title: Obesity may influence the relationship between sex hormones and lower urinary tract symptoms.
abstract: OBJECTIVE
  The effects of serum testosterone in the lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) are not well established. The objective of the study is to evaluate the association of sex hormones with LUTS and control the results by patient weight.
  
  
  METHODS
  The study comprised a cross-sectional analysis of 725 men included in a prostate cancer screening program at University of Sao Paulo Medical School. The serum concentrations of total testosterone (TT), free testosterone (FT) and sex hormone binding globulin (SHBG) were measured. Variables analyzed were age, American Urological Association (AUA) symptom score, storage symptoms, voiding symptoms, quality of life score, prostate specific antigen levels and prostate volume. Obesity was measured through the calculation of body mass index (BMI). A regression analysis model was performed.
  
  
  RESULTS
  Median patient age was 65 years (48 to 94). A higher TT level was significantly associated with a severe AUA symptom score only among patients with a BMI ≥ 25. Median TT was 371, 370 and 427ng/dL (p = 0.017) in patients with mild, moderate and severe LUTS respectively. The multivariate regression analysis in patients with BMI ≥ 25 showed that only age, TT and sex score were related to LUTS.
  
  
  CONCLUSIONS
  A higher TT is associated with a severe AUA score symptom index only in obese patients. Further analysis are necessary to evaluate the mechanisms through which testosterone may influence LUTS in these patients.
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, SP, Brazil.
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Antunes
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, SP, Brazil.
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Araújo
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, SP, Brazil.
authors.forename: Elcio
authors.initials: E
authors.lastname: Nakano
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, SP, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Muracca
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, SP, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000503:physiopathology; D009929:Organ Size; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000503:physiopathology; D012016:Reference Values; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*; D018709:Statistics, Nonparametric; D013739:Testosterone / Q000097:blood*
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D017430:Prostate-Specific Antigen