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Thursday, May 9, 2013

Testosterone Supplementation Does Not Worsen Lower Urinary Tract Symptoms

Testosterone Supplementation Does Not Worsen Lower Urinary Tract Symptoms  [Abstract: 1384] 

Introduction and Objectives - Testosterone replacement therapy (TRT) is commonly used to treat men with hypogonadism; however, there has been caution is using TRT in men with moderate to severe lower urinary tract symptoms (LUTS) for fear of worsening their symptoms. The primary objective of this study was to examine the effect of TRT on LUTS in hypogonadal men.

Methods - We retrospectively reviewed Northwestern Memorial Faculty Foundation’s (NMFF) outpatient database and identified patients with a diagnosis of hypogonadism who received TRT from 2002 to 2012. LUTS were assessed by use of the AUASI pre- and post- TRT. Testosterone and PSA were also continuously measured, and all patients were closely monitored for side effects to TRT. Patients who had progression of their LUTS to the point of requiring surgery were included in the study until the point of their operation.

Results - We identified 120 hypogonadal men who underwent TRT, the majority of whom had topical therapy or a combination of topical and pellet based therapy (57.5% and 20.8%, respectively). The mean baseline AUASI was 10.8 and our mean duration of TRT was 23 months.

The mean change in AUASI was -1.07, with a range from -19 to 15. The mean baseline PSA was 1.6 and the mean change in PSA was 0.44, with a range from -10.4 to 11.4. 6.7% of patients had a baseline PSA >4.0, and they had greater improvement in AUASI than those patients with baseline PSA <4 --1.-31.7=""> 3 points while 22.5% had worsening of their AUASI >3 points. Patients with an improved AUASI had a mean PSA change of 0.3, while those who had worsening of their AUASI had a mean PSA change of 0.7 (pNS).

Approximately 7.5% of these men initiated new medications for their LUTS during the course of the study and there was no significant change in their AUASI when compared to patients without any change in their medications. Additionally, 3.3% of patients had progression of their LUTS and required transurethral resection of the prostate.

Conclusions - We demonstrate that initiating TRT in hypogonadal men does not cause a worsening of their LUTS, in fact many men have an improvement in symptoms while PSA changes appear minor. Future research should focus on larger patient population studies to further examine this relationship.

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