Testosterone Therapy in Patients with BPH

Safety of Testosterone in BPH Patients

The European Association of Urology guidelines confirm that testosterone therapy does not worsen lower urinary tract symptoms or significantly increase prostate volume in men with mild to moderate BPH 1
Multiple studies show that testosterone therapy is safe and does not significantly worsen lower urinary tract symptoms or increase prostate volume in most men with BPH, except in those with severe symptoms 1

The European Urology guidelines recommend measuring PSA levels in men over 40 years of age prior to starting testosterone therapy to exclude prostate cancer 2, 3
If PSA is elevated at baseline, a second test is recommended to rule out spurious elevation, as suggested by The Journal of Urology guidelines 2
Hemoglobin/hematocrit should be measured at baseline, as testosterone therapy can increase these values, according to The Journal of Urology guidelines 3
Patients should be assessed for cardiovascular disease risk factors before starting therapy, as recommended by The Journal of Urology guidelines 4

If hematocrit exceeds 54%, intervention such as dose reduction or temporary discontinuation is warranted, as suggested by The Journal of Urology guidelines 3

Testosterone therapy is contraindicated in men currently trying to conceive, as it can cause azoospermia, according to The Journal of Urology guidelines 4, 5

The goal of testosterone therapy should be to achieve total testosterone levels in the middle tertile of the normal reference range, as recommended by The Journal of Urology guidelines 4
Starting with lower doses and titrating up as needed is recommended, especially in men with BPH, according to the European Urology guidelines 1
Clinicians should use the minimal dosing necessary to normalize testosterone levels and improve symptoms, as suggested by The Journal of Urology guidelines 4

In hypogonadal men with mild erectile dysfunction, testosterone therapy can be used as first-line treatment, according to the European Urology guidelines 1
Testosterone therapy may improve anemia, bone mineral density, lean body mass, and depressive symptoms in hypogonadal men, as suggested by The Journal of Urology guidelines 3