Association Between Testosterone Replacement Therapy and Prostatic Disorders in Elderly Hypogonadal Men.

TRT use was associated with a significant 16% reduction in the hazard of prostate cancer among elderly hypogonadal men.

• The prostate cancer risk analysis included 546,964 hypogonadal men following 1:1 propensity score matching.
• Cox regression analysis yielded HR = 0.84 (95% CI: 0.82–0.86) for PCa hazard among TRT users.
• Reductions in PCa hazard were observed across long-term (15%), short-term (16%), parenteral (12%), and topical (13%) TRT use.
• Sensitivity analyses excluding individuals with elevated PSA and family history of PCa similarly demonstrated an 18% reduction in PCa hazard among TRT users.

TRT use was associated with a 13% increase in the hazard of benign prostatic hyperplasia among elderly hypogonadal men.

• The BPH risk analysis included 412,782 hypogonadal men following 1:1 propensity score matching.
• Cox regression analysis yielded HR = 1.13 (95% CI: 1.11–1.14) for BPH hazard among TRT users.
• Parenteral TRT was associated with a larger increase in BPH hazard (19%) compared to topical TRT (12%).
• Long-term topical TRT use was linked to a modest 9% increase in BPH hazard.

The associations between TRT and prostatic outcomes varied by treatment duration, administration route, and aromatase inhibitor coadministration.

• TRT use was categorized by treatment duration (long-term vs short-term), administration route (parenteral vs topical), and aromatase inhibitor (AI) coadministration.
• Parenteral TRT was associated with a larger increase in BPH hazard (19%) than topical TRT (12%).
• Long-term topical TRT use showed the most modest BPH hazard increase at 9%.
• Both short-term (16%) and long-term (15%) TRT use were associated with reductions in PCa hazard.

This study used a large-scale retrospective cohort design drawing from Medicare enrollment and claims data spanning 2007 to 2020.

• Data were sourced from Medicare Parts A/B/C/D for men aged ≥65 with diagnosed primary or secondary hypogonadism.
• Cox regression analysis and 1:1 propensity score matching, both stratified by age group, were employed.
• Propensity score matching produced comparable baseline characteristics at the time of hypogonadism diagnosis between TRT users and non-users.
• The PCa and BPH analyses included 546,964 and 412,782 matched hypogonadal men, respectively.

Concerns about prostate-related complications frequently result in hypogonadal men remaining untreated with TRT.

• The study was motivated by the clinical concern that potential prostate-related complications associated with TRT lead hypogonadal men to remain untreated.
• The authors identified a need for large-scale evidence to inform clinical decision-making and support a more individualized approach to care.
• Prior evidence on TRT and prostate outcomes was considered insufficient to adequately address these concerns.