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

Objectives: To determine the impact of testosterone therapy on the incidence of benign prostatic hyperplasia in a large cohort of hypogonadal men, and to evaluate the relationship between testosterone therapy in hypogonadal men and prostatic interventions.

Methods: We used the 2011-2020 IBM MarketScan database to identify hypogonadal males above 18 years old and determine if they received testosterone therapy. ICD-9, -10, CPT, HCPCS, and NDC codes were used for diagnoses, interventions, and medications. We ran Cox proportional hazard models to determine the effect of testosterone therapy on receiving a diagnosis of benign prostatic hyperplasia and interventions. Models were adjusted for age, region, population density, and comorbidities, with testosterone therapy within the last 6 months considered a time-varying covariate.

Results: In our total cohort of 882,570 hypogonadal men, 157,185 (17.8%) were diagnosed with benign prostatic hyperplasia. For the first 2.5 years after hypogonadism diagnosis, there was no significant difference in the diagnosis of prostatic hyperplasia between patients on testosterone therapy and those who were not (HR:1, 95%CI:0.98-1.01, p=0.66). However, from 2.5 years onward, men who were on testosterone therapy had a 32% higher risk of receiving a diagnosis of benign prostatic hyperplasia (HR:1.32, 95%CI:1.28-1.36, p<0.001). Hypogonadal men with benign prostatic hyperplasia who received testosterone therapy showed no significant difference in interventions compared to those who did not receive testosterone (HR:0.95, 95%CI:0.89-1, p=0.08).

Conclusions: In the long term, testosterone therapy increased the risk of receiving a diagnosis of benign prostatic hyperplasia in hypogonadal men. Testosterone therapy in hypogonadal men with benign prostatic hyperplasia did not change the need for interventions.