Obesity, sex, and LUTS: What's the connection?

Two studies presented at the 2010 AUA annual meeting shed light on the relationship between total testosterone and LUTS in men. In the first study, data including AUA Symptom Score, serum total testosterone, serum PSA, digital rectal exam results, prostate volume, and body mass index were collected from 13,487 men (see article, No relationship between total testosterone, LUTS). Although increasing age and PSA were associated with LUTS, total testosterone was not. In a second study, serum testosterone declined with age at a mean of 0.19% per year (see article, Testosterone decline linked with worsening LUTS). There was no association between total testosterone and prostate volume. Of interest, rapid declines in testosterone levels were associated with worsening LUTS scores and decreased maximum flow.

We should use caution in clinical extrapolation of these results given the variability of serum testosterone measurement in individual patients. Nevertheless, the use of exogenous testosterone will become increasingly accepted as men age. We have recognized that use of exogenous testosterone can affect body fat, BMI, and lipid metabolism. In an era in which we increasingly strive to optimize men's health, an understanding of the complex interaction of medical therapies designed to improve voiding (alpha-blockers and 5-alpha-reductase inhibitors), sexual function (testosterone), and lipid metabolism (statins) will be better described.

Steven A. Kaplan, MD

Dr. Kaplan, a member of the Urology Times Editorial Council, is professor of urology at Weill Cornell Medical College, New York.