The Impact of Testosterone Therapy on Benign Prostatic Hyperplasia in Hypogonadal Males

OBJECTIVE To determine the impact of testosterone therapy (TT) on the incidence of benign prostatic hyperplasia (BPH) in a large cohort of hypogonadal males and to evaluate the relationship between TT in hypogonadal males and prostatic interventions. METHODS We used the 2011-2020 International Business Machines Corporation MarketScan database to identify hypogonadal males above 18 years old and determine if they received TT. International Classification of Diseases, 9th and 10th Revisions, Current Procedural Terminology, Healthcare Common Procedure Coding System Procedure Codes, and National Drug Code (NDC) codes were used for diagnoses, interventions, and medications. We ran Cox proportional hazard models to determine the effect of TT on receiving a diagnosis of BPH and interventions. Models were adjusted for age, region, population density, and comorbidities, with TT within the last 6 months considered a time-varying covariate. RESULTS In our total cohort of 882,570 hypogonadal males, 157,185 (17.8%) were diagnosed with BPH. For the first 2.5 years after hypogonadism diagnosis, there was no significant difference in the diagnosis of prostatic hyperplasia between patients on TT and those who were not (HR:1, 95%CI:0.98-1.01, P = .66). However, from 2.5 years onward, males who were on TT had a 32% higher risk of receiving a diagnosis of BPH (HR:1.32, 95%CI:1.28-1.36, P < .001). Hypogonadal males with BPH who received TT showed no significant difference in interventions compared to those who did not receive testosterone (HR:0.95, 95%CI:0.89-1, P = .08). CONCLUSION In the long term, TT increased the risk of receiving a diagnosis of BPH in hypogonadal males. TT in hypogonadal males with BPH did not change the need for interventions. UROLOGY 196: 325-332, 2025. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.