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Appropriate use of testosterone therapy does not appear to raise prostate cancer risk - Harvard Health

Appropriate use of testosterone therapy does not appear to raise prostate cancer risk In the journals - Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing A study publis

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Appropriate use of testosterone therapy does not appear to raise prostate cancer risk

In the journals

  • Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

A study published online Dec. 27, 2023, by JAMA Network Open confirms prior research showing that testosterone replacement therapy (TRT) in men with documented low testosterone levels does not increase their risk of prostate cancer compared to men not using TRT.

Researchers recruited 5,246 men with hypogonadism (a condition in which the testes don't produce enough testosterone), no family history of prostate cancer, and prostate-specific antigen (PSA) levels of less than 3 nanograms per milliliter (ng/ml), a number associated with a low risk of prostate cancer. The researchers randomly divided the men into two groups.

For 14 months, the men used either a topical testosterone gel at a dose designed to maintain normal testosterone levels, or an inactive (placebo) gel. Researchers measured PSA levels and conducted digital rectal exams of the prostate at regular intervals over the next three years. By the end of that period, the number of men diagnosed with prostate cancer was equally low in both the testosterone and placebo groups. Those in the TRT group did see their PSA levels rise during the first year of using the gel. However, the increase was small, and PSA levels did not rise again after that, according to the researchers. The testosterone users also reported few symptoms of an enlarged prostate, such as frequent urination, difficulty urinating, and dripping.

The study was limited to men with hypogonadism who had a low risk of prostate cancer, so it's not clear how TRT may affect higher-risk men or those who use testosterone in higher amounts, for longer periods of time, or for treating other conditions.

Image: © gorodenkoff /Getty Images

About the Author

Matthew Solan, Former Executive Editor, Harvard Men's Health Watch

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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Related questions

01Does testosterone cause prostate cancer recurrence?

Testosterone does not cause recurrent prostate cancer. The disease can return if some cancer cells remain after treatment or if some spread to a different part of the body before treatment.

Source: www.medicalnewstoday.com ↗
02Testosterone supplementation after prostate cancer?

Two experts examine the pros and cons of this controversial practice At some point in their 40s, men’s testosterone production begins to slow. By some estimates, levels of this hormone drop by about 1% a year. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone. These include reduced sex drive and sense of vitality, erectile dysfunction, decreased energy, lower muscle mass and bone density, and anemia. When severe, these signs and symptoms characterize a condition called hypogonadism. Researchers estimate that hypogonadism affects two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment, according to the FDA. Deciding which patients should receive testosterone supplementation has proved tricky, however. For example, little consensus exists on what constitutes low testosterone. (The Endocrine Society considers a man to have low testosterone if the blood level is less than 300 ng/dl; some physicians set higher or lower benchmarks.) In addition, some men may have low blood levels of testosterone but not experience any symptoms. And few large, randomized studies on the long-term risks or benefits of testosterone supplementation have been completed. One of the most heated debates centers on whether testosterone fuels prostate cancer. If that’s true, say some experts, then why do men develop prostate cancer when they are older, at the same time their testosterone levels are dropping? (See Figure 1.) Others point to the fact that many men with prostate cancer, especially those with advanced or metastatic cancers, take hormone therapy that nearly stops the production of testosterone to tamp down the disease. Under the influence of hormone therapy, tumors regress. So wouldn’t the opposite be true — that giving a man testosterone will accelerate or promote tumor growth?

Source: www.health.harvard.edu ↗
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