Pelvic floor integrity is an important predictor of stress urinary incontinence. Androgen receptors have been found in the pelvic floor musculature and fascia and testosterone administration has been shown to increase levator ani hypertrophy and improve stress incontinence in a rodent model. We sought to examine the relationship between serum total testosterone levels and self-reported urinary incontinence in women.
We included women over 20 years of age in the 2012 cycle of National Health and Nutrition Examination Survey (NHANES) who underwent serum total testosterone measurement and answered self-reported urinary incontinence questions. A weighted, multivariate logistic regression model was used to determine the association between incontinence and serum testosterone levels after adjusting for age, body mass index, diabetes, race, parity, menopause and time of venipuncture.
2,321 women were included in the analysis. The prevalence of stress incontinence (SUI) was 37.5%, urge incontinence (UUI) - 29.8% and mixed incontinence (MUI) - 16.4%. Women in the lowest quartile of serum testosterone concentration were more likely to complain of stress (OR 1.45, 95% CI 1.03-2.12) and mixed incontinence (OR 1.68, 95% CI 1.23-2.22). No association was noted between serum testosterone levels and urge incontinence.
Very low levels of serum testosterone are associated with an increased likelihood of stress and mixed incontinence in women. Given the role of pelvic musculature in maintaining urethral support and the anabolic effect of androgens on skeletal muscle, a physiologic mechanism for this relationship can be proposed and further evaluated in prospective and translational studies.
The Journal of urology. 2017 Aug 25 [Epub ahead of print]
Michelle M Kim, Evgeniy I Kreydin
Department of Urology, Massachusetts General Hospital, Boston, MA., Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA. Electronic address: .