Sperling Prostate Center

Is Testosterone Replacement Therapy Safe for Prostate Cancer Patients?

For over 75 years, testosterone replacement therapy (TRT) has been a big no-no for prostate cancer (PCa) patients. It’s unfortunate, because as men age, it’s not unusual for testosterone levels to drop, often leading to low libido, loss of muscle tone, weight gain, fatigue, and even mental/emotional changes such as depression. While PCa survivors with low T (low testosterone) just had to suffer with it, their fellow men without PCa but who had low T could make full use of TRT to restore their sex drive, erections, and other qualities of manly vigor.

For PCa patients, it may have been especially frustrating during the fairly recent surge in promotion of supposed testosterone-building supplements and other products, which I described as a rollercoaster of testosterone use. On the other hand, published literature began appearing during the same period, showing that TRT is actually safe for PCa patients.

When updating a 2018 blog on PCa and TRT safety, I cited a literature review that had been conducted by a French research group that’s worth looking at in greater depth. The authors combed through 135 articles published from 1994-2019, and after eliminating articles that did not meet their criteria, they analyzed the remaining 92 papers.[i]

They point out that for at least the past 75 years, TRT has been forbidden for men with a history of PCa based on the belief that regardless of T levels in the blood, the tumor cells were fueled by androgens (male hormones), particularly testosterone. Yet they found a paradox, and they state that “… while prostate cancer is extremely sensitive to low levels of testosterone, there is ample evidence that its growth is not influenced by androgens at higher concentrations.” This seems to be counterintuitive. If a little T encourages tumor growth, wouldn’t a healthy T level promote it like throwing kerosene on a fire?

To explain this situation, the French teams turn to what is called a saturation theory. Each prostate cell—and prostate cancer cell—has receptors on its surface that bind with testosterone molecules. Once a receptor has formed this bond, it is occupied and unavailable to additional T molecules. Think of a lock that requires a specific key to open it. Once you put the right key in the lock, trying to insert more keys is useless. The lock is occupied. Thus, the surface receptors are saturated. Thus, the T circulating in the blood becomes available for biological actions in other androgen receptor locations, including bone, muscle, fatty tissue and the reproductive, cardiovascular, immune, neural and blood development systems.[ii] This means TRT can be prescribed for PCa patients who also have low T.

Of course, low T must be diagnosed by a physician by means of a simple blood test. A normal range is considered 300 to 1,000 ng/dL (nanograms per deciliter); low T is diagnosed when levels fall below 300 (ng/dL). While declining T levels often naturally occur as men age, there are many other conditions that
can cause loss of interest in sex, depression, lethargy, depression, etc. This is why turning to advertised supplements or other products is ill-advised, since low T may not be the problem.

On the other hand, studies show that administering TRT does not affect prostate volume or PSA, whether a man is healthy, has active localized PCa, or has already been treated for PCa. Ironically, the French team cites studies that link low T levels with increased risk of developing PCa—a correlation that’s seen between aging-related drop in T levels and rising numbers of PCa diagnoses. In fact, there are dangers associated with aging-related low T. For men with existing localized PCa, low T is correlated with more aggressive disease, with disease progression, and with increased chance for recurrence.

Being diagnosed with PCa, and going through the stress of treatment and recovery, is already enough reason for depression. A PCa patient should not also have to suffer less quality of life due to loss of testosterone. When appropriately prescribed, TRT has beneficial, lifechanging results. These include better energy, overall vitality, boost in libido, improved erectile function, body composition and bone mineral density. Just as important, “Patients with localized prostate cancer may benefit from androgen therapy without compromising their chance of curing cancer,” say the authors. For men who are on Active Surveillance, or who were already treated, this is also true as long as there’s no evidence of cancer outside the gland or residual cancer.

Quality of life is as valuable as quantity of life. If you or a loved one has a history of PCa, and is also experiencing symptoms of low testosterone levels, talk to a doctor who has experience with TRT use in PCa patients who also have low T.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Lenfant L, Leon P, Cancel-Tassin G, Audouin M et al. Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Urologic Oncology: Seminars and Original Investigations, Elsevier, 2020, 38 (8), pp.661-670.
[ii] Davey RA, Grossmann M. Androgen Receptor Structure, Function and Biology: From Bench to Bedside. Clin Biochem Rev. 2016;37(1):3-15.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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