Effects of Testosterone Level on Lower Urinary Tract Symptoms

Presentation Number: THR-124
Date of Presentation: March 5th, 2015

E. David Crawford1, Wendy Poage2, Allen Nyhuis3, David Alan Price3, Sherie A Dowsett3 and David Muram*3
1University of Colorado, 2Prostate Conditions Education Council, 3Eli Lilly and Company



Lower urinary tract symptoms (LUTS) are common in older men, with moderate-to-severe symptoms being reported in 45% of men aged 70-80 years (1). Benign prostatic hyperplasia (BPH) is commonly associated with LUTS. Testosterone has a stimulatory effect on prostate cells and prescribing information for testosterone replacement therapies (TRT) warns that the therapy may worsen BPH symptoms. While the relationship between BPH and endogenous total testosterone (TT) levels has been widely studied, there is less understanding of the relationship between TT and LUTS symptoms (2,3). The purpose of this post hoc analysis was to determine the relationship, if any, between TT level and LUTS as assessed by the International Prostate Symptom Score (IPSS) score. 


The study sample comprised men who elected to be screened during the 2013 Prostate Cancer Awareness Week. Men undergoing screening provided informed consent, completed a series of health questionnaires, including the IPSS, underwent a medical evaluation and, for a large subset, had blood drawn for laboratory assays, including measurement of TT level. Prostate size was determined by digital rectal examination. Analyses were performed using data from men with TT levels measured from an 8-11 AM blood draw. Spearman correlation coefficients were calculated between TT levels and prostate size categories, IPSS categories and QoL ratings as well as between TT levels and total, irritative symptom and obstructive symptom subscores. Analysis of covariance was used to adjust the IPSS variables for prostate size.


Mean TT levels (ng/dl) by prostate size category were: Normal 419.2 (n=106), Enlarged 394.7 (n=71), Abnormal 416.4 (n=7), and Abnormal/Suspicious 515.2 (n=19). There was no significant correlation between prostate size category and TT level (r= +0.03; p=0.69). Mean TT levels by IPSS category were: None 468.5 (n=15), Mild 414.0 (n=138), Moderate 397.4 (n=66), and Severe 437.9 (n=7). There was no significant correlation between IPSS category and TT level (r= -0.06; p=0.40). Mean TT levels by IPSS QoL rating were as follows: Delighted 474.5 (n=43), Pleased 424.6 (n=65), Mostly Satisfied 361.2 (n=63), Mixed 448.2 (n=29), Mostly Dissatisfied 337.2 (n=17), Unhappy 435.8 (n=6). There was no significant correlation between IPSS QoL rating and TT level (r= -0.13; p=0.055). There were no significant correlations between TT level and IPSS total, irritative symptom and obstructive symptom scores. Adjustment for prostate size yielded similar findings.


Endogenous TT levels did not correlate with LUTS or prostate size. This supports the saturation theory in which TT is not able to induce further androgen-stimulated prostate tissue growth due to receptor saturation. Any LUTS worsening following TRT in hypogonadal men may be related to stimulation of prostatic cells previously deprived of testosterone.


Disclosure: EDC: Consultant, Ferring Pharmaceuticals, Consultant, Dendreon, Consultant, Jansen Pharmaceuticals, Consultant, Genomic Health, Consultant, MDx, Consultant, Bayer, Inc., Employee, Ferring Pharmaceuticals. WP: Collaborator, MDx Health, Collaborator, Strand Diagnostics, Collaborator, Genomic Dx, Collaborator, Abbott Laboratories, CME Programming, Independent Contractor, Bayer, Inc.. AN: Employee, Eli Lilly & Company. DAP: Employee, Eli Lilly & Company. SAD: Employee, Eli Lilly & Company. DM: Employee, Eli Lilly & Company.