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AUA2022: BEST POSTERS: Lower Urinary Tract Symptoms, Erectile Dysfunction, and Quality of Life Improve under Long-Term Testosterone Therapy in Obese Men with Functional Hypogonadism

By: Ahmad Haider, MD; Karim Sultan Haider, MD; Gheorghe Doros, PhD; Abdulmaged Traish, PhD | Posted on: 01 Oct 2022

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging men are closely associated with quality of life (QoL). We updated previously published long-term effects of testosterone therapy (TTh) in an ongoing registry study, focusing on the subgroup of obese men with functional hypogonadism.1,2

Methods

Of 476 obese men with functional hypogonadism, 281 chose TTh by means of testosterone undecanoate injections 1,000 mg/12 weeks following an initial 6-week interval (T-group), and 195 opted against TTh and served as controls (CTRL). Twelve-year data are presented. LUTS was assessed by International Prostate Symptom Score (IPSS), erectile function by the International Index of Erectile Function–Erectile Function Domain (IIEF-EF), and QoL by the Aging Males’ Symptoms scale. Post-voiding residual bladder volume (RBV) and prostate volume were measured by ultrasound. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids, and QoL to account for baseline differences between the groups.

Results

Mean±SD age at baseline was 59.9±5.5 years (T-group) and 62.9±5.0 years (CTRL, p <0.0001). Mean±SD followup was 9.4±3.0 years in the T-group and 8.9±3.0 years in CTRL, while median followup was 11 and 10 years, respectively. Alpha-blockers were used at baseline by 53.7% in the T-group and 56.4% in CTRL (p=0.3963), and phosphodiesterase type 5 inhibitors by 23.1% in the T-group and 26.2% in CTRL (p=0.4501).

After 12 years, IPSS (mean±SD baseline 7.9±3.4) decreased by 5.8±0.2 (p <0.0001) in the T-group. In CTRL, IPSS (mean±SD baseline 5.1±1.8) increased by 4.2±0.3 (p <0.0001, Fig. 1). Estimated adjusted difference between groups was —9.3 (95% CI: —10.7, —9.3; p <0.0001).

RBV in the T-group (mean±SD baseline 61.1±22.8) decreased by 48.8±1.6 mL (p <0.0001). In CTRL, RBV (mean±SD baseline 53.7±16.0) increased by 39.1±2.3 mL (p <0.0001, Fig. 2). Estimated adjusted difference between groups: —87.3 mL (95% CI: —93.5, —81.1; p <0.0001).

Figure 1. Changes in IPSS in men with functional hypogonadism and obesity, with (281) or without (195) long-term testosterone therapy. HDL, high-density lipoprotein. LDL, low-density lipoprotein.
Figure 2. Changes in residual voiding volume in men with functional hypogonadism and obesity, with (281) or without (195) long-term testosterone therapy. HDL, high-density lipoprotein. LDL, low-density lipoprotein.

Mean±SD prostate volume (mL) in the T-group increased by 3.6±0.2 (p <0.0001) and in CTRL by 4.4±0.3 (p <0.0001). The estimated adjusted difference between groups was not statistically significant.

Mean±SD IIEF-EF in the T-group increased from 17.5±5.9 (mild to moderate) by 11.1±0.3 to 29.2±1.1 (no ED, p <0.0001). In CTRL, IIEF-EF decreased from 18.9±3.9 (mild to moderate) by 14.4±0.4 to 7.7±1.1 (severe, p < 0.0001, Fig. 3). Estimated adjusted difference between groups: 25.5 (95% CI: 24.5, 26.5; p <0.0001).

Mean±SD QoL improved from 53.7±9.5 (severe symptoms) by 31.1 points in the T-group to 16.9 (no symptoms, p <0.0001) and declined from 40.0±5.7 (moderate symptoms) by 21.8 points to 69.8 (severe symptoms) in CTRL (p <0.0001, Fig. 4).

Discussion

“In obese men with functional hypogonadism, long-term TTh improved LUTS and ED sustainably over 12 years.”
Figure 3. Changes in IIEF-EF in men with functional hypogonadism and obesity, with (281) or without (195) long-term testosterone therapy.HDL, high-density lipoprotein. LDL, low-density lipoprotein.
Figure 4. Changes in Aging Males’ Symptoms (AMS) scale in men with functional hypogonadism and obesity, with (281) or without (195) long-term testosterone therapy. HDL, high-density lipoprotein. LDL, low-density lipoprotein.

We have previously described progressive improvements of LUTS, ED, and QoL under TTh over 8 years1 and of ED and QoL over 10 years.2 Among the effects of long-term TTh contributing to the observed improvements are substantial weight loss in the magnitude of 20% in obese men. Moreover, testosterone improves vascular function and inflammation.3

Conclusion

In obese men with functional hypogonadism, long-term TTh improved LUTS and ED sustainably over 12 years. This may have contributed to improvements in QoL. In the untreated CTRL group, LUTS, ED, and QoL deteriorated. Changes in LUTS seemed to be independent of prostate volume.

  1. Haider KS, Haider A, Doros G, Traish A. Long-term testosterone therapy improves urinary and sexual function, and quality of life in men with hypogonadism: results from a propensity matched subgroup of a controlled registry study. J Urol. 2018;199(1):257-265.
  2. Saad F, Caliber M, Doros G, Haider KS, Haider A. Long-term treatment with testosterone undecanoate injections in men with hypogonadism alleviates erectile dysfunction and reduces risk of major adverse cardiovascular events, prostate cancer, and mortality. Aging Male. 2020;23(1):81-92.
  3. Kelly DM, Jones TH. Testosterone: a vascular hormone in health and disease. J Endocrinol. 2013;217(3):R47–R71.