Is it possible that testosterone supplements could actually reduce risk for prostate cancer?

According to a report on the MedPage Today web site, three presentations given at the recently completed annual meeting of the American Urological Association addressed prostate cancer risk among men taking testosterone supplements. Here is a link to the full text of the MedPage Today report.

Now we need to be very clear up front that in all three of these studies, the patients being given testosterone supplements were men with hypogonadism (abnormally low testosterone levels). It is already well understood that giving testosterone supplements to such men is highly appropriate. The real controversy has long been about giving testosterone supplementation to men with perfectly normal serum testosterone levels, which is (possibly) a whole other kettle of fish. However, …

Two of these tree studies do very definitely give support to the hypothesis that, in men with hypogonadism, testosterone supplementation may actually reduce the risk for a diagnosis with prostate cancer.

The three studies referred to in the MedPage Today article are respectively by Loeb et al. (abstract no. 1145), by Haider et al. (abstract no. PD09-06), and by Walsh et al. (abstract no. MP04-04).

Loeb et al. used data from the Swedish National Prostate Cancer Register (NPCR), and the Prescribed Drug Register in Sweden, including 38,570 prostate cancer cases diagnosed from 2009 to 2012 and 192,838 age-matched controls, to show that patients treated with testosterone replacement therapy (TRT) had a higher risk of favorable-risk prostate cancer (odds ratio [OR] = 1.35), and a lower risk of aggressive disease (OR = 0.50). They also observed similar patterns when they restricted their database to men with > 1 year of adherent TRT use.

Haider et al. used data from a much smaller registry study in 360 patients to show that long-term treatment with testosterone supplements in hypogonadal men may (a) reduce the overall incidence of prostate cancer and (b) protect such hypogonadal men against risk for high-grade prostate cancer.

Walsh et al. used data from 157,312 men with low total serum testosterone levels in the Veterans Administration databases to show that: (a) among the men receiving testosterone supplements, there was no sign of any association between cumulative T dose and increased risk for prostate cancer; (b) the same was true of risk for aggressive prostate cancer. However, their data showed no sign of a reduction in risk for prostate cancer in general or aggressive prostate cancer in particular.

The question that is raised by all these data is now, “How should we define ‘hypogonadal’ status?”

Clearly this is relatively easy in men of about 50 and under. The problem is more difficult among men of 50 and older, when “normal” serum testosterone levels start to fall across the entire age group. What we still do not know is whether, among this set of patients (all already at significant risk for prostate cancer because of their age), the use of testosterone supplements adds to that risk or reduces that risk! This is clearly a question that the urology research community now needs to work on.

Is it possible that, by giving TRT to aging men with serum T levels that are falling down below the normal levels seen in men of 50 years and younger, we could actually stimulate a massive reduction in risk for prostate cancer in general — not to mention aggressive forms of the disease — among older men? Now that would be quite something! After all, something like 95 percent of all prostate cancers are diagnosed in men > 50 years of age.

6 Responses

  1. Is there ever a case for TRT for men with low T who have had prostate cancer and have been cured or are in remission?

  2. Bob:

    Dr. Morgantaler would tell you that absolutely there is. Some other physicians would tell you there may well be. Many are still on the fence. And there are still a few old-fashioned holdouts who would tell you, “No way in Hell!”

    The question is whether anyone can find the money to do the appropriate prospective trials. You’d think that at least one of the manufacturers of testosterone supplements might be interested. My suspicion, however, is that they are more worried about a negative result to such trials than they are enthused by the possibility of a positive result.

  3. I am living proof of this article. My last biopsy was 0/16 cores. I am on TRT. I have been shouting this material (along with Dr. M.) for at least 2 years. Now I have proof.

    In fairness, I have always had low-volume, Gleason 6 at all times during this.

    Low T is the enemy. It causes far more harm than you might imagine. …

  4. Add another in Dr. M.’s camp: diagnosed in September 2008 with Gleason 3 + 4; radiation completed February 2009; started TRT February 2013 after persistent findings of hypogonadism for 4 years; PSA never above 0.2 since treatment. Hoorah for T!!

  5. I agree that low T (like 2!) is devastating to the male body. I felt much better when I was on a HT hiatus when T went from 7 to 275. Look forward to another hiatus this October!

  6. Yes. It’s everything to us. …

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