The Anabolic Effect of Testosterone on Pelvic Floor Muscles

Inclusion Criteria:

• Women, age 60 years and older.

• Medically documented pure stress urinary incontinence on physical exam or urodynamictesting.

• Normal mammogram within the last 12 months

• Endometrial thickness of ≤4 mm in women with an intact uterus assessed byendometrial ultrasound.

• Ability and willingness to provide informed consent.

Exclusion Criteria:

• • Medically documented urge or mixed urinary incontinence (stress and urge) onphysical exam or urodynamic testing.

• Participating in pelvic floor muscle training (PFMT) therapy currently or inthe past 3 months

• Previous pelvic surgery (i.e., hysterectomy, pelvic organ prolapse repair,mid-urethral sling placement, injection of urethral bulking agents) orradiation treatment to the pelvis.

• History of ≥ Grade 3 pelvic organ prolapse

• Neurologic disorder causing UI or bladder dysfunction (i.e., multiplesclerosis, Parkinson's disease, stroke, cerebral palsy, spinal cord injury)

• Current urinary tract infection

• History of breast or endometrial cancer

• Use of systemic estrogen therapy in the past 3 months

• Baseline hematocrit >48%, serum creatinine >2.5 mg/dL; HbA1c >8.0%; BMI >40kg/m2

• Uncontrolled hypertension defined as an average of two blood pressure readingsof greater than 160/100.

• Subjects who are on insulin therapy will be excluded.

• Uncontrolled congestive heart failure

• Myocardial infarction, acute coronary syndrome, revascularization surgery orstroke within 6 months

• History of pulmonary embolism, deep vein thrombosis or a genetic thromboembolicdisorder

• History of bipolar disorder, schizophrenia or untreated major depression

• Presence of metallic implants (pacemakers, aneurysm clips, etc.) that precludethe patient from undergoing MRI