Low testosterone, incontinence may be linked in older women

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Chicago-A recent study shows older women with decreased levels of serum testosterone are more likely to experience incontinence, but this does not necessarily mean urologists should be giving testosterone to older women, a study author says.

“What I do advocate is: We need to know a lot more about the impact of hormone levels on the aging bladder,” Michael B. Chancellor, MD, researcher for Beaumont Health, Royal Oak, MI.

The results, part of the Health, Aging, and Body Composition (Health ABC) study, sought to determine whether serum free testosterone levels were associated with urinary leakage in older women in a population-based cohort.

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Nearly half of women ages 50 years and older experience incontinence, and this percentage increases as women get older-particularly after women go through menopause. During menopause, women experience a decline in testosterone. However, the relationship between loss of testosterone in the blood and urinary incontinence in older women is not well understood.

The authors studied 3,075 healthy and well-functioning Caucasian and African-American men and women ages 70 to 79 years participating in the Health ABC study. They measured serum free and total testosterone and administered urinary health questionnaires to each participant. Urinary incontinence was defined as self-reported daily urinary leakage.

Data were first split by gender and then grouped by self-reported urinary leakage (less than once per month, once per month or more, once per week or more, and daily). Then, a one-way ANOVA test was performed by gender between urinary leakage groups using both the free and total testosterone data. Additional testing was performed with pairwise Student’s t-tests, as the distribution of testosterone samples was approximately normal.

According to the survey results, women-but not men-with urinary incontinence had decreased serum testosterone compared with women who experienced urinary leakage less than once per month.

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There was also a trend toward higher free testosterone in serum with women who experienced urinary leakage more than once per month or more than once per week.

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This supports the hypothesis that testosterone may play an important role in supporting the health of muscles in the pelvic floor as well as those that maintain urethral support, Dr. Chancellor said, noting that androgen receptors are found throughout the pelvic floor and lower urinary tract. When muscles in these areas are healthy, they help prevent involuntary leakage of urine.

“Testosterone is a very controversial topic, not just in men, but also in women,” Dr. Chancellor said. He cautioned that more research is needed, as one of the limitations of the study is that urologists were not involved.

“It was much harder than I thought” to look at the impact of one hormone level on female incontinence, he said.