Effect of testosterone replacement therapy on lower urinary tract symptoms: A systematic review and network meta-analysis.

No significant differences in IPSS, PSA level, or prostate volume were found between TRT administration routes and placebo in pairwise meta-analysis.

• 21 RCTs involving 2453 participants were included in the analysis.
• P values for TRT delivered by transdermal, intramuscular, and oral routes for IPSS were 0.93, 0.20, and 0.76 respectively.
• P values for PSA level across transdermal, intramuscular, and oral routes were 0.20, 0.27, and 0.98 respectively.
• P values for prostate volume across transdermal, intramuscular, and oral routes were 0.18, 0.04, and 0.16 respectively.
• Indirect comparison of all three administration routes also demonstrated no significant differences in IPSS, PSA level, and prostate volume.

Long-term intramuscular TRT significantly decreased IPSS scores in subgroup analysis.

• Subgroup analysis was conducted to assess the impact of TRT duration on outcomes.
• Long-term intramuscular TRT significantly decreased IPSS with p = 0.03.
• Other forms of TRT showed no significant change in IPSS compared with placebo.

Short-term transdermal TRT significantly increased PSA levels in subgroup analysis.

• Short-term transdermal TRT increased PSA levels with p < 0.001.
• Other forms of TRT showed no significant change in PSA level compared with placebo.
• This finding was identified through subgroup analysis by TRT duration.

Short-term intramuscular TRT significantly increased prostate volume in subgroup analysis.

• Short-term intramuscular TRT increased prostate volume with p = 0.04.
• Other forms of TRT showed no significant change in prostate volume compared with placebo.
• This finding was identified through subgroup analysis stratified by treatment duration.

Surface under the cumulative ranking curve (SUCRA) analysis indicated that intramuscular TRT had the highest probability of being the best method for decreasing IPSS.

• Intramuscular TRT had an 83% probability of being the best method for decreasing IPSS according to SUCRA analysis.
• This analysis was part of the network meta-analysis comparing all three administration routes.
• The SUCRA finding supported the conclusion that intramuscular TRT may be the preferred treatment for aging men with LOH and LUTS.

A systematic search across multiple databases identified 21 RCTs for inclusion in the network meta-analysis.

• Databases searched included PubMed, Embase, The Cochrane Library, CNKI, WanFang Data, and VIP.
• Included studies reported data on International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) level, or prostate volume.
• The total study population across included RCTs was 2453 participants.
• The study population consisted of aging men with late-onset hypogonadism (LOH).