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Low testosterone is common in MetS. A randomized clinical trial was designed to evaluate if 24\u00a0weeks of testosterone therapy (TTh) in BPH men with MetS and low testosterone improve urinary symptoms and prostate inflammation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>One-hundred-twenty men with MetS waitlisted for BPH surgery were enrolled. They were categorized into <jats:italic>normal testosterone<\/jats:italic> (TT\u2009\u2265\u200912\u00a0nmol\/L and cFT\u2009\u2265\u2009225\u00a0pmol\/L; <jats:italic>n<\/jats:italic>\u2009=\u200948) and <jats:italic>testosterone deficient<\/jats:italic> (TD) (TT\u2009&lt;\u200912\u00a0nmol\/L and\/or cFT\u2009&lt;\u2009225\u00a0pmol\/L; <jats:italic>n<\/jats:italic>\u2009=\u200972) then randomized to testosterone gel 2% (5\u00a0g\/daily) or placebo for 24\u00a0weeks. At baseline and follow-up, questionnaires for urinary symptoms and trans-rectal ultrasound were performed. Prostate tissue was collected for molecular and histopathological analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>No differences in the improvement of urinary symptoms were found between TTh and placebo (OR [95% CI] 0.96 [0.39; 2.37]). In TD\u2009+\u2009TTh, increase in prostate but not adenoma volume was observed (2.64\u00a0mL [0.07; 5.20] and 1.82\u00a0mL [\u2212\u00a00.46; 0.41], respectively). Ultrasound markers of inflammation were improved. In a subset of 61 men, a hyper-expression of several pro-inflammatory genes was found in TD\u2009+\u2009placebo when compared with normal testosterone. TTh was able to counteract this effect. For 80 men, the inflammatory infiltrate was higher in TD\u2009+\u2009placebo than in normal testosterone (0.8 points [0.2; 1.4]) and TD\u2009+\u2009TTh men (0.9 points [0.2; 1.5]).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Twenty-four weeks of TTh in TD men with BPH and MetS improves ultrasound, molecular and histological proxies of prostate inflammation. This does not result in symptom improvement.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-022-01776-9","type":"journal-article","created":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T07:02:36Z","timestamp":1647500556000},"page":"1413-1425","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Testosterone does not affect lower urinary tract symptoms while improving markers of prostatitis in men with benign prostatic hyperplasia: a randomized clinical trial"],"prefix":"10.1007","volume":"45","author":[{"given":"G.","family":"Rastrelli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Cipriani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Lotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Cellai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Comeglio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Filippi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Boddi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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