A Canadian population experience: Total testosterone levels do not correlate with lower urinary tract symptom severity
Ioana Fugaru1, Karim Courtemanche2, Solomon Sasson3, Sebastien Belliveau3, Peter Chan1.
1Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada; 2Sanford Health, Bismark, ND, United States; 3Faculty of Medicine, McGill University, Montreal, QC, Canada
Introduction: Lower urinary tract symptoms (LUTS) and hypogonadism both affect the aging male. The correlation between androgen levels, prostate volume, and LUTS remains to be fully elucidated. The primary objective of this study was to explore the presence and severity of LUTS and their correlation with total testosterone (TT) levels in a Canadian population.
Methods: Data were collected from consented adult males (n=1684) who participated in a public health awareness event between 2007 and 2018. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. Body mass index (BMI), lipid profile, prostate-specific antigen (PSA), and TT were measured. Men <45 years were excluded. Men were categorized depending on TT level (<230 ng/dL, 230–346 ng/dL, and ≥346 ng/dL) and IPSS category (mild [0–7], moderate [8–19], and severe [20–35] symptoms). Data were analyzed using statistical tests in GraphPrism 8.
Results: Mean age was 55.5 years with a mean BMI of 27.9 (n=1654), PSA of 1.8 ng/ml (n=1404), and TT of 334 ng/dL (n=1654). Mild LUTS were found in 52.6% of participants (n=714), while 38% of participants (n=516) had moderate LUTS and 9.4% had severe LUTS (n=127). IPSS category was found to correlate with age (p<0.0001) and PSA value (p<0.0001), as well as low-density lipoproteins (LDL) levels (p=0.0145). In men with mild LUTS, 20% had low TT (<230 ng/dL). Similarly, 19% of men with moderate LUTS and 21% of men with severe LUTS had low TT. When comparing IPSS category with TT levels of <230 ng/dL and ≥346 ng/dL, no significant difference was identified (p=0.6570). While 9.4% of men experienced severe LUTS, only 22% of these men were on medical therapy for their symptoms.
Conclusions: In this cross-sectional Canadian study, we identify that among men ≥45 years, age, PSA, and LDL levels, but not TT levels, correlate with IPSS category. In our population, 78% of men reporting severe LUTS were not under specific treatment. This highlights the importance of assessing LUTS to properly identify patients with undermined quality of life.
