Unlocking the Link between Hypogonadism and Urethral Stricture: The Importance of Early Detection
Hypogonadism, a condition in which the body produces little or no sex hormones, has been linked to urethral stricture (US). Two recent studies found that low levels of testosterone are more common in patients with anterior urethral stricture than in the general population. Additionally, men with low testosterone had shown a higher rate of panurethral stricture compared with eugonadal men. These findings suggest that low testosterone may be a risk factor for the development of US, and early diagnosis of hypogonadism may be beneficial in detecting and treating US.
→ What is urethral stricture (US)?
Urethral stricture refers to a narrowing of the urethra, the tube that carries urine out of the body from the bladder. This narrowing can occur anywhere along the length of the urethra, from the bladder to the opening at the tip of the penis in males or the external urethral opening in females.
Correlation between Low Testosterone and Urethral Stricture
One study published in The Journal of Urology in September 2021 found that significantly lower levels of total testosterone, calculated-free testosterone, and bioavailable testosterone were present in patients with US compared to the control group. Additionally, these patients also presented significantly higher levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The rate of hypoandrogenism was calculated as the proportion of patients who fulfilled the criteria of total testosterone <300 ng/dL and/or calculated-free testosterone <8 nmol/L, and it was 3.249 times higher in patients with US compared to the control group. According to the observations, the patients with US showed lower total testosterone level compared with control group (391 vs 495 ng/dL, p < 0.01). (1)
Another study published in Reconstructive Urology in April 2018 found that hypoandrogenism was present in 57% of men in the US group compared to 28% of age-matched men in the national database. The mean stricture length in men with hypoandrogenism was 7.2 cm, which was significantly longer than the 4.8 cm mean length in eugonadal men. Furthermore, men with low testosterone had a higher rate of panurethral stricture compared with eugonadal men (20.6% vs 4%), although overall distribution of stricture locations were not statistically different between the two groups. (2)
These findings suggest that low testosterone may be a risk factor for the development of US and may contribute to increased stricture severity. It is possible that the extent of spongiofibrosis is greater in patients with low testosterone, leading to longer strictures. Another study published in Reconstructive Urology in July 2017 supports this hypothesis, demonstrating that low levels of testosterone are associated with decreased expression of the androgen receptor and angiogenesis in periurethral tissue. The study analyzed urethral tissue samples from men with urethral stricture and found that those with low testosterone levels had reduced expression of the androgen receptor (AR) and angiopoietin 1 receptor TIE-2, which are involved in AR-mediated angiogenesis. This suggests that low testosterone may be associated with decreased vasculogenesis in the urethra and corpus spongiosum, which could result in general urethral compromise. (3)
Given these findings, regular check-ups for hypogonadism could be beneficial in detecting and treating Urethral Stricture (US). This could involve measuring serum testosterone levels and identifying hypoandrogenism when total testosterone is <300 ng/dL. Early diagnosis and treatment of hypogonadism could potentially prevent or reduce the severity of US. (4) Overall, better understanding of the correlation between hypogonadism and US can lead to improved management and outcomes for patients with US.
Bonilla A. S. et al, The Journal of Urology, LOW SERUM TESTOSTERONE IS SIGNIFICANTLY MOREFREQUENT IN PATIENTS DIAGNOSED WITH ANTERIORURETHRAL STRICTURE. A CASE-CONTROL STUDY, 2021
Spencer J. et al, Reconstructive Urology, Hypoandrogenism is Prevalent in Males With Urethral Stricture Disease and is Associated with Longer Strictures, 2018
Hofer M.D. et al, Urology, Low Testosterone Levels Result in Decreased Periurethral Vascularity via an Androgen Receptor-Mediated Process: Pilot Study in Urethral Stricture Tissue, 2017
Pouche-Sanz I. et al,The Journal of Urology, Addressing the Relationship Between Testosterone Levels and Urethral Stricture: A Case-Control Study, 2022
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