title: Testosterone supplementation does not worsen lower urinary tract symptoms.
abstract: OBJECTIVE
  Testosterone replacement therapy is commonly used to treat men with hypogonadism. However, there has been caution in using testosterone replacement therapy in men with moderate to severe lower urinary tract symptoms for fear of worsening the symptoms. In this study we examine the effect of testosterone replacement therapy on lower urinary tract symptoms in hypogonadal men.
  
  
  METHODS
  We retrospectively reviewed our outpatient database and identified patients with a diagnosis of hypogonadism who received testosterone replacement therapy from 2002 to 2012. Lower urinary tract symptoms were assessed using the AUASI (American Urological Association symptom index) before and after testosterone replacement therapy. Testosterone and prostate specific antigen were also continuously measured, and all patients were closely monitored for side effects of testosterone replacement therapy. Patients who had progression of lower urinary tract symptoms to the point of requiring surgery were included in the study.
  
  
  RESULTS
  We identified 120 hypogonadal men who received testosterone replacement therapy, the majority of whom had topical therapy or a combination of topical and pellet based therapy (57.5% and 20.8%, respectively). Mean baseline AUASI (±SD) was 10.8 (±7.8) and mean duration of testosterone replacement therapy was 692 days (±773). Mean change in AUASI was -1.07 (±6.06). Mean baseline prostate specific antigen was 1.6 ng/dl (±1.9) and mean change in prostate specific antigen was 0.44 (±2.2). Of the patients 8.1% had a baseline prostate specific antigen greater than 4.0 ng/dl, and these patients had greater improvement in AUASI than those with a baseline prostate specific antigen less than 4.0 ng/dl (-1.9 vs -1.0, p not significant). Overall 45.8% of patients had a less than 3-point change in AUASI in either direction. Of the 120 patients 38 (31.7%) had improvement in AUASI 3 or more points while 27 (22.5%) had worsening of AUASI 3 or more points. Patients with an improved AUASI had a mean prostate specific antigen change of 0.3 (±3.4), while those who had worsening of AUASI had a mean prostate specific antigen change of 0.7 (±2.2) (p not significant). Approximately 9 of 120 (7.5%) of these men initiated new medications for lower urinary tract symptoms during the course of the study. There was no significant change in AUASI compared to patients without any use of lower urinary tract symptoms medications. In addition, 4 (3.3%) patients had progression of lower urinary tract symptoms and required transurethral resection of the prostate.
  
  
  CONCLUSIONS
  We demonstrate that initiating testosterone replacement therapy in hypogonadal men involves a low risk of worsening lower urinary tract symptoms. In fact, many men experience symptom improvement while changes in prostate specific antigen appear minor. Future research should focus on larger patient population studies to further examine this relationship.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Pearl
authors.forename: Daniel
authors.initials: D
authors.lastname: Berhanu
authors.forename: Nathaly
authors.initials: N
authors.lastname: François
authors.forename: Puneet
authors.initials: P
authors.lastname: Masson
authors.forename: Sherwin
authors.initials: S
authors.lastname: Zargaroff
authors.forename: John
authors.initials: J
authors.lastname: Cashy
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D018450:Disease Progression; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy; D059411:Lower Urinary Tract Symptoms / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen; D012189:Retrospective Studies; D013739:Testosterone / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D013739:Testosterone; D017430:Prostate-Specific Antigen
keywords: BMI; BPH; LUTS; PSA; PVR; QoL; TRT; androgens; benign prostatic hyperplasia; body mass index; hormone replacement therapy; lower urinary tract symptoms; post-void residual; prostate specific antigen; prostatic hyperplasia; quality of life; testosterone; testosterone replacement therapy