The Relationship Between Testosterone Levels and the Severity of Lower Urinary Tract Symptoms : A Comprehensive Systematic Review
Abstract
Introduction: The relationship between testosterone levels and lower urinary tract symptoms (LUTS) in men remains controversial, with conflicting evidence from observational studies and interventional trials. This systematic review aims to comprehensively evaluate the association between testosterone levels and LUTS severity, and to assess the effects of testosterone replacement therapy (TRT) on urinary symptoms. Methods: We systematically screened studies involving adult male participants with LUTS assessment using validated instruments (IPSS, AUA-SI) and testosterone measurement via validated laboratory methods. Eighty studies comprising randomized controlled trials, observational registry studies, and cross-sectional analyses were included. Results: Cross-sectional studies showed inconsistent baseline associations between testosterone levels and LUTS severity, with some demonstrating significant negative correlations (r=-0.334, p=0.031) (21) while large-scale trials found no relationship (1,3,4). However, interventional studies consistently demonstrated that long-term TRT significantly improved LUTS. In registry studies of up to 16 years, mean IPSS decreased from 7.0±3.5 to 1.5±2.0 in treated men versus worsening from 4.9±2.0 to 14.3±5.3 in controls (p<0.0001) (5). Improvements were observed independent of prostate size (6,9) and were particularly pronounced in men with metabolic comorbidities, including type 2 diabetes (7) and obesity (59). Mechanistic studies identified…
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