Testosterone, or low T. No matter what you call it, it’s time to debunk the myth that testosterone therapy for men with low T increases prostate cancer risk.

It all began over 80 years ago. “In 1941 Huggins and Hodges reported that marked reductions in T by castration or estrogen treatment caused metastatic [prostate cancer or PCa] to regress, and administration of exogenous T caused [PCa] to grow. Remarkably, this latter conclusion was based on results from only one patient.”^[i] For decades afterward, this misled clinicians to believe that testosterone therapy, or TTh, fed the development of PCa.

However, since the late 1960s there’s been an increasing body of published research suggesting that this is simply not the case. Today, medical societies concerned with prostate cancer such as the European Association of Urology (EAU) and the American Urological Association (AUA) acknowledge that TTh does not appear to increase PCa risk—though they hedge on the issue by calling for continued research.

In fact, published reviews of high quality clinical trials comparing TTh vs placebo have yet to demonstrate a clear link between testosterone therapy (including injectables, gels, etc.) and developing or worsening the disease. One critique of such studies, however, is that they don’t distinguish between men at low risk (i.e. no family history of PCa) and men at high risk due to PCa family history.

To remedy this, a multicenter team from the U.S. and Italy ran a population analysis of patients with low T covering a 10-year period.^[ii] All patients were defined as being at high risk for PCa based on family history. The study formed two patient cohorts of 623 men each whose baseline characteristics were balanced between the two groups:

1. One group of low T patients received TTh over the 10 years of the study.
2. The other group of low T patients did not receive TTh during the 10 years.

Based on their analysis, the authors found that the cohort who received TTh did not show a higher risk of being diagnosed with any PCa or of receiving any active treatment compared with the non-TTh cohort.

What makes this study unique is its focus on men at high risk for PCa. The authors cite several earlier studies, including one of the most recent randomized controlled studies that did not find “any significant difference in terms of incidence of high grade or any PCa in TTh group [with] respect to placebo.”^[iii] However, that study did not include men considered at high-risk for the disease. Although there are a few limitations to the new study, the work of these authors has strong numbers demonstrating that testosterone therapy for men with low T who have a family history of PCa does not appear to raise their chances of developing PCa. Thus, the authors express hope that their findings “… should stimulate the scientific community to conduct [randomized controlled trials] in this field, which are crucial for further understanding the relationship between TTh and PCa in this population.”^[iv]

On a final note, testosterone therapy has now been demonstrated to be safe for prostate cancer patients who have undergone treatment and who also have low T. There is no clear evidence that it increases the risk of disease progression or recurrence. However, experts recommend that doctors and patients discuss the benefits and possible risks, and also that a patient’s low T has been validated through testing and not symptoms alone.

We congratulate the authors on their research demonstrating that TTh is safe for men at high PCa risk due to family history, should they become deficient in the all-important male hormone, testosterone.

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.

References

[i] Morgentaler, Abraham. Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth. European Urology, Volume 50, Issue 5, 935 – 939.
[ii] Pozzi E, Able CA, Kohn T, Kava BR, Montorsi F, Salonia A. Incidence of prostate cancer in men with testosterone deficiency and a family history of prostate cancer receiving testosterone therapy: a comparative study. BMJ Oncol. 2025 Mar 6;4(1):e000520.
[iii] Bhasin S, Travison TG, Pencina KM, et al. Prostate Safety Events During Testosterone Replacement Therapy in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open. 2023;6:e2348692.
[iv] Pozzi et al, ibid.