TESTOSTERONE AND LOWER URINARY TRACT SYMPTOMS IN MEN: A REVIEW

Abstract

Lower urinary tract symptoms (LUTS) are a common manifestation of age-related changes in men, traditionally associated with benign prostatic hyperplasia (BPH). However, the multifactorial nature of LUTS, including neurogenic and metabolic disorders, necessitates a reconsideration of the role of androgens in their pathogenesis. Objective. The aim of this study is to analyze the relationship between testosterone levels and LUTS and to evaluate the efficacy and safety of hormone replacement therapy (HRT). Materials and Methods. A systematic review of 125 publications from 2000 to 2025 was conducted, encompassing a total of 149,862 patients. Study selection was based on evidence-based medicine criteria (Cochrane/Newcastle-Ottawa), with a focus on the effects of endogenous testosterone and HRT on the International Prostate Symptom Score (IPSS), prostate volume, and urodynamic parameters. Results. The existing data contradict the hypothesis that prostate enlargement is directly linked to systemic testosterone levels. The concentrations of androgens within prostate tissue are influenced by local factors and achieve saturation at serum testosterone levels around 150 ng/dL. It has been demonstrated that testosterone can influence lower urinary tract function via receptors located in the urothelium, regulation of nitric oxide, and enhancement of pelvic blood flow, which positively impacts storage and voiding symptoms. Reviews of randomized trials indicate that there is no statistically significant deterioration of lower urinary tract symptoms (LUTS) or uncontrolled prostate enlargement associated with hormone replacement therapy (HRT) in hypogonadal men. In contrast, therapy has been shown to enhance bladder capacity, alleviate the severity of nocturia, and normalize metabolic parameters (such as obesity and insulin resistance) linked to LUTS. Conclusion. Testosterone serves a protective function in preserving urinary tract health. Replacement therapy for men experiencing age-related androgen deficiency is a clinically sound and safe approach that does not elevate the risk of benign prostatic hyperplasia (BPH) progression. Additional research is required to refine treatment protocols for patients with significant comorbidities.