madman
Super Moderator
ABSTRACT
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as a weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and is considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as the decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term “male hypogonadism” is commonly used to categorize testosterone deficiency. Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue. Although the mechanism of testosterone-replacement therapy (TRT) effects on men with hypogonadism are not yet identified, TRT has been shown to effectively relieve the symptoms of TDS as well as LUTS by several studies. Although the present review demonstrates the effectiveness and safety of TRT in men with TDS by prior studies, future large-scale clinical trials should be conducted to present more high-quality evidence to clinicians and patients.
INTRODUCTION
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as a weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are considered the ultimate clinical manifestation of benign prostatic hyperplasia (BPH) and benign prostatic enlargement, which cause bladder outlet obstruction [1,2]. With the increasing population of aging males, many recent studies have focused on extending the life and prolonging good health in these individuals [1,3]. In this regard, many researchers have investigated testosterone, which is related to the differentiation and development of male genital organs.
Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue [4]. Several studies have reported that men experience a decline in testosterone levels beginning in their 40s, and that about 30% of men meet the TDS criteria at the age of 70 years [5-7]. In the Boston Area Community Health Survey, the prevalence of symptomatic TDS among men aged 30–79 years was about 6% [8]. In addition, 26.5% of men in their 60s and 70s have reported bothersome LUTS [9].
Testosterone replacement therapy (TRT) has been shown to effectively relieve the symptoms of TDS [10-16]. However, the increasing use of TRT among men who are at risk for LUTS has raised concerns about its potential adverse effects [17]. In particular, TRT may exacerbate LUTS because androgens play an integral role in the development and growth of the prostate epithelium [18].
Longitudinal studies have not consistently associated testosterone with the development of LUTS after adjusting for age [19]. However, Favilla et al. reported that high levels of testosterone were associated with an increased risk of severe LUTS [20], which have been listed by the Endocrine Society as a relative contraindication to the TRT because the treatment may worsen symptoms [21]. Some studies have demonstrated that TRT does not aggravate LUTS among men with TDS, but their results have not yet been formally accepted [14,22-25]. Relatedly, several of the Endocrine Society’s recommendations pertaining to TRT have recently been critically reevaluated [26].
Thus, in the present study, we performed a systematic review of the relationship between TRT and LUTS to clarify the available evidence.
TESTES, PROSTATE, AND ANDROGENS
*Prostate Development and Androgen Levels
*Prostate Growth and Androgens
*Testosterone Decline and BPH
*BPH/LUTS, Prostatic Inflammation, and Androgens
*BPH/LUTS and MetS
MALE HYPOGONADISM
*Definition and Diagnosis of TDS
TRT ON TDS
*General Thinking About TRT and BPH/LUTS
*Evidence for the Benefits of TRT in BPH/LUTS
*Evidence for TRT Risk in BPH/LUTS
CONCLUSIONS
The present review showed no evidence to support warnings that TRT worsens LUTS in men with TDS. TRT is already used worldwide as a treatment for TDS, and much evidence is still emerging regarding this treatment. Furthermore, TRT may also improve nocturia in men with TDS. Therefore, it is enough to warn patients that LUTS may worsen after TRT. However, further high-quality evidence is needed to inform clinicians using TRT to treat men with both TDS and severe LUTS.
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as a weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and is considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as the decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term “male hypogonadism” is commonly used to categorize testosterone deficiency. Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue. Although the mechanism of testosterone-replacement therapy (TRT) effects on men with hypogonadism are not yet identified, TRT has been shown to effectively relieve the symptoms of TDS as well as LUTS by several studies. Although the present review demonstrates the effectiveness and safety of TRT in men with TDS by prior studies, future large-scale clinical trials should be conducted to present more high-quality evidence to clinicians and patients.
INTRODUCTION
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as a weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are considered the ultimate clinical manifestation of benign prostatic hyperplasia (BPH) and benign prostatic enlargement, which cause bladder outlet obstruction [1,2]. With the increasing population of aging males, many recent studies have focused on extending the life and prolonging good health in these individuals [1,3]. In this regard, many researchers have investigated testosterone, which is related to the differentiation and development of male genital organs.
Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue [4]. Several studies have reported that men experience a decline in testosterone levels beginning in their 40s, and that about 30% of men meet the TDS criteria at the age of 70 years [5-7]. In the Boston Area Community Health Survey, the prevalence of symptomatic TDS among men aged 30–79 years was about 6% [8]. In addition, 26.5% of men in their 60s and 70s have reported bothersome LUTS [9].
Testosterone replacement therapy (TRT) has been shown to effectively relieve the symptoms of TDS [10-16]. However, the increasing use of TRT among men who are at risk for LUTS has raised concerns about its potential adverse effects [17]. In particular, TRT may exacerbate LUTS because androgens play an integral role in the development and growth of the prostate epithelium [18].
Longitudinal studies have not consistently associated testosterone with the development of LUTS after adjusting for age [19]. However, Favilla et al. reported that high levels of testosterone were associated with an increased risk of severe LUTS [20], which have been listed by the Endocrine Society as a relative contraindication to the TRT because the treatment may worsen symptoms [21]. Some studies have demonstrated that TRT does not aggravate LUTS among men with TDS, but their results have not yet been formally accepted [14,22-25]. Relatedly, several of the Endocrine Society’s recommendations pertaining to TRT have recently been critically reevaluated [26].
Thus, in the present study, we performed a systematic review of the relationship between TRT and LUTS to clarify the available evidence.
TESTES, PROSTATE, AND ANDROGENS
*Prostate Development and Androgen Levels
*Prostate Growth and Androgens
*Testosterone Decline and BPH
*BPH/LUTS, Prostatic Inflammation, and Androgens
*BPH/LUTS and MetS
MALE HYPOGONADISM
*Definition and Diagnosis of TDS
TRT ON TDS
*General Thinking About TRT and BPH/LUTS
*Evidence for the Benefits of TRT in BPH/LUTS
*Evidence for TRT Risk in BPH/LUTS
CONCLUSIONS
The present review showed no evidence to support warnings that TRT worsens LUTS in men with TDS. TRT is already used worldwide as a treatment for TDS, and much evidence is still emerging regarding this treatment. Furthermore, TRT may also improve nocturia in men with TDS. Therefore, it is enough to warn patients that LUTS may worsen after TRT. However, further high-quality evidence is needed to inform clinicians using TRT to treat men with both TDS and severe LUTS.
