The effect of partial androgen deficiency on lower urinary tract and erectile function

Aim of the study: Due to the increase of the numbers of aging man, the accompanying problems like BPH, prostate cancer, psychocologic problems, metabolic syndrome and osteoporosis become more commonly emphasized in recent discussions. Endocrinological pathologies are detected as aetiology of those problems. In this study it is aimed to study the relationship between the clinical parameters like lower urinary tract symptoms and erectile dysfunction between testosterone and the effect of testosterone replacement therapy on the clinical and biochemical parameters. .Material and Methods: Thirty two patients with a serum total testosterone level under 319 ng/dl who applied from October 2006 to September 2008 to the Urologic clinics of Firat University Hospital due to erectile dysfunction and loss in libido are enrolled in the study. The patients have filled the AMS-Q (Aging Male Symptoms Questionnaire)with 17, the IIEF (International Index of erectile function) with 15 and the IPSS (International Prostate Symptom Score) questionnaire with 7 miction habit and 1 quality of life questions during a personal conversation with the physician. Patients with a IIEF score 63 and lower and AMS score 27 and over are diagnosed as hypogonadic and enrolled in the study. The routine biochemical tests like luteinising hormone (LH), prolactin, total testosterone (TT), free testosterone (fT), sex hormone binding globuline (SHBG), dehydroepiandrostenadion sulfate (DHEA-S) and albumin which are releated with erectile dysfunction and loss of libido are performed and the lipid profile is measured. The bioavailable testosterone is calculated with the calculator on the official web page of the International Society for the Study of the Aging Male (www. issam. ch).Also uroflowmetry and postmictional rest measurement are performed in order to study the lower urinary tract symptoms objectively. Androgen replacement therapy is given to all patients after completing the pretreatment tests. The patients are invited to follow-up after 3 months and all the pretreatment parameters are measured after 3 months of treatment.Results:There was a statistically significant relation between age, IPSS and SHBG in a positive and between age Qmax, Qave and bioavailable testosterone in a negative way. There was no relationship between age and AMS, IIEF, PMR, total testosterone, free testosterone, prolactin, FSH, LH, DHEA-S, progesterone and the lipid profile. Between the before and after treatment results of IIEF, Qave, Qmax and the three testosterone forms there was a statistically significant relation observed in a positive and AMS, PMR ve LH results in a negative way. There was no relation between the before and after treatment parameters detected by the other analysed parameters. There was no relation between the AMS, IIEF and IPSS scores. A positive statistically significant relationship between IIEF scores, free testosterone and bioavailable testosterone is detected.Discussion: The data have shown that hypogonadism occurs in aging males and the symptoms can be evaluated with the questionnaire IIEF, AMS and IPSS and some of the symptoms could be eliminated with testosterone replacement therapy.Keywords: Hypogonadism, Testosterone, IIEF, AMS, IPSS