Skip to main content
Top
Published in: Current Bladder Dysfunction Reports 2/2017

01-06-2017 | BPH-Related Voiding Dysfunction (R Lee, Section Editor)

Effects of Testosterone Replacement Therapy on Lower Urinary Tract Symptoms

Authors: Grace E. Kohn, Taylor P. Kohn, Ranjith Ramasamy

Published in: Current Bladder Dysfunction Reports | Issue 2/2017

Login to get access

Abstract

Purpose of Review

While early studies suggested that testosterone replacement therapy would enlarge the prostate and worsen lower urinary tract symptoms, this review seeks to examine the combined evidence of observational studies, randomized control trials, and meta-analyses published on the topic to determine if testosterone replacement therapy worsens lower urinary tract symptoms in hypogonadal men.

Recent Findings

The combined evidence of 15 randomized control trials and 2 meta-analyses has demonstrated emphatically that testosterone replacement therapy has no effect on lower urinary tract symptoms in hypogonadal men with mild and moderate symptoms.

Summary

No randomized control trial has sufficiently examined the effect of testosterone replacement therapy in men with severe lower urinary tract symptoms. While a few observational studies have seen no effect when hypogonadal men with severe lower urinary tract symptoms are treated with testosterone replacement therapy, future randomized controlled trials specifically studying the effect of testosterone on men with severe lower urinary tract symptoms are warranted. In summary, clinicians should rest assured that testosterone does not worsen lower urinary tract symptoms in hypogonadal men with mild or moderate lower urinary tract symptoms.
Literature
1.
go back to reference Behre HM, Tammela TL, Arver S, Tolra JR, Bonifacio V, Lamche M, et al. A randomized, double-blind, placebo-controlled trial of testosterone gel on body composition and health-related quality-of-life in men with hypogonadal to low-normal levels of serum testosterone and symptoms of androgen deficiency over 6 months with 12 months open-label follow-up. The aging male: the official journal of the International Society for the Study of the Aging Male. 2012;15(4):198–207. doi:10.3109/13685538.2012.699562.CrossRef Behre HM, Tammela TL, Arver S, Tolra JR, Bonifacio V, Lamche M, et al. A randomized, double-blind, placebo-controlled trial of testosterone gel on body composition and health-related quality-of-life in men with hypogonadal to low-normal levels of serum testosterone and symptoms of androgen deficiency over 6 months with 12 months open-label follow-up. The aging male: the official journal of the International Society for the Study of the Aging Male. 2012;15(4):198–207. doi:10.​3109/​13685538.​2012.​699562.CrossRef
2.
go back to reference Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87(2):589–98. doi:10.1210/jcem.87.2.8201.CrossRefPubMed Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87(2):589–98. doi:10.​1210/​jcem.​87.​2.​8201.CrossRefPubMed
3.
go back to reference Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86(2):724–31. doi:10.1210/jcem.86.2.7219.CrossRefPubMed Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86(2):724–31. doi:10.​1210/​jcem.​86.​2.​7219.CrossRefPubMed
4.
go back to reference Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA. Pharmacokinetics, efficacy, and safety of a permeation-enhanced testosterone transdermal system in comparison with bi-weekly injections of testosterone enanthate for the treatment of hypogonadal men. J Clin Endocrinol Metab. 1999;84(10):3469–78. doi:10.1210/jcem.84.10.6078.PubMed Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA. Pharmacokinetics, efficacy, and safety of a permeation-enhanced testosterone transdermal system in comparison with bi-weekly injections of testosterone enanthate for the treatment of hypogonadal men. J Clin Endocrinol Metab. 1999;84(10):3469–78. doi:10.​1210/​jcem.​84.​10.​6078.PubMed
6.
7.
go back to reference Wang C, Alexander G, Berman N, Salehian B, Davidson T, McDonald V, et al. Testosterone replacement therapy improves mood in hypogonadal men—a clinical research center study. The Journal of Clinical Endocrinology & Metabolism. 1996;81(10):3578–83. Wang C, Alexander G, Berman N, Salehian B, Davidson T, McDonald V, et al. Testosterone replacement therapy improves mood in hypogonadal men—a clinical research center study. The Journal of Clinical Endocrinology & Metabolism. 1996;81(10):3578–83.
8.
go back to reference Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men 1. The Journal of Clinical Endocrinology & Metabolism. 2000;85(8):2839–53. Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men 1. The Journal of Clinical Endocrinology & Metabolism. 2000;85(8):2839–53.
10.
11.
go back to reference Barry MJ, Fowler Jr FJ, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–57. discussion 64PubMed Barry MJ, Fowler Jr FJ, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–57. discussion 64PubMed
13.
go back to reference •• Cui Y, Zhang Y. The effect of androgen-replacement therapy on prostate growth: a systematic review and meta-analysis. Eur Urol. 2013;64(5):811–22. doi:10.1016/j.eururo.2013.03.042. This meta-analysis demonstrates that prostate size does not change in hypogonadal men undergoing androgen replacement therapy. •• Cui Y, Zhang Y. The effect of androgen-replacement therapy on prostate growth: a systematic review and meta-analysis. Eur Urol. 2013;64(5):811–22. doi:10.​1016/​j.​eururo.​2013.​03.​042. This meta-analysis demonstrates that prostate size does not change in hypogonadal men undergoing androgen replacement therapy.
14.
go back to reference Shigehara K, Sugimoto K, Konaka H, Iijima M, Fukushima M, Maeda Y, et al. Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study. The aging male : the official journal of the International Society for the Study of the Aging Male. 2011;14(1):53–8. doi:10.3109/13685538.2010.518178.CrossRef Shigehara K, Sugimoto K, Konaka H, Iijima M, Fukushima M, Maeda Y, et al. Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study. The aging male : the official journal of the International Society for the Study of the Aging Male. 2011;14(1):53–8. doi:10.​3109/​13685538.​2010.​518178.CrossRef
15.
go back to reference • Basaria S, Harman SM, Travison TG, Hodis H, Tsitouras P, Budoff M, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314(6):570–81. doi:10.1001/jama.2015.8881. In this recently published randomized control trial of 248 hypogondal men, the authors demonstrate no clinically or statistically significant increase in lower urinary tract symptoms after 3 years of testosterone replacement therapy. • Basaria S, Harman SM, Travison TG, Hodis H, Tsitouras P, Budoff M, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314(6):570–81. doi:10.​1001/​jama.​2015.​8881. In this recently published randomized control trial of 248 hypogondal men, the authors demonstrate no clinically or statistically significant increase in lower urinary tract symptoms after 3 years of testosterone replacement therapy.
16.
go back to reference Chiang HS, Hwang TI, Hsui YS, Lin YC, Chen HE, Chen GC, et al. Transdermal testosterone gel increases serum testosterone levels in hypogonadal men in Taiwan with improvements in sexual function. Int J Impot Res. 2007;19(4):411–7. doi:10.1038/sj.ijir.3901562.CrossRefPubMed Chiang HS, Hwang TI, Hsui YS, Lin YC, Chen HE, Chen GC, et al. Transdermal testosterone gel increases serum testosterone levels in hypogonadal men in Taiwan with improvements in sexual function. Int J Impot Res. 2007;19(4):411–7. doi:10.​1038/​sj.​ijir.​3901562.CrossRefPubMed
17.
go back to reference Kalinchenko SY, Tishova YA, Mskhalaya GJ, Gooren LJ, Giltay EJ, Saad F. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol. 2010;73(5):602–12. doi:10.1111/j.1365-2265.2010.03845.x.CrossRef Kalinchenko SY, Tishova YA, Mskhalaya GJ, Gooren LJ, Giltay EJ, Saad F. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol. 2010;73(5):602–12. doi:10.​1111/​j.​1365-2265.​2010.​03845.​x.CrossRef
18.
go back to reference Kenny AM, Prestwood KM, Gruman CA, Marcello KM, Raisz LG. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. J Gerontol A Biol Sci Med Sci. 2001;56(5):M266–72.CrossRefPubMed Kenny AM, Prestwood KM, Gruman CA, Marcello KM, Raisz LG. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. J Gerontol A Biol Sci Med Sci. 2001;56(5):M266–72.CrossRefPubMed
19.
go back to reference •• Kohn TP, Mata DA, Ramasamy R, Lipshultz LI. Effects of testosterone replacement therapy on lower urinary tract symptoms: a systematic review and meta-analysis. Eur Urol. 2016; doi:10.1016/j.eururo.2016.01.043. This meta-analysis demonstrates that lower urinary tract symptoms are not worsened in hypogonadal men undergoing testosterone replacement therapy. •• Kohn TP, Mata DA, Ramasamy R, Lipshultz LI. Effects of testosterone replacement therapy on lower urinary tract symptoms: a systematic review and meta-analysis. Eur Urol. 2016; doi:10.​1016/​j.​eururo.​2016.​01.​043. This meta-analysis demonstrates that lower urinary tract symptoms are not worsened in hypogonadal men undergoing testosterone replacement therapy.
20.
go back to reference Konaka H, Sugimoto K, Orikasa H, Iwamoto T, Takamura T, Takeda Y, et al. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: a multicenter randomized controlled trial in Japan (EARTH Study). Asian journal of andrology. 2015; doi:10.4103/1008-682x.148720.PubMedCentral Konaka H, Sugimoto K, Orikasa H, Iwamoto T, Takamura T, Takeda Y, et al. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: a multicenter randomized controlled trial in Japan (EARTH Study). Asian journal of andrology. 2015; doi:10.​4103/​1008-682x.​148720.PubMedCentral
21.
go back to reference Marks LS, Mazer NA, Mostaghel E, Hess DL, Dorey FJ, Epstein JI, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296(19):2351–61. doi:10.1001/jama.296.19.2351.CrossRefPubMed Marks LS, Mazer NA, Mostaghel E, Hess DL, Dorey FJ, Epstein JI, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296(19):2351–61. doi:10.​1001/​jama.​296.​19.​2351.CrossRefPubMed
22.
go back to reference Meuleman EJ, Legros JJ, Bouloux PM, Johnson-Levonas AO, Kaspers MJ, Elbers JM, et al. Effects of long-term oral testosterone undecanoate therapy on urinary symptoms: data from a 1-year, placebo-controlled, dose-ranging trial in aging men with symptomatic hypogonadism. The aging male : the official journal of the International Society for the Study of the Aging Male. 2015;18(3):157–63. doi:10.3109/13685538.2015.1032925. Meuleman EJ, Legros JJ, Bouloux PM, Johnson-Levonas AO, Kaspers MJ, Elbers JM, et al. Effects of long-term oral testosterone undecanoate therapy on urinary symptoms: data from a 1-year, placebo-controlled, dose-ranging trial in aging men with symptomatic hypogonadism. The aging male : the official journal of the International Society for the Study of the Aging Male. 2015;18(3):157–63. doi:10.​3109/​13685538.​2015.​1032925.
23.
go back to reference Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100(8):2956–62. doi:10.1210/jc.2014-4434. Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100(8):2956–62. doi:10.​1210/​jc.​2014-4434.
24.
go back to reference Srinivas-Shankar U, Roberts SA, Connolly MJ, O'Connell MD, Adams JE, Oldham JA, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010;95(2):639–50. doi:10.1210/jc.2009-1251.CrossRefPubMed Srinivas-Shankar U, Roberts SA, Connolly MJ, O'Connell MD, Adams JE, Oldham JA, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010;95(2):639–50. doi:10.​1210/​jc.​2009-1251.CrossRefPubMed
25.
go back to reference Tan WS, Low WY, Ng CJ, Tan WK, Tong SF, Ho C, et al. Efficacy and safety of long-acting intramuscular testosterone undecanoate in aging men: a randomised controlled study. BJU Int. 2013;111(7):1130–40. doi:10.1111/bju.12037.CrossRefPubMed Tan WS, Low WY, Ng CJ, Tan WK, Tong SF, Ho C, et al. Efficacy and safety of long-acting intramuscular testosterone undecanoate in aging men: a randomised controlled study. BJU Int. 2013;111(7):1130–40. doi:10.​1111/​bju.​12037.CrossRefPubMed
26.
go back to reference Tammela T. Benign prostatic hyperplasia. Practical treatment guidelines. Drugs Aging. 1997;10(5):349–66.CrossRefPubMed Tammela T. Benign prostatic hyperplasia. Practical treatment guidelines. Drugs Aging. 1997;10(5):349–66.CrossRefPubMed
27.
28.
go back to reference Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–59. doi:10.1210/jc.2009-2354.CrossRefPubMed Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–59. doi:10.​1210/​jc.​2009-2354.CrossRefPubMed
29.
go back to reference Holmäng S, Mårin P, Lindstedt G, Hedelin H. Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate. 1993;23(2):99–106. doi:10.1002/pros.2990230203.CrossRefPubMed Holmäng S, Mårin P, Lindstedt G, Hedelin H. Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate. 1993;23(2):99–106. doi:10.​1002/​pros.​2990230203.CrossRefPubMed
30.
go back to reference Brock G, Heiselman D, Maggi M, Kim SW, Rodriguez Vallejo JM, Behre HM, et al. Effect of testosterone solution 2% on testosterone concentration, sex drive and energy in hypogonadal men: results of a placebo controlled study. J Urol. 2016;195(3):699–705. doi:10.1016/j.juro.2015.10.083.CrossRefPubMed Brock G, Heiselman D, Maggi M, Kim SW, Rodriguez Vallejo JM, Behre HM, et al. Effect of testosterone solution 2% on testosterone concentration, sex drive and energy in hypogonadal men: results of a placebo controlled study. J Urol. 2016;195(3):699–705. doi:10.​1016/​j.​juro.​2015.​10.​083.CrossRefPubMed
31.
go back to reference Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. Jama. 2008;299:39. Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. Jama. 2008;299:39.
Metadata
Title
Effects of Testosterone Replacement Therapy on Lower Urinary Tract Symptoms
Authors
Grace E. Kohn
Taylor P. Kohn
Ranjith Ramasamy
Publication date
01-06-2017
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 2/2017
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-017-0419-2

Other articles of this Issue 2/2017

Current Bladder Dysfunction Reports 2/2017 Go to the issue

BPH-Related Voiding Dysfunction (R Lee, Section Editor)

Meditate Temporary Implantable Nitinol Device

BPH-Related Voiding Dysfunction (R Lee, Section Editor)

Accurate Estimation of Prostate Size in the Evaluation of Nocturia

Cancer-Associated Voiding Dysfunction (A Peterson, Section Editor)

The Male Transobturator Sling for Stress Incontinence After the Treatment of Prostate Cancer