Introduction: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in elderly men are closely associated with quality of life (QoL). We aimed to assess long-term effects of testosterone therapy (TTh) in obese hypogonadal men in a registry study.
Methods: Of 476 obese men with functional hypogonadism, 281 men chose TTh by means of testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group). 195 men opted against TTh and served as controls (CTRL). 12-year data are presented. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the groups.
Results: Mean age at baseline: 59.9±5.5 years (T-group) and 62.9±5.0 (CTRL) (p < 0.0001). Mean (median) follow-up: T-group 9.4±3.0 (11), CTRL 8.9±3.0 (10) years. Alpha-blockers were used at baseline by 53.7% in the T-group and 56.4% in CTRL (p=0.3963), PDE5 inhibitors by 23.1% in the T-group and 26.2% in CTRL (p=0.4501).
IPSS (baseline: 7.9±3.4) decreased by 5.8±0.2 (p < 0.0001) in the T-group in year 12. In CTRL, IPSS (baseline: 5.1±1.8) increased by 4.2±0.3 (p < 0.0001). Estimated adjusted difference between groups: -9.3 [95% CI: -10.7;-9.3] (p < 0.0001).
Residual bladder volume (RBV) in the T-group (baseline: 61.1±22.8) decreased by 48.8±1.6 mL (p < 0.0001) in year 12. In CTRL, RBV (baseline: 53.7±16.0) increased by 39.1±2.3 mL (p < 0.0001). Estimated adjusted difference between groups: -87.3 mL [95% CI: -93.5;-81.1] (p < 0.0001).
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) in year 12. In CTRL, IIEF-EF decreased from 18.9±3.9 (mild to moderate) by 14.4±0.4 to 7.7±1.1 (severe). Estimated adjusted difference between groups: 25.5 (95% CI: 24.5;26.5) (p < 0.0001 for all).QoL, assessed by the Aging Males’ Symptoms scale (AMS), improved from 53.7±9.5 (severe symptoms) by 31.1 points in the T-group to 16.9 (no symptoms) and worsened from 40.0±5.7 (moderate symptoms) by 21.8 points to 69.8 (severe symptoms) in CTRL.
Conclusions: In obese men with functional hypogonadism, long-term TTh improves LUTS and ED sustainably over 12 years. This may have contributed to improvements in QoL. In the untreated control group, LUTS, ED, and QoL deteriorated.
Source of Funding: Data entry and statistical analysis was compensated by Bayer AG.