Skip to main content

Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study

World Journal of Urology volume 32, pages 1049–1054 (2014)Cite this article

Abstract

Purpose

Many men with “late-onset hypogonadism” (LOH) experience lower urinary tract symptoms (LUTS) that can be distressing and may decrease quality of life. LUTS often appear in men when testosterone levels begin to decline, which could be a significant association. We investigated whether testosterone replacement could alleviate LUTS in men with LOH.

Methods

Two hundred and sixty-one hypogonadal patients (mean age 59.5 years) presenting with erectile dysfunction, having also been evaluated for LUTS, received a single testosterone undecanoate injection at day 1, at week 6 and quarterly thereafter. Parameters, including International Prostate Symptom Score (IPSS), post-voiding residual urine volume, transrectal ultrasound, prostate volume and prostate-specific antigen were measured at each treatment visit. Two hundred and fifty-nine patients were included in the full analysis set. These were subsequently divided into weight losers (L ≥ 5 % weight loss at last visit from baseline) and non-losers (NL). t test analyses were used to compare the IPSS means of these subgroups. The potentially confounding effect on IPSS of using the phosphodiesterase-5 inhibitor (PDE5i) vardenafil was also accounted for.

Results

Mean IPSS showed a significant decrease with time following initiation of testosterone treatment (p < 0.05). No significant differences were observed in either IPSS between L and NL groups or in mean IPSS between vardenafil users and non-users.

Conclusion

Testosterone replacement is associated with improvements in LUTS which are not confounded by weight loss or PDE5i. The mechanisms of this association require further investigation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Yassin A, Saad F, Hoesl CE, Traish AM, Hammadeh M, Shabsigh R (2006) Alpha-adrenoceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS—implications for clinical practice. Andrologia 38:1–12

    Article  CAS  PubMed  Google Scholar 

  2. Yassin AA, El-Sakka AI, Saad F, Gooren LJ (2008) Lower urinary-tract symptoms and testosterone in elderly men. World J Urol 26:359–364

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Rohrmann S, Nelson WG, Rifai N, Kanarek N, Basaria S, Tsilidis KK, Smit E, Giovannucci E, Platz EA (2007) Serum sex steroid hormones and lower urinary tract symptoms in third national health and nutrition examination survey (NHANES III). Urology 69:708–713

    Article  PubMed  Google Scholar 

  4. Kaufman JM, Vermeulen A (2005) The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 26:833–876

    Article  CAS  PubMed  Google Scholar 

  5. McVary KT, Rademaker A, Lloyd GL, Gann P (2005) Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 174:1327–1433

    Article  PubMed  Google Scholar 

  6. Shabsigh R (1997) The effects of testosterone on the cavernous tissue and erectile function. World J Urol 15:21–26

    Article  CAS  PubMed  Google Scholar 

  7. Rhoden EL, Riedner CE, Fornari A, Fuchs SC, Ribeiro EP (2008) Evaluation of the association between lower urinary tract symptoms and erectile dysfunction, considering its multiple risk factors. J Sex Med 5:2662–2668

    Article  PubMed  Google Scholar 

  8. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW (2002) Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 168:599–604

    Article  CAS  PubMed  Google Scholar 

  9. Schatzl G, Madersbacher S, Haitel A, Gsur A, Preyer M, Haidinger G, Gassner C, Ochsner M, Marberger M (2003) Associations of serum testosterone with microvessel density, androgen receptor density and androgen receptor gene polymorphism in prostate cancer. J Urol 169:1312–1315

    Article  CAS  PubMed  Google Scholar 

  10. Litman HJ, Bhasin S, O’Leary MP, Link CL, McKinlay JB (2007) An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey. BJU Int 100:321–326

    Article  CAS  PubMed  Google Scholar 

  11. Traish AM, Park K, Dhir V, Kim NN, Moreland RB, Goldstein I (1999) Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology 140:1861–1868

    CAS  PubMed  Google Scholar 

  12. Stage AC, Hairston JC (2005) Symptom scores: mumbo jumbo or meaningful measures? Curr Urol Rep 6:251–256

    Article  PubMed  Google Scholar 

  13. McVary KT, Monnig W, Camps JL Jr, Young JM, Tseng LJ, van den Ende G (2007) Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 177:1071–1077

    Article  CAS  PubMed  Google Scholar 

  14. McVary KT, Roehrborn CG, Kaminetsky JC, Auerbach SM, Wachs B, Young JM, Esler A, Sides GD, Denes BS (2007) Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 177:1401–1407

    Article  CAS  PubMed  Google Scholar 

  15. Zhang X, Zang N, Wei Y, Yin J, Teng R, Seftel A, Disanto ME (2012) Testosterone regulates smooth muscle contractile pathways in the rat prostate: emphasis on PDE5 signaling. Am J Physiol Endocrinol Metab 302:E243–E253

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Saboor Aftab SA, Kumar S, Barber TM (2013) The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. Clin Endocriol (Oxf) 78:330–337

    Article  CAS  Google Scholar 

  17. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U (2000) Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 12:305–311

    Article  CAS  PubMed  Google Scholar 

  18. Vermeulen A (2001) Androgen replacement therapy in the aging male—a critical evaluation. J Clin Endocrinol Metab 86:2380–2390

    CAS  PubMed  Google Scholar 

  19. Kwan M, Greenleaf WJ, Mann J, Crapo L, Davidson JM (1983) The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men. J Clin Endocrinol Metab 57:557–562

    Article  CAS  PubMed  Google Scholar 

  20. Rosenzweig BA, Bolina PS, Birch L, Moran C, Marcovici I, Prins GS (1995) Location and concentration of estrogen, progesterone, and androgen receptors in the bladder and urethra of the rabbit. Neurourol Urodyn 14:87–96

    Article  CAS  PubMed  Google Scholar 

  21. Celayir S (2003) Effects of different sex hormones on male rabbit urodynamics: an experimental study. Horm Res 60:215–220

    Article  CAS  PubMed  Google Scholar 

  22. Filippi S, Morelli A, Sandner P, Fibbi B, Mancina R, Marini M, Gacci M, Vignozzi L, Vannelli GB, Carini M, Forti G, Maggi M (2007) Characterization and functional role of androgen-dependent PDE5 activity in the bladder. Endocrinology 148:1019–1029

    Article  CAS  PubMed  Google Scholar 

  23. Morelli A, Sarchielli E, Comeglio P, Filippi S, Mancina R, Gacci M, Vignozzi L, Carini M, Vannelli GB, Maggi M (2011) Phosphodiesterase type 5 expression in human and rat lower urinary tract tissues and the effect of tadalafil on prostate gland oxygenation in spontaneously hypertensive rats. J Sex Med 8:2746–2760

    Article  CAS  PubMed  Google Scholar 

  24. Giuliano F, Uckert S, Maggi M, Birder L, Kissel J, Viktrup L (2013) The mechanism of action of phosphodiesterase type 5 inhibitors in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Eur Urol 63:506–516

    Article  CAS  PubMed  Google Scholar 

  25. Shabsigh R, Arver S, Channer KS, Eardley I, Fabbri A, Gooren L, Heufelder A, Jones H, Meryn S, Zitzmann M (2008) The triad of erectile dysfunction, hypogonadism and the metabolic syndrome. Int J Clin Pract 62:791–798

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Bhasin S, Calof OM, Storer TW, Lee ML, Mazer NA, Jasuja R, Montori VM, Gao W, Dalton JT (2006) Drug insight: testosterone and selective androgen receptor modulators as anabolic therapies for chronic illness and aging. Nat Clin Pract Endocrinol Metab 2:146–159

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

Aksam Yassin has received honoraria for lectures from Bayer Healthcare, Ferring Pharmaceuticals and GSK. Ridwan Shabsigh has received honoraria for lectures from Bayer Healthcare. Editorial support for the manuscript was provided by Astra-Health, www.astra-health.co.uk.

Author information

Authors and Affiliations

  1. Department of Urology, Klinikum Braunschweig, Brunswick, Germany

    Dany-Jan Yassin & Peter G. Hammerer

  2. Segeberger Kliniken, Institute of Urology and Andrology, Rathausallee 94 a, 22846, Norderstedt-Hamburg, Germany

    Yousef El Douaihy & Aksam A. Yassin

  3. Dresden International University, Dresden, Germany

    Aksam A. Yassin

  4. Division of Urology, Maimonides Medical Center, Brooklyn, NY, USA

    James Kashanian & Ridwan Shabsigh

Authors
  1. Dany-Jan Yassin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yousef El Douaihy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aksam A. Yassin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Kashanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ridwan Shabsigh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter G. Hammerer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aksam A. Yassin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Yassin, DJ., El Douaihy, Y., Yassin, A.A. et al. Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. World J Urol 32, 1049–1054 (2014). https://doi.org/10.1007/s00345-013-1187-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1187-z

Keywords

  • LOH
  • Testosterone
  • LUTS
  • BPH
  • IPSS