One of the most heated debates in medicine is whether testosterone fuels prostate cancer. If that is true, say some experts, then why do men develop prostate cancer when they are older, at the same time their testosterone levels are dropping? (Harvard University, 2011)
A large study of nearly 150,000 men published by two doctors from UM Medicine in Seattle, shows that in men over 40 with low testosterone levels, treatment with testosterone was not associated with increased risk for prostate cancer. Testosterone, the natural hormone that drives men’s sexual development as well as physical strength and bone health drops about 1-2% per year with age. That leads to symptoms of Low T (male hypogonadism) like reduced muscle mass, irritability, and low sex drive.
THE STUDY THAT STARTED THE MYTH (that testosterone therapy causes prostate cancer) was fueled by a number of “low power studies ” based on flawed theories dating back to the 1940s when in one study, doctors discovered that when castrating people with prostate cancer, they lived a bit longer. In this study of just one man (yes one), they noticed that he lived longer after castrating him. So, they assumed that lowering testosterone by castration was the answer. For decades, it is still amazingly accepted that testosterone therapy causes prostate cancer. Importantly, this study did not look at men without prostate cancer and did not look at what happens when you give testosterone.
WHAT IS NOW KNOWN: Fortunately, there have been several studies that clearly refute the belief that testosterone therapy increased the risk of prostate cancer among men in the general population.
In one of the studies called the Registry of Hypogonadism in Men (RHYME) study, researchers also found that testosterone therapy did not increase the incidence of benign prostatic hyperplasia (BPH) with its associated lower urinary tract symptoms of urinary urgency and frequency. There were no differences in PSA levels in testosterone-treated men compared to untreated men either. Instead, they found testosterone therapy may improve voiding symptoms. Notably, there was a small improvement in prostate symptom scores in the testosterone-treated group compared to the placebo group.
In the RHYME study, the testosterone prescriptions that were used were mostly topical gels (63%) or injections (31%), with only 2% receiving oral administration of testosterone. It is important that such research findings are made widely available to doctors in clinical practices so that men suffering from Low T or hypogonadism are not denied a much-needed treatment that will improve their health, wellbeing, and quality of life.
For questions about the different testosterone hormone replacement therapies available, please call our Towne Lake compounding pharmacy at 770-635-7697 and ask to speak to Julius, our compounding pharmacist.
Studies/Citations:
Harvard University https://www.health.harvard.edu/blog/testosterone-supplementation-after-prostate-cancer-20090619180
Michaud JE, Billups KL, Partin AW. Ther Adv Urol. 2015 Dec; 7(6): 378–387. doi: 10.1177/1756287215597633
Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol. 2006 Nov;50(5):935-9.
Agarwal PK, Oefelein MG. Testosterone replacemen testosterone therapy after primary treatment for prostate cancer. J Urol. 2005 Feb;173(2):533-6.
Araujo AB, Kupelian V, Page ST, et al. Sex steroids and all-cause and cause-specific mortality in men. Arch Intern Med. 2007;167:1252-60.
Bhasin S, Singh AB, Mac RP, Carter B, Lee MI, Cunningham GR. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl. 2003;24:299-311.
Bhasin S, Storer TW, Berman N, et al. Testosterone replacement increases fat-free mass and muscle size in hypogonadal men. J Clin Endocrinol Metab. 1997;82:407-13.