title: The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review.
abstract: OBJECTIVE
  To systematically review prospective trials evaluating the clinical effects of testosterone-replacement therapy on lower urinary tract symptoms and prostate volume.
  
  
  METHODS
  We performed a literature review through PubMed, Embase, and Cochrane Library from 1994 to 2015 for prospective trials of hypogonadal men with benign prostatic hyperplasia or lower urinary tract symptoms treated with testosterone-replacement therapy. We evaluated the abstracts for outcomes related to International Prostate Symptom Score, prostate volume, and urodynamic parameters.
  
  
  RESULTS
  An original cohort of 3079 abstracts was reviewed. Thirty-five trials were selected for inclusion. The majority of trials reviewed found no significant prostate growth due to testosterone-replacement therapy. Studies of men with baseline mild lower urinary tract symptoms demonstrated either no change or an improvement in symptoms after treatment. There was a lack of relevant urodynamic studies. Trials of men with the metabolic syndrome demonstrated uniform improvement in lower urinary tract symptoms. Forty-six percent of all the trials identified included exclusion criteria for baseline severe-range lower urinary tract symptoms or other signs of obstructive lower urinary tract symptoms.
  
  
  CONCLUSIONS
  The current literature demonstrates scant support for a causative relationship between testosterone-replacement therapy, de novo or worsening lower urinary tract symptoms, and prostate volume. Furthermore, our review found an absence of high quality evidence that would support guideline recommendations that testosterone-replacement therapy is relatively contraindicated in men with severe-range lower urinary tract symptoms. Future clinical trials with more inclusive voiding criteria are needed.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA. Electronic address: mkathrins@bwh.harvard.edu.
authors.forename: Martin
authors.initials: M
authors.lastname: Kathrins
authors.affiliation: Department of Surgery, Texas A&M Health Science Center College of Medicine, Temple, TX.
authors.forename: Karen
authors.initials: K
authors.lastname: Doersch
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Tony
authors.initials: T
authors.lastname: Nimeh
authors.affiliation: Division of Urology, Cooper Medical School of Rowan University, Camden, NJ.
authors.forename: Arturo
authors.initials: A
authors.lastname: Canto
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Craig
authors.initials: C
authors.lastname: Niederberger
authors.affiliation: Division of Urology, Cooper Medical School of Rowan University, Camden, NJ.
authors.forename: Allen
authors.initials: A
authors.lastname: Seftel
mesh_terms: D002986:Clinical Trials as Topic; D020249:Hormone Replacement Therapy; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000139:chemically induced*; D008297:Male; D011446:Prospective Studies; D013739:Testosterone / Q000009:adverse effects*
chemical_list: D013739:Testosterone