly prevalent age-related condition—remains a subject of debate. While TT has been hypothesized to exacerbate BPH risk, evidence from recent studies has largely debunked this notion, finding no significant correlation between TT and BPH or lower urinary tract symptoms (LUTS).3,4
Our study adds a nuanced perspective to this evolving narrative by leveraging a robust cohort of 882,570 hypogonadal males from the Merative MarketScan database.5 We investigated the relationship between TT and BPH diagnoses, as well as the need for BPH-related interventions. For the first 2.5 years post-diagnosis of hypogonadism, men on TT did not show a higher incidence of BPH. However, beyond this period, our findings indicate a 32% increased risk of BPH diagnosis among males receiving TT. Importantly, TT did not elevate the likelihood of requiring BPH-related interventions. TT was associated with a longer time to intervention for BPH, suggesting that while it might be linked to higher diagnostic rates, the clinical progression of BPH remains unaffected.5
These findings diverge from earlier investigations that reported no significant impact of TT on BPH. The discrepancy may stem from our study’s larger cohort and extended follow-up duration, which captured long-term trends potentially missed in smaller, short-term investigations. While the study is comprehensive, it is not without limitations. Reliance on administrative data and diagnosis codes introduces the possibility of misclassification bias, and the findings may not generalize to uninsured populations or those covered by public health plans. The increased diagnostic rates observed in TT recipients may reflect heightened medical surveillance rather than a direct relationship with TT.
TT remains a valuable therapeutic option for hypogonadal males, offering symptom relief without significantly impacting BPH progression. Our findings align with this perspective, suggesting that TT, while associated with a higher likelihood of BPH diagnosis over the long term, does not accelerate disease progression or necessitate earlier interventions. However, the observed increase in diagnostic rates beyond 2.5 years warrants further investigation to clarify its clinical significance. For clinicians, these findings highlight the importance of individualized care and ongoing monitoring in hypogonadal patients undergoing TT.
Written by: Kiarad Fendereski,1 Joshua John Horns,1 Hojat Dehghanbanadaki,1 Claudia M. Watkins,2 James M. Hotaling1
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT.
- The University of Nevada Reno, Reno, NV
- Sizar O, Leslie SW, Schwartz J. Male Hypogonadism. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
- Wang C, Swerdloff RS. Testosterone Replacement Therapy in Hypogonadal Men. Endocrinol Metab Clin North Am. 2022;51: 77–98. doi:10.1016/j.ecl.2021.11.005
- Fendereski K, Ghaed MA, Calvert JK, Hotaling JM. Hypogonadism and urologic surgeries: a narrative review. Transl Androl Urol. 2022;11: 1045–1062. doi:10.21037/tau-22-308
- Bhasin S, Travison TG, Pencina KM, O’Leary M, Cunningham GR, Lincoff AM, et al. Prostate Safety Events During Testosterone Replacement Therapy in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open. 2023;6: e2348692. doi:10.1001/jamanetworkopen.2023.48692
- Fendereski K, Horns JJ, Dehghanbanadaki H, Watkins CM, Hotaling JM. The Impact of Testosterone Therapy on Benign Prostatic Hyperplasia in Hypogonadal Males. Urology. 2024. doi:10.1016/j.urology.2024.11.006