Neil Osterweil

May 18, 2017

BOSTON — A possible link between low levels of testosterone in women and urinary incontinence raises the possibility that testosterone replacement therapy might help, results from a new study suggest.

"Testosterone may prevent pelvic floor atrophy, thereby reducing the risk of urinary incontinence," said investigator Michelle Kim, MD, PhD, from Massachusetts General Hospital in Boston.

Levator ani muscles are known to have androgen receptors. In one rodent model, testosterone administered after surgically induced urinary incontinence resulted in levator hypertrophy (Int Urol Nephrol. 2011;43:1003-1008).

Because it is unclear whether the same association exists in humans, Dr Kim and her colleagues were prompted to assess the correlation between testosterone and incontinence.

The team looked at data on 2123 women who took part in the 2012 cycle of the National Health and Nutrition Examination Survey (NHANES) and had serum total testosterone measured at the time.

On univariate analysis, a low level of serum testosterone was significantly associated with stress, urgency, and mixed incontinence (P < .001 for all). After adjustment for age, the association remained significant for stress and mixed incontinence, but not for urgency incontinence.

This "makes sense because the mechanism of stress urinary incontinence relies so heavily on the integrity of the pelvic floor, whereas urgency may not," Dr Kim explained here at the American Urological Association 2017 Annual Meeting.

This opens the possibility of testosterone replacement therapy for women with incontinence.

On a multivariate analysis that controlled for age, body mass index, diabetes, race, parity, and time of venipuncture, women in the lowest quartile of testosterone levels were significantly more likely than those in the other three quartiles to report stress incontinence (odds ratio [OR], 1.49; P < .05) or mixed incontinence (OR, 1.65, P < .01). Urge incontinence was elevated numerically but not significantly in this model.

"This opens the possibility of testosterone replacement therapy for women with incontinence," said Tomas Griebling, MD, from the University of Kansas Medical Center in Kansas City, who moderated the briefing on this study. "Obviously, more research has to be done, but this sets the stage for it."

"I'm fascinated by these results; it's not something we usually look at in these patients," he told Medscape Medical News.

In future clinical proof-of-concept studies, vaginally delivered testosterone could be used, said Dr Kim.

The study was internally funded. Dr Kim and Dr Griebling have disclosed no relevant financial relationships.

American Urological Association (AUA) 2017 Annual Meeting: Abstract PD05-07. Presented May 15, 2017.

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