Can Testosterone Therapy Cause or Worsen BPH?

As men age, it is common to encounter both Benign Prostatic Hyperplasia, BPH, and low testosterone, known as hypogonadism. Either condition is often disruptive to a man’s life. In an ideal world, both problems would be treated quickly and completely. However, there are concerns over the relationship between testosterone replacement therapy (TRT) and the development or worsening of BPH. Concerns center around the fact that testosterone is converted to by the body to dihydotestosterone (DHT), which in turn is known to stimulate an increase in prostate size. This has become an important topic of discussion as testosterone replacement therapy has increased in popularity in recent years.

Many studies have been conducted on this topic, however additional research is needed to understand the extent of the relationship between TRT and BPH. Some conclusions follow:

A 2004 paper1 followed a 53 year old through treatment for sexual dysfunction. Over the course of the treatment, and even after, the patient’s prostate specific antigen (PSA) increased significantly which can indicate prostate enlargement or other prostatic issues.  In fact, during and after the course of treatment, the patient’s prostate volume increased significantly1. Again, an increase in prostatic volume is not necessarily specifically due to BPH, but those already experiencing the symptoms of BPH can experience a worsening. The authors consider significant BPH symptoms to be a reason to closely monitor men’s lower urinary tract symptoms prior to, and during testosterone replacement therapy.

A recent study in the Indian Journal of Urology2 seems to agree with the conclusions posited above. The authors, in reviewing other studies, conclude that higher testosterone serum levels alone may have no effect on BPH – indeed, they may help prevent the development of BPH. However, their review showed that there may be a significant risk of BPH in patients with higher levels of DHT – the product of testosterone conversion by the enzyme 5-alpha reductase.

So what can a patient with low testosterone do when the relationship between BPH and TRT is unclear? Patients should, of course, consult with their urologist and medical team to learn more about the benefits and risks of hormone replacement therapy. If their medical team believes the benefits of starting testosterone therapy outweigh the potential for worsened BPH, they may want to consider hormone therapy.

1Gore J, Rajifer J. Rising PSA during Testosterone Replacement Therapy. Rev Urol. 2004; 6(Suppl 6): S41–S43 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472885/

2Patel N, Parsons J. Kellogg. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014 Apr-Jun; 30(2): 170–176. doi:  10.4103/0970-1591.126900 http://www.indianjurol.com/article.asp?issn=0970-1591;year=2014;volume=30;issue=2;spage=170;epage=176;aulast=Patel