Objective
To investigate the correlation between testosterone levels and lower urinary tract symptoms (LUTS) and bladder outlet obstruction (BOO), to evaluate the change in testosterone secretion during treatment for LUTS, and to determine the factors that influence testosterone secretion.
Methods
This was an open-labeled, single-center, prospective study of 110 outpatients with LUTS caused by benign prostatic hyperplasia. Silodosin, an alpha-1 blocker that is not known to affect testosterone secretion, was administered to the patients. Before administration and 1 year after administration, serum testosterone level was measured, and the International Prostate Symptom Score and a urodynamic study were used to assess subjective and objective symptoms.
Results
A total of 104 patients with a mean age of 70.4 years were included in the analysis. According to pretreatment evaluation, no statistically significant correlations existed between the serum total testosterone level and the International Prostate Symptom Score (r = −0.08, P = .44) or BOO index (r = 0.04, P = .68). One year after silodosin administration, the mean serum testosterone level significantly increased from 5.09 to 5.52 ng/mL (P <.001). Additionally, a significant positive correlation was observed between the change in testosterone level and improvement in the BOO index (r = 0.52, P <.001).
Conclusion
In patients with benign prostatic hyperplasia, treatment with silodosin significantly increased testosterone secretion, and improvements in objective symptoms such as BOO were found to be the factors that influenced testosterone secretion.
In elderly men, various symptoms resulting from low testosterone levels that are attracting the attention of medical professionals are characterized as late onset hypogonadism (LOH) syndrome.1 The clinical signs of LOH syndrome are decrease in libido and sexual desire, decrease in muscle mass and strength, decrease in bone mineral density, increase in visceral fat, decline in memory, anemia, and increase of insulin resistance.2, 3 and 4 LOH syndrome is believed to be caused by metabolic syndrome (MetS) and extreme stress, and the prevalence of MetS is significantly higher in men with LOH than in healthy controls. 5 and 6
Elderly men also commonly experience lower urinary tract symptoms (LUTS), the main cause of which is benign prostatic hyperplasia (BPH). LUTS associated with BPH have a significant negative impact on the patient’s quality of life (QOL).7 Recently, results of an epidemiological survey suggested that LUTS are related to MetS and are observed in many patients with LOH syndrome.8 and 9
Therefore, could LOH syndrome and LUTS affect each other? Some researchers have reported inverse associations between serum total testosterone (TT) levels and LUTS,10 and 11 but many studies have indicated that LUTS were not associated with the serum TT level.12 and 13 Additionally, some studies have reported that androgen-replacement therapy (ART) for patients with LOH syndrome resulted in improvement in LUTS,14 and 15 whereas others reported that ART had little effect on LUTS.16 and 17 Consequently, data on the relationship between testosterone levels and severity of LUTS and the effect of ART on LUTS are conflicting, and further studies are required to reach definitive conclusions. Furthermore, no reports have indicated whether improvements in LUTS and bladder outlet obstruction (BOO) through medical therapy influence LOH syndrome and testosterone secretion.
The aims of the present study were (i) to investigate the correlation between testosterone levels and the severity of LUTS and BOO; (ii) to evaluate the change in testosterone secretion during treatment for LUTS; and (iii) to determine the factors that influence testosterone secretion during treatment for LUTS.
