Should a patient with benign prostatic hyperplasia (BPH) discontinue testosterone (androgen) replacement therapy?

From the Guidelines

Individuals with an enlarged prostate should not automatically stop testosterone therapy, as the current evidence does not support a direct link between testosterone and worsening prostate enlargement. The relationship between testosterone and prostate health is complex, and modern evidence suggests that testosterone can be safely used in many men with BPH if properly monitored 1.

When considering the management of benign prostatic hyperplasia (BPH), the focus should be on alleviating symptoms and preventing disease progression. According to the American Urological Association guideline on the management of BPH, 5 alpha-reductase inhibitors such as finasteride and dutasteride are effective treatments for patients with lower urinary tract symptoms (LUTS) associated with prostatic enlargement 1.

Key points to consider in the management of BPH include:

• The use of 5 alpha-reductase inhibitors to reduce prostatic size, increase peak urinary flow rate, and reduce BPH symptoms 1.
• The importance of individualized assessment for men with BPH who are on testosterone therapy, considering the potential benefits and risks of continuing or adjusting therapy.
• The role of regular prostate monitoring through physical exams and PSA testing for men on testosterone therapy, especially those with existing prostate conditions.

In terms of testosterone therapy, it is crucial to weigh the benefits against potential impacts on prostate health and urinary function. The decision to continue or adjust testosterone therapy in men with an enlarged prostate should be made on a case-by-case basis, taking into account the individual's overall health, symptoms, and response to treatment. Consultation with a healthcare provider is essential to determine the best course of action.

From the FDA Drug Label

Men with BPH treated with androgens are at an increased risk for worsening of signs and symptoms of BPH. Monitor patients with BPH for worsening signs and symptoms. Testosterone gel is contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate

The patient with an enlarged prostate should be cautious when taking testosterone. The FDA drug label recommends monitoring patients with BPH for worsening signs and symptoms, and it is contraindicated in men with known or suspected carcinoma of the prostate. However, it does not explicitly state that someone with an enlarged prostate should stop their testosterone.

• The decision to stop testosterone should be made on a case-by-case basis, considering the individual's overall health and medical history.
• It is essential to weigh the potential benefits of testosterone therapy against the potential risks, particularly in patients with BPH.
• Patients should be closely monitored for worsening signs and symptoms of BPH while taking testosterone 2, 2.

From the Research

Testosterone and Enlarged Prostate

• The relationship between testosterone and an enlarged prostate is complex, with some studies suggesting that testosterone can exacerbate prostate growth 3, 4.
• However, other studies have found that 5-alpha reductase inhibitors, which block the conversion of testosterone to dihydrotestosterone (DHT), can be effective in reducing prostate size and improving symptoms in men with benign prostatic hyperplasia (BPH) 3, 5, 4.
• DHT is thought to play a key role in the development of BPH, and reducing its levels through 5-alpha reductase inhibition can help to prevent and retard the progression of the disease 4.

Stopping Testosterone Therapy

• There is no clear evidence to suggest that stopping testosterone therapy is necessary for men with an enlarged prostate 6, 7.
• In fact, some studies have found that testosterone deficiency can have negative effects on metabolic and sexual function in men, and that testosterone therapy can be beneficial in improving these outcomes 6.
• However, men with BPH who are taking 5-alpha reductase inhibitors should be aware of the potential adverse effects of these medications on their overall health and quality of life, including sexual dysfunction and metabolic changes 6, 7.

Considerations for Men with Enlarged Prostate

• Men with an enlarged prostate should discuss their treatment options with their healthcare provider, including the potential benefits and risks of 5-alpha reductase inhibitors and testosterone therapy 3, 6, 5.
• Regular monitoring of prostate size and symptoms, as well as metabolic and sexual function, can help to inform treatment decisions and minimize the risk of adverse effects 6, 7.