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Does Testosterone Optimization Cause Prostate Cancer?

Testosterone optimization for health in men and women has become popular as well as a hot-button topic over the last 5-10 years. It has become an important factor in hormone optimization but it comes with baggage. There are rumors of benefits as well as risks. I have a heart for optimal health so I've been studying this stuff for years. Also, being a urologist, my specialty has become the leader in hormone optimization, particularly in men. If you want to skip the rest of this article, here's the take away: a normal testosterone is better for your health than a low testosterone - for guys or gals (and they both have different normal levels). And, specific to this article, all studies to date show that testosterone optimization does not increase a man’s risk for prostate cancer. …I still want you to keep reading, though!

Testosterone replacement has been around, actually, for quite a while --since the 1940's--but only recently has it become popular. My first brush with it was when I was a resident (i.e. urologist-in-training) at the University of Virginia. We ran what we called 'resident clinic' (don't worry, real doctors backed us up!). I pulled a chart out of the door to find a new patient referred by another urologist from 2 hours south of Charlottesville for 'elevated PSA on testosterone replacement'. I just blankly stared at the chart. I had no idea what that meant or what I was supposed to do. Getting the background story from the patient, he was on testosterone replacement and had been for several years and now had a PSA (a screening test for prostate cancer) above the normal range. His urologist wasn't sure what to do, so here he was! I promptly asked my boss (a real urologist - not just one in training) what to do. He asked me, "Does testosterone optimization increase his risk for prostate cancer?" Again, blank stare from me. He just smirked but never answered his own question for me. We ended up performing a prostate biopsy and, lo and behold, the guy didn't have prostate cancer. So then the next question was, ‘Should he stop his testosterone optimization?’

The answers to those questions came months later. We had a visiting professor by the name of Abe Morgantaler. Turns out he was an expert on this testosterone stuff! He showed study after study showing no relationship between any increased risk of prostate cancer and testosterone optimization. Several studies have evenshown the opposite – that the lower the testosterone level, the higher the chance of having a prostate biopsy showing prostate cancer. On the other end of things, no studies, I repeat none, show an increased risk of getting prostate cancer with an optimization in testosterone levels. So, the short answer on prostate cancer and testosterone optimization is that it doesn't appear to have any relationship - in other words, replacing testosterone to a normal level does not appear to increase your risk of developing prostate cancer.

So let’s take it to the next level. What if you’ve had prostate cancer, your psa level is negligible but you feel miserable because your testosterone level is low. Can you have your level optimized? Let’s ask another way. Consider this scenario – let’s say you and your twin brother both get prostate cancer and have it treated. Both of you have negligible psa levels afterwards. Your brother’s testosterone level is in the normal range and he feels fine but your level is low and you’re tired all the time and moody. You go to your doctor who says you can’t have testosterone levels optimized because you’ve had prostate cancer. But, wait a second, your brother’s levels are fine. Does it put him at increased risk for recurrence? All studies point to ‘no’. So, again, I ask, why can’t your levels be normal too? Good question. And one you should ask a healthcare provider who specializes in this.

Prostate cancer risk is just one factor in testosterone optimization. It’s complicated and, even as healthcare providers, we’re still learning. Turns out a normal testosterone has many benefits and very little, if any, risks. That said, guy or girl, you need to see a healthcare provider who specializes in hormones to manage them. They better understand appropriate levels to optimize benefits and minimize risks.

Testosterone optimization can help improve fatigue (i.e. energy), mood, muscle strength, sex drive and (in men) erections. It also does several other things you can't see like improve heart health, better control diabetes, lower cholesterol, improve bone strength and lower risk for dementia. It's no holy grail but it does kill (or severely injure) at least 10 birds with 1 stone!

Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville, Mississippi.

This blog post is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship. If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.

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