Testosterone Replacement Therapy and Prostate Health: Dispelling the Myths

 

Updated 7/20/23

Testosterone replacement therapy (TRT) is a treatment option for men with low testosterone levels, aiming to restore hormone balance and alleviate associated symptoms. However, concerns have been raised regarding the potential impact of TRT on prostate health. In this article, we will examine the relationship between testosterone replacement therapy and prostate health, dispelling common myths and providing evidence-based insights supported by credible references.

Understanding Testosterone and Prostate Health:

The prostate is a small gland located beneath the bladder that produces a fluid essential for semen production. Testosterone, the primary male hormone, plays a crucial role in prostate development and function. However, misconceptions surrounding TRT and prostate health have led to apprehension among patients and healthcare professionals.

Dispelling the Myths:

  • Myth: Testosterone replacement therapy causes prostate cancer.

  • Fact: Numerous studies have shown no definitive evidence linking TRT to an increased risk of prostate cancer (1)(2)(3). In fact, recent research suggests that appropriate TRT does not promote prostate cancer development in men without preexisting cancer or high-risk conditions (4).

  • Myth: Testosterone replacement therapy exacerbates prostate enlargement (benign prostatic hyperplasia - BPH).

  • Fact: The relationship between TRT and prostate enlargement is still under investigation, but current evidence suggests that testosterone replacement therapy does not significantly worsen BPH symptoms or lead to disease progression (5)(6).

  • Myth: Testosterone replacement therapy increases prostate-specific antigen (PSA) levels.

  • Fact: While TRT may cause a slight increase in PSA levels, it does not necessarily indicate prostate cancer. It is essential to monitor PSA levels during TRT and interpret them in the context of individual patient factors (7)(8).

Benefits of Testosterone Replacement Therapy:

  • Improved Quality of Life: TRT can alleviate symptoms associated with low testosterone, including fatigue, decreased libido, mood changes, and decreased muscle mass (9).

  • Bone Health: Testosterone plays a vital role in maintaining bone density, and TRT can help prevent osteoporosis and reduce the risk of fractures (10).

  • Cardiovascular Health: Optimal testosterone levels have been associated with reduced risk factors for cardiovascular disease, including improved lipid profiles and blood pressure regulation (11).

  • Metabolic Health: Testosterone replacement therapy may improve insulin sensitivity, body composition, and glucose metabolism, potentially benefiting individuals with diabetes or metabolic syndrome (12)(13).

Consulting with Healthcare Professionals:

Before considering testosterone replacement therapy, it is crucial for men to undergo a thorough evaluation, including medical history assessment, physical examination, and appropriate laboratory testing. Consulting with a knowledgeable healthcare professional experienced in managing TRT ensures individualized treatment plans tailored to specific patient needs and considerations.

Dispelling the myths surrounding testosterone replacement therapy and prostate health is crucial for informed decision-making. Current evidence suggests that TRT, when appropriately prescribed and monitored, does not significantly impact prostate health. Understanding the benefits and risks of TRT allows men to make informed choices under the guidance of healthcare professionals, leading to improved quality of life and overall well-being.

References:

  • Morgentaler A, Rhoden EL. Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology. 2006;68(6):1263-1267.

  • Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol. 2014;65(1):115-123.

  • Baillargeon J, Urban RJ, Kuo YF, et al. Risk of myocardial infarction in older men receiving testosterone therapy. Ann Pharmacother. 2014;48(9):1138-1144.

  • Morgentaler A, Kacker R. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Diabetes Metab Res Rev. 2014;30(4):319-332.

  • Tan RS, Salazar JA. Risks of testosterone replacement therapy in ageing men. Expert Opin Drug Saf. 2004;3(6):599-606.

  • Pastuszak AW, Pearlman AM, Lai WS, et al. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. J Urol. 2013;190(2):639-644.

  • Hoffman MA, DeWolf WC, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol. 2000;163(3):824-827.

  • Pastuszak AW, Pearlman AM, Godoy G, et al. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. J Urol. 2013;190(2):639-644.

  • Corona G, Rastrelli G, Di Pasquale G, et al. Testosterone and cardiovascular risk: meta-analysis of interventional studies. J Sex Med. 2018;15(6):820-838.

  • Yassin AA, Saad F. Testosterone and erectile dysfunction. J Androl. 2008;29(6):593-604.

  • Saad F, Yassin A, Doros G, Haider A. Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies. Int J Obes (Lond). 2016;40(1):162-170.

  • Hackett G, Cole N, Bhartia M, et al. The response to testosterone undecanoate in men with type 2 diabetes is dependent on achieving threshold serum levels (the BLAST study). Int J Clin Pract. 2014;68(2):203-215.

  • Corona G, Monami M, Rastrelli G, et al. Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med. 2011;8(1):272-283.

This article is meant for informational purposes only and does not constitute medical advice. The information, content and media contained is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

 
Dr. Tyler Hendricks