The relationship between testosterone and prostate cancer is no longer viewed as a simple “fuel for fire” scenario. While prostate cancer cells use testosterone to grow, modern medicine has shifted toward a more nuanced understanding.
1. Risk of Developing Cancer
- Endogenous (Natural) Testosterone: Higher natural levels of testosterone are generally not linked to a higher risk of developing prostate cancer.
- Testosterone Replacement Therapy (TRT): Most research indicates that TRT does not increase the risk of developing new prostate cancer in men with low testosterone (hypogonadism).
- Low Testosterone Paradox: Surprisingly, men with very low testosterone levels may actually be at a higher risk for aggressive prostate cancer.
2. Treatment & Management
- Androgen Deprivation Therapy (ADT): This standard treatment for advanced prostate cancer works by lowering testosterone levels to “starve” the cancer cells.
- The Saturation Model: This theory suggests that prostate cancer cells only need a small amount of testosterone to grow. Once they are “saturated,” adding more testosterone doesn’t necessarily speed up growth.
- Bipolar Androgen Therapy (BAT): An emerging treatment for advanced, resistant cancer that involves giving high-dose testosterone to “shock” and potentially stabilize cancer cells.
3. Use of TRT After Cancer Diagnosis
- After Treatment: Many urologists now consider TRT safe for men who have been successfully treated (e.g., via radical prostatectomy) and have an undetectable PSA level.
- Active Surveillance: Some studies suggest TRT may be safe for men with low-risk cancer on active surveillance, but this requires strict monitoring.
- Monitoring: If you use testosterone with a history of prostate cancer, doctors typically require regular PSA tests and digital rectal exams (DRE) to ensure no recurrence.
Guidelines & Expert Views
The American Urological Association (AUA) states there is an absence of evidence linking TRT to the development of prostate cancer, but also notes that evidence is currently inadequate to fully quantify the risk-benefit ratio for those with a history of the disease.
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Or are you currently undergoing or completed prostate cancer treatment? Get input that is being modified yearly.
The FDA had an updated emerging hormone science conference on these issues. And the lectures were radically different from positions by most doctors five years ago.