Long-term effects of testosterone therapy on prostate volume and LUTS in hypogonadal men: a retrospective study

Peter Ströberg; Ramin Ghaffarpour; Börje Ljungberg; Johan Svensson

doi:10.2340/sju.v61.45576

Authors

Peter Ströberg Urohälsan i Skövde, Skövde, Sweden; Department of Urology Region Jönköpings län, Jönkoping, Sweden
Ramin Ghaffarpour Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden
Börje Ljungberg Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden
Johan Svensson Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/sju.v61.45576

Keywords:

testosterone treatment, late onset hypogonadism, prostate volume, lower urinary tract symptoms

Abstract

Introduction: Up to 20% of aging men have low serum testosterone (late-onset hypogonadism [LOH]), and approximately 80% develop benign prostatic enlargement (BPE) with increasing age. Both age and prostate size are linked to lower urinary tract symptoms (LUTS). This study aimed to evaluate the effect of testosterone replacement therapy (TRT) on prostate volume and LUTS in men with LOH.

Materials and methods: From 2004 to 2017, 511 men underwent annual checkups including physical examination, transrectal ultrasound, bladder scanning, serum Prostate-Specific Antigen (s-PSA), and serum testosterone and questionnaires on LUTS and LOH symptoms. None had prior treatments affecting prostate size or LUTS at baseline. During the annual follow-ups, 167 men (33%) were diagnosed with symptomatic LOH and received TRT. A longitudinal statistical model was used to compare periods with and without treatment regarding prostate growth, post-void residual urine, IPSS (International Prostate Symptom Score), quality of life (QoL), and s-PSA.

Results: Participants contributed 3745 visits (median 7 per man), including 904 (24%) after testosterone initiation. TRT was associated with a mean increase in prostate growth rate of 0.22 mL/year compared with untreated periods (p = 0.023). No significant differences were observed in LUTS, QoL, or s-PSA between treated and untreated periods

Conclusion: In ageing males with late-onset hypogonadism, testosterone replacement therapy was linked to a small but statistically significant increase in prostate growth rate without measurable effects on urinary symptoms.

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References

Harman SM, Metter EJ, Tobin JD, et al. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86(2):724–731.

https://doi.org/10.1210/jcem.86.2.7219 DOI: https://doi.org/10.1210/jcem.86.2.7219

Fitzpatrick JM. The natural history of benign prostatic hyperplasia. BJU Int. 2006;97(Suppl 2):3–6; discussion 21–22.

https://doi.org/10.1111/j.1464-410X.2006.06097.x DOI: https://doi.org/10.1111/j.1464-410X.2006.06097.x

Lieber MM, Rhodes T, Jacobson DJ, et al. Natural history of benign prostatic enlargement: long-term longitudinal population-based study of prostate volume doubling times. BJU Int. 2010;105(2): 214–219.

https://doi.org/10.1111/j.1464-410X.2009.08719.x DOI: https://doi.org/10.1111/j.1464-410X.2009.08719.x

Jacobsen SJ, Girman CJ, Lieber MM. Natural history of benign prostatic hyperplasia. Urology. 2001;58(6 Suppl. 1):5–16; discussion 16.

https://doi.org/10.1016/s0090-4295(01)01298-5 DOI: https://doi.org/10.1016/S0090-4295(01)01298-5

Sarma AV, Jacobson DJ, McGree ME, et al. A population-based study of incidence and treatment of benign prostatic hyperplasia among residents of Olmsted County, Minnesota: 1987 to 1997. J Urol. 2005;173(6):2048–2053.

https://doi.org/10.1097/01.ju.0000158443.13918.d6 DOI: https://doi.org/10.1097/01.ju.0000158443.13918.d6

Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Treatment for benign prostatic hyperplasia among community dwelling men: the Olmsted County study of urinary symptoms and health status. J Urol. 1999;162(4):1301–1306.

https://doi.org/10.1016/S0022-5347(05)68271-7 DOI: https://doi.org/10.1016/S0022-5347(05)68271-7

Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am. 2016;43(3):289–297.

https://doi.org/10.1016/j.ucl.2016.04.001 DOI: https://doi.org/10.1016/j.ucl.2016.04.001

Castration as a remedy for enlarged prostate. JAMA. 1894;XXIII(20):766767.

https://doi.org/10.1001/jama.1894.02421250028006 DOI: https://doi.org/10.1001/jama.1894.02421250028006

Axcrona K, Aaltomaa S, da Silva CM, et al. Androgen deprivation therapy for volume reduction, lower urinary tract symptom relief and quality of life improvement in patients with prostate cancer: degarelix vs goserelin plus bicalutamide. BJU Int. 2012;110(11):1721–1728.

https://doi.org/10.1111/j.1464-410X.2012.11107.x DOI: https://doi.org/10.1111/j.1464-410X.2012.11107.x

Lee JH, Kim Y, Park YW, et al. Relationship between benign prostatic hyperplasia/lower urinary tract symptoms and total serum testosterone level in healthy middle-aged eugonadal men. J Sex Med. 2014;11(5):1309–1315.

https://doi.org/10.1111/jsm.12489 DOI: https://doi.org/10.1111/jsm.12489

Roberts RO, Jacobson DJ, Rhodes T, et al. Serum sex hormones and measures of benign prostatic hyperplasia. Prostate. 2004;61(2):124–131.

https://doi.org/10.1002/pros.20080 DOI: https://doi.org/10.1002/pros.20080

Park YW, Kim SB, Kwon H, et al. The relationship between lower urinary tract symptoms/benign prostatic hyperplasia and the number of components of metabolic syndrome. Urology. 2013;82(3):674–679.

https://doi.org/10.1016/j.urology.2013.03.047 DOI: https://doi.org/10.1016/j.urology.2013.03.047

Kathrins M, Doersch K, Nimeh T, et al. The relationship between testosterone-replacement therapy and lower urinary tract symptoms: a systematic review. Urology. 2016;88:22–32.

https://doi.org/10.1016/j.urology.2015.11.006 DOI: https://doi.org/10.1016/j.urology.2015.11.006

Fendereski K, Horns JJ, Dehghanbanadaki H, et al. The impact of testosterone therapy on benign prostatic hyperplasia in hypogonadal males. Urology. 2025;196:325–332.

https://doi.org/10.1016/j.urology.2024.11.006 DOI: https://doi.org/10.1016/j.urology.2024.11.006

Pearl JA, Berhanu D, François N, et al. Testosterone supplementation does not worsen lower urinary tract symptoms. J Urol. 2013;190(5):1828–1833.

https://doi.org/10.1016/j.juro.2013.05.111 DOI: https://doi.org/10.1016/j.juro.2013.05.111

Debruyne FM, Behre HM, Roehrborn CG, et al. RHYME Investigators. Testosterone treatment is not associated with increased risk of prostate cancer or worsening of lower urinary tract symptoms: prostate health outcomes in the Registry of Hypogonadism in Men. BJU Int. 2017;119(2):216–224.

https://doi.org/10.1111/bju.13578 DOI: https://doi.org/10.1111/bju.13578

Kohn TP, Mata DA, Ramasamy R, et al. Effects of testosterone replacement therapy on lower urinary tract symptoms: a systematic review and meta-analysis. Eur Urol. 2016;69(6):1083–1090.

https://doi.org/10.1016/j.eururo.2016.01.043 DOI: https://doi.org/10.1016/j.eururo.2016.01.043

Holmäng S, Mårin P, Lindstedt G, et al. Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate. 1993;23(2):99–106.

https://doi.org/10.1002/pros.2990230203 DOI: https://doi.org/10.1002/pros.2990230203

Yassin A, Alwani M, Al-Zoubi RM, et al. Voiding function improves under long-term testosterone treatment (TTh) in hypogonadal men, independent of prostate size. Int Urol Nephrol. 2023;55(7):1649–1658.

https://doi.org/10.1007/s11255-023-03602-4 DOI: https://doi.org/10.1007/s11255-023-03602-4

Idan A, Griffiths KA, Harwood DT, et al. Long-term effects of dihydrotestosterone treatment on prostate growth in healthy, middle-aged men without prostate disease: a randomized, placebo-controlled trial. Ann Intern Med. 2010;153(10):621–632.

https://doi.org/10.7326/0003-4819-153-10-201011160-00004 DOI: https://doi.org/10.7326/0003-4819-153-10-201011160-00004

Bhasin S, Travison TG, Pencina KM, et al. Prostate safety events during testosterone replacement therapy in men with hypogonadism: a randomized clinical trial. JAMA Netw Open. 2023;6(12):e2348692.

https://doi.org/10.1001/jamanetworkopen.2023.48692 DOI: https://doi.org/10.1001/jamanetworkopen.2023.48692

Mohamed O, Freundlich RE, Dakik HK, et al. The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. Int J Impot Res. 2010;22(1):20–24.

https://doi.org/10.1038/ijir.2009.35 DOI: https://doi.org/10.1038/ijir.2009.35

Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49(9):1239–1242.

https://doi.org/10.1053/meta.2000.8625 DOI: https://doi.org/10.1053/meta.2000.8625

Salonia A, Capogrosso P, Boeri L, et al. European Association of Urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie’s disease. Eur Urol. 2025;88(1):76–102.

https://doi.org/10.1016/j.eururo.2025.04.010 DOI: https://doi.org/10.1016/j.eururo.2025.04.010

Moore C, Huebler D, Zimmermann T, et al. The Aging Males’ Symptoms scale (AMS) as outcome measure for treatment of androgen deficiency. Eur Urol. 2004;46(1):80–87.

https://doi.org/10.1016/j.eururo.2004.01.009 DOI: https://doi.org/10.1016/j.eururo.2004.01.009

Banerjee PP, Banerjee S, Brown T, et al. Androgen action in prostate function and disease. Am J Clin Exp Urol. 2018;6(2):62–77.

Tek M, Balli E, Cimen B, et al. The effect of testosterone replacement therapy on bladder functions and histology in orchiectomized mature male rats. Urology. 2010;75(4):886–890.

https://doi.org/10.1016/j.urology.2009.08.016 DOI: https://doi.org/10.1016/j.urology.2009.08.016

Bhasin S, Thompson IM. Prostate risk and monitoring during testosterone replacement therapy. J Clin Endocrinol Metab. 2024;109(8):1975–1983.

https://doi.org/10.1210/clinem/dgae334 DOI: https://doi.org/10.1210/clinem/dgae334

Stranne J. 2023/2024 update of the national prostate cancer guidelines in Sweden. Scand J Urol. 2024;59:210–211.

https://doi.org/10.2340/sju.v59.42656 DOI: https://doi.org/10.2340/sju.v59.42656