Urology
Volume 69, Issue 4 , Pages 708-713, April 2007

Serum Sex Steroid Hormones and Lower Urinary Tract Symptoms in Third National Health and Nutrition Examination Survey (NHANES III)

  • Sabine Rohrmann

      Affiliations

    • Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany
    • ,
  • William G. Nelson

      Affiliations

    • James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • ,
  • Nader Rifai

      Affiliations

    • Department of Laboratory Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
    • ,
  • Norma Kanarek

      Affiliations

    • Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • ,
  • Shehzad Basaria

      Affiliations

    • Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • ,
  • Konstantinos K. Tsilidis

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • ,
  • Ellen Smit

      Affiliations

    • Portland State University School of Community Health, Portland, Oregon
    • ,
  • Edward Giovannucci

      Affiliations

    • Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
    • Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
    • Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
    • ,
  • Elizabeth A. Platz

      Affiliations

    • James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • Corresponding Author InformationReprint requests: Elizabeth A. Platz, Sc.D., M.P.H., Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E6138, Baltimore, MD 21205.

Received 19 July 2006; accepted 5 January 2007.

Objectives

To evaluate the association of circulating sex steroid hormones and sex hormone binding globulin (SHBG) with lower urinary tract symptoms (LUTS).

Methods

We included 260 men, 60 years old or older, who participated in Phase 1 (1988 to 1991) of the Third National Health and Nutrition Examination Survey and for whom surplus serum was available. We measured the serum concentrations of testosterone, androstanediol glucuronide (AAG), estradiol, and SHBG. Free testosterone was calculated from the circulating testosterone, SHBG, and albumin. The cases (n = 128) were men with two to four symptoms (nocturia, hesitancy, incomplete emptying, and weak stream), but who had never undergone noncancer prostate surgery. The controls (n = 132) were men who neither had symptoms nor had undergone noncancer prostate surgery. We adjusted for age, race/ethnicity, waist circumference, cigarette smoking, alcohol consumption, and physical activity in logistic regression models and used sampling weights.

Results

The cases had statistically significantly greater AAG and estradiol concentrations than did the controls. After multivariate adjustment, the men in the top tertile of AAG (odds ratio 2.62, 95% confidence interval 1.12 to 6.14) had a greater risk of LUTS compared with men in the bottom two tertiles. Also, men with a greater estradiol concentration (odds ratio 1.78, 95% confidence interval 0.91 to 3.49) and a greater estradiol/SHBG molar ratio (odds ratio 2.41, 95% confidence interval 1.39 to 4.17) had a greater risk of LUTS than did men with lower concentrations. No consistent associations were seen for circulating testosterone, free testosterone, or SHBG.

Conclusions

In this cross-sectional study representative of older U.S. men, circulating AAG, a metabolite of dihydrotestosterone, and estradiol were associated with an increased risk of having LUTS.

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 This study is the second from the Hormone Demonstration Program, which is supported by the Maryland Cigarette Restitution Fund Research Grant Program at the Johns Hopkins University.

PII: S0090-4295(07)00012-X

doi:10.1016/j.urology.2007.01.011

Urology
Volume 69, Issue 4 , Pages 708-713, April 2007

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