Updates on androgen replacement therapy and lower urinary tract symptoms: a narrative review.

Lower urinary tract symptoms (LUTS) are commonly associated with hypogonadism in elderly men.

• LUTS are caused by higher tension at the bladder neck level due to fibrosis or stiffness, or benign prostatic hyperplasia causing static obstruction of the bladder outlet.
• Symptoms include hesitancy, intermittency, weak stream, nocturia, urine frequency, and urgency.
• Hypogonadism is identified as reduced testes capability in producing sex steroids and sperm, categorized as testosterone deficiency.
• Both obstructive and irritative LUTS are common in elderly men with hypogonadism.

Testosterone therapy (TTh) has been reported to be effective in the development of male genital organs in hypogonadal men.

• Several studies have reported on the effectiveness of TTh in the development of male genital organs.
• The mode of action (MoA) of testosterone therapy on hypogonadal men requires more research and understanding.
• The review covers the latest updates of TTh in LUTS including potential adverse effects, advantages, and disadvantages.

Testosterone therapy does not appear to worsen lower urinary tract symptoms in hypogonadal men.

• Multiple studies reviewed suggest TTh does not negatively impact LUTS in hypogonadal men.
• The review assessed both obstructive and irritative urinary symptoms in the context of TTh.
• The review was conducted as a narrative review summarizing current evidence on TTh and LUTS.

Benign prostatic hyperplasia (BPH) and bladder neck fibrosis or stiffness are the primary structural causes of LUTS in aging men.

• BPH causes static obstruction of the bladder outlet contributing to LUTS.
• Higher tension at the bladder neck level due to fibrosis or stiffness is an alternative structural cause.
• Both mechanisms produce overlapping symptom profiles including storage and voiding symptoms.

Testosterone therapy has both potential advantages and disadvantages in the management of LUTS in hypogonadal men.

• The review specifically addressed potential adverse effects of TTh in relation to LUTS.
• Advantages and disadvantages of TTh for LUTS were reviewed as part of the narrative analysis.
• The paper presents this as an area requiring continued investigation given the complexity of the relationship between testosterone levels and urinary tract function.