Recent studies in support of neutral effects of testosterone therapy in prostate cancer patients:
For this reason, top urologists and andrologists from all over the world have started to administer testosterone to men with treated and untreated (still active) prostate cancer. Kardoust Parizi and colleagues in their review of the literature, published in October 2019, found 21 clinical studies. None of these studies showed any increase in risk of recurrence or aggressiveness of prostate cancer with testosterone therapy. One smaller study even showed a fourfold decrease in risk of recurrence of prostate cancer in men receiving testosterone therapy! The data show that it’s time to change our view and lose the fear that testosterone therapy could cause prostate cancer in men.
A small possibility that testosterone therapy could nevertheless increase the risk of prostate cancer:
In my opinion, testosterone therapy can exceptionally increase the risk of prostate cancer when too much of the testosterone converts to the female hormone estradiol. Estradiol is known to cause metaplasia of the prostatic epithelial cells, the cells in which prostate cancer originates. Men who tend to convert testosterone to estradiol too quickly are recognizable. Their body is feminized (breast development, more fat mass, and less hair), and in the serum, they usually have high estrogen levels (estradiol and estrone). They also often drink large amounts of alcohol and coffee. Both drinks increase this conversion.
In men with high estrogen levels, testosterone therapy should be given with an aromatase blocker, a blocker of the enzyme that converts testosterone to estradiol, such as anastrozole. Close monitoring is necessary when physicians treat with such a blocker because low levels of estradiol are linked to osteopenia and increased mortality. The guideline is to avoid excessive levels of estradiol (30 pg/mL or 110 pmol/L or above) and insufficient levels of estradiol (18 pg/mL = 66 pmol/L or lower).
To access the relevant data on testosterone deficiency, testosterone therapy, and their association with prostate cancer on the International Hormone Society website, in the Evidence-based hormone therapies section (available soon).
To get more references and practical information on testosterone therapy, read my 600-page book for physicians, “Testosterone, the Therapy for Real Gentlemen”.
To get practical and in-depth training on testosterone therapy and come attend the hormone therapy workshop in Orlando on August 21-22, 2020. Check out the Evidence-based hormone therapy workshop here, which will be available at the A4M 28th Annual Spring Congress being held in Orlando, Florida on August 20-22, 2020.
