Obesity may influence the relationship between sex hormones and lower urinary tract symptoms

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: The effects of serum testosterone in the lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) are not well established. The objective of the study is to evaluate the association of sex hormones with LUTS and control the results by patient weight. Materials and Methods:The study comprised a cross-sectional analysis of 725 men included in a prostate cancer screening program at University of Sao Paulo Medical School. The serum concentrations of total testosterone (TT), free testosterone (FT) and sex hormone binding globulin (SHBG) were measured. Variables analyzed were age, American Urological Association (AUA) symptom score, storage symptoms, voiding symptoms, quality of life score, prostate specific antigen levels and prostate volume. Obesity was measured through the calculation of body mass index (BMI). A regression analysis model was performed.Results: Median patient age was 65 years (48 to 94). A higher TT level was significantly associated with a severe AUA symptom score only among patients with a BMI ≥ 25. Median TT was 371, 370 and 427ng/dL (p = 0.017) in patients with mild, moderate and severe LUTS respectively. The multivariate regression analysis in patients with BMI ≥ 25 showed that only age, TT and sex score were related to LUTS. Conclusions: A higher TT is associated with a severe AUA score symptom index only in obese patients. Further analysis are necessary to evaluate the mechanisms through which testosterone may influence LUTS in these patients.

Metabolic syndrome and benign prostatic hyperplasia: association or coincidence?

“…The combined effects of these may result in overexpression of toll-like receptors, transformation of prostatic cells into antigen-presenting cells, and up-regulation of growth factors (andromedins), leading to prostate enlargement. Among hormonal determinants of BPH, the majority of studies have reported sex steroid imbalances between total or free testosterone, dihydrotestosterone, estrogen, and progesterone levels [ 2 – 7 ], although their circulating levels did not necessarily reflect the causal relationship with prostatic volume and severity of LUTS.…”

“…In addition to these sex-steroid derangements, our results suggest that they may be also extended by changes in circulating DHEA-S and SHBG. Only a few studies in the literature have evaluated SHBG in patients with BPH, and the results have been inconsistent [ 7 – 10 ]. In our series, SHBG concentration was negatively associated with the prevalence of BPH.…”

“…In addition, subjects with excess visceral fat are often prone to developing insulin resistance which, in turn, may be an independent risk factor for BPH [ 34 – 36 ]. Hence, obese, dyslipidemic, and aged males are at risk for MetS, whose components are important determinants of prostate enlargement [ 7 , 11 ] as well as of other abdominal obesity-related comorbidities, including cardiovascular disease, obstructive sleep apnea, and nonalcoholic fatty liver disease [ 37 ].…”

“…Much less is known about the association between BPH and the level of sex-hormone binding globulin (SHBG); to date, studies have yielded inconsistent results. Although some studies have failed to find an association between SHBG levels and the incidence of BPH or the severity of LUTS [ 7 , 8 ], other reports have demonstrated that SHBG is inversely associated with larger prostate glands [ 9 , 10 ].…”

Testosterone and benign prostatic hyperplasia

“…These concepts are reinforced by other studies that demonstrate that in obese men (body mass index [BMI] >25), only age, increasing total testosterone and sex score were related to their worsening LUTS. 40 …”