The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review

• Published in: Urology (Ridgewood, N.J.) N.J.), 2016-02, Vol.88, p.22-32
• Main Authors: Kathrins, Martin, Doersch, Karen, Nimeh, Tony, Canto, Arturo, Niederberger, Craig, Seftel, Allen
• Format: Article
• Language: English
• Subjects: Clinical Trials as Topic; Hormone Replacement Therapy; Humans; Lower Urinary Tract Symptoms - chemically induced; Male; Prospective Studies; Testosterone - adverse effects; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2015.11.006

Objectives To systematically review prospective trials evaluating the clinical effects of testosterone-replacement therapy on lower urinary tract symptoms and prostate volume. Materials and 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. Conclusion 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.