Effects of testosterone on the lower urinary tract go beyond the prostate: New insights, new treatment options

The traditional assumption that the prostate is an organ exquisitely sensitive to androgen action still olds true, but with lower-than-normal circulating levels of testosterone, all ndrogen receptors are saturated and a further increase in circulating levels of testosterone has no effect n the prostate (saturation model). Prostate disease (prostate cancer and benign prostatic yperplasia, BPH) usually occur at an age when circulating levels of testosterone are declining, so it is unlikely hat they are to be attributed to an excess of testosterone. The bother of BPH is presently subsumed nder ‘pathology of the lower urinary tract’. Surprisingly, these structures have androgen receptors, nd depend for their relaxation on nitric oxide, for which the mechanism, in turn, is aided by ndrogens. This explains why phosphodiesterase type-5 inhibitors also benefit erectile function and symptoms f the lower urinary tract. Normalisation of testosterone in hypogonadal men favours this action. uring the development of the prostate, epithelium and mesenchyme are under the control of esticular androgens, and interact to form an organised secretory organ. Furthermore, many of the disease rocesses of the prostate have been attributed to androgen action, and consequently, therapies have een aimed at manipulating androgen activity