From the Guidelines
Testosterone replacement therapy should be used with caution in men with benign prostatic hyperplasia (BPH) as it may worsen symptoms due to the conversion of testosterone to dihydrotestosterone (DHT), which stimulates prostate growth. The relationship between testosterone replacement and BPH is complex, and the risk of worsening symptoms is particularly relevant for men with pre-existing moderate to severe BPH symptoms 1.
Key Considerations
- The prostate gland's growth and development are influenced by androgens, with testosterone being converted to DHT by the enzyme 5-alpha reductase, leading to an increase in cellular mass and potentially exacerbating BPH symptoms 1.
- Before initiating testosterone therapy, a baseline prostate assessment, including digital rectal examination and possibly PSA testing, is recommended to evaluate the current state of the prostate.
- Regular monitoring of prostate symptoms using tools like the International Prostate Symptom Score (IPSS) during treatment is crucial to promptly identify any worsening of BPH symptoms.
Management of Worsening BPH Symptoms
- If BPH symptoms worsen during testosterone replacement therapy, treatment options may include adding medications like alpha-blockers (e.g., tamsulosin, alfuzosin) or 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) to alleviate symptoms.
- Adjusting the testosterone dosage or, in some cases, discontinuing testosterone replacement therapy may also be considered based on the severity of symptoms and the patient's overall health status.
From the Research
Testosterone Replacement Therapy and BPH
- The relationship between testosterone replacement therapy (TRT) and benign prostatic hyperplasia (BPH) is complex, with some studies suggesting that TRT may worsen BPH symptoms 2.
- Testosterone is converted to dihydrotestosterone (DHT) in the prostate, which is a key factor in the development of BPH 3.
- 5-alpha-reductase inhibitors, such as finasteride, can reduce DHT levels and are used to treat BPH 4, 3.
- However, the use of 5-alpha-reductase inhibitors can also have negative effects on metabolic and sexual function in men 5.
Clinical Considerations
- TRT has been associated with an increased risk of BPH, as well as other side effects such as polycythemia, prostate cancer, and gynecomastia 2.
- Carefully designed clinical trials are needed to investigate the risks and benefits of TRT in symptomatic age-related hypogonadism 2.
- The decision to initiate TRT in patients with BPH or other prostate-related conditions should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 6.