Relationship Between Low Testosterone and Benign Prostatic Hyperplasia (BPH)

Pathophysiological Relationship

BPH develops due to an imbalance between cellular growth and apoptosis in the prostatic transition zone, with hormonal factors playing a significant role 1

Multiple studies have failed to demonstrate exacerbation of voiding symptoms attributable to BPH during testosterone supplementation therapy 2
While prostate volume increases slightly during testosterone replacement therapy (mainly during the first six months), this does not typically translate to worsened urinary symptoms 2
The poor correlation between prostate volume and urinary symptoms explains why testosterone replacement doesn't typically worsen LUTS despite modest increases in prostate size 2

Individual men with hypogonadism may occasionally experience increased voiding symptoms with testosterone replacement therapy, so monitoring is still important 2

During testosterone replacement therapy, prostate volume should be monitored, particularly during the first six months when most changes occur 2
Urine flow rates, post-void residual volumes, and prostate symptoms should be assessed to detect any individual variations in response 2
Regular monitoring is recommended for men with risk factors for BPH progression, regardless of testosterone status 1