Information for healthcare professionals

    • Interview Questions
      Monica Caliber Medical Writer, MSc University of Stockholm / Karolinska Institute, Sweden Baylor University, TX, USA

      Historically, the largest concern about testosterone has been that it will make prostate tissue grow, both benign and malign. As it turns out, modern data show it is not that simple. As explained by the saturation model, the prostate is only sensitive to testosterone at hypogonadal (i.e. low) testosterone levels. At higher testosterone levels, the prostate gets saturated with testosterone, which means that further elevations in testosterone level will not further stimulate the prostate.

      Regarding prostate cancer, accumulating data show that testosterone therapy in men with a history of prostate cancer who have been treated with radical prostatectomy or radiation, does not increase risk of prostate cancer recurrence.

      One common question among physicians is “what should I do with rising PSA”? Men who start testosterone therapy with very low testosterone levels will see a rise in PSA level during the first 3-6 months, thereafter it will stabilise and stay within the normal range. The level at which PSA stabilises should then be taken as a new baseline against which future monitoring should be compared. If PSA levels continue to rise after the first year of testosterone therapy or if it rises above the normal range, a prostate biopsy is indicated.

      Another common concern is whether testosterone therapy can activate pre-cancerous (occult) prostate cells. About half of men aged 50 or older have prostate cancer microfoci. Studies show that testosterone therapy does not activate these prostate cancer cells. A meta-analysis concluded that regardless of the administration method, testosterone therapy does not promote prostate cancer development nor progression (1).

      The question of whether men with a history of prostate cancer can be offered testosterone therapy is an active area of research. Dr Morgentaler says “Yes, if under close monitoring”. Studies show that testosterone therapy in men with a history of prostate cancer does not increase risk of metastatic prostate cancer nor death. This is also the experience Dr Morgentaler has had in his practice.

      Another group is men who currently have low grade prostate cancer and are on active surveillance. A small study showed that men on active surveillance who received testosterone therapy have no prostate cancer progression compared to men on active surveillance who do not receive testosterone therapy (2).

      The Androgen Society is the first professional medical society dedicated entirely to testosterone deficiency (hypogonadism) and its treatment. The mission of the Androgen Society is to promote excellence in research, education, and clinical practice regarding testosterone deficiency and its treatment. The Androgen Society provides a “home” for all the various disciplines involved with testosterone, including endocrinology, urology, sexual medicine, andrology, general medicine, epidemiology, and cardiology.

      The take home message is that testosterone deficiency is an underrecognized and undertreated medical condition with significant negative health consequences, and that testosterone therapy is safe and improves sexual function and general health, as well as provides numerous other health benefits (reduced body fat, increased muscle mass and bone mineral density, improved glycemic control, reduced triglycerides etc.).

      References:

      1. Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):132-43.
      2. Kacker R, Hult M, San Francisco IF, Conners WP, Rojas PA, Dewolf WC, Morgentaler A. Can testosterone therapy be offered to men on active surveillance for prostate cancer? Preliminary results. Asian J Androl. 2016 Jan-Feb;18(1):16-20.


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      Last updated: 2018
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