Short answer: The labels warn it can in men who already have an enlarged prostate (BPH), and ask prescribers to watch for worsening. In trials of men screened for prostate problems, it did not on average. A review of 14 trials found no difference from placebo in urinary symptom scores, and in TRAVERSE, urinary retention, prostate procedures and new urinary medicines were no more common on testosterone than on placebo.
The AndroGel 1.62% label says men with BPH treated with androgens are at higher risk of worsening BPH signs and symptoms, and that these men should be monitored (section 5.4). Xyosted, Jatenzo and the other recent labels carry the same warning. The older Depo-Testosterone label says men with BPH may develop sudden blockage of urine flow, and that the androgen is stopped if this happens and restarted, if at all, at a lower dose (Precautions).
Some urinary effects show up in the trial and post-approval lists:
A 2016 meta-analysis pooled 14 randomized trials with 2,029 men, average age 64.5, using gels, injections or capsules. It measured symptoms with the International Prostate Symptom Score (IPSS), a questionnaire where a higher score means worse symptoms. The score changed by −0.41 points on testosterone and +0.12 on placebo, with no meaningful difference between groups.
The TRAVERSE prostate study followed 5,204 men aged 45 to 80 on testosterone gel or placebo for about 22 months on average. Acute urinary retention, invasive prostate procedures, prostate biopsy and new medicine for urinary symptoms were no more common on testosterone, and IPSS changes did not differ. PSA rose more on testosterone.
TRAVERSE excluded men with a PSA above 3.0 ng/mL or an IPSS above 19, which is the severe range. So its reassurance applies to men without severe symptoms at the start. The labels' warning is aimed at men who already have BPH, and the trials do not rule out that some of them get worse.
MedlinePlus notes that prostate enlargement happens to almost all men as they age, so new urinary symptoms on testosterone may or may not be caused by it. The prostate exam and PSA checks the labels ask for are covered in PSA and prostate monitoring on TRT.
MedlinePlus lists the usual BPH symptoms: dribbling at the end, being unable to urinate, not emptying fully, leaking, getting up 2 or more times a night, a slow or delayed start, straining, a sudden strong urge and a weak stream. Pain or blood in the urine may mean infection. The testosterone Medication Guides say to call a provider about urination problems, and being unable to pass urine needs care right away.
A short note of night trips and stream changes before and after starting gives the prescriber a comparison. Dose Track keeps those notes on the same timeline as each dose.
Read more on Dose Track: PSA monitoring on TRT · AndroGel side effects · Depo-Testosterone side effects · Low testosterone