For decades, men with prostate cancer were routinely advised against testosterone replacement therapy (TRT), even if they had clinically low testosterone levels. The concern was based on the belief that testosterone could fuel prostate cancer growth. However, emerging research is challenging this long-held view. Experts now suggest that, in carefully selected men with low-risk, localised prostate cancer and hypogonadism (low testosterone), testosterone replacement therapy may not increase the risk of cancer progression when administered under close medical supervision.

What Is Hypogonadism?

Hypogonadism is a condition in which the body produces insufficient testosterone. According  to a study published in journal Androgens, it becomes increasingly common with age and is estimated to affect up to 40% of older men. Low testosterone may cause:

  1. Persistent fatigue
  2. Reduced muscle mass and strength
  3. Low libido
  4. Erectile dysfunction
  5. Mood changes
  6. Difficulty concentrating
  7. Reduced bone density

For many men, testosterone replacement therapy can significantly improve quality of life by relieving these symptoms.

Also read:  Testosterone May Not Be The Key To Strength And Toughness

Why Was Testosterone Avoided In Prostate Cancer?

Historically, doctors believed testosterone acted as fuel for prostate cancer cells. This assumption came from early observations that reducing testosterone levels slowed the growth of advanced prostate cancer. As a result, men diagnosed with prostate cancer were generally considered unsuitable candidates for testosterone therapy. However, newer scientific evidence has questioned whether this concern applies equally to men with early-stage, low-risk prostate cancer.

The Androgen Saturation Model

One explanation behind this changing perspective is the androgen saturation model. According to this theory, prostate cells become saturated with testosterone at relatively low hormone levels. Once these receptors are fully occupied, further increases in testosterone do not significantly stimulate additional tumour growth.

This suggests that restoring testosterone to normal physiological levels may not necessarily accelerate cancer progression in carefully selected patients.

What Does The Research Show?

A comprehensive review evaluated seven observational studies involving 295 men receiving testosterone replacement therapy while on active surveillance for localised prostate cancer. Their outcomes were compared with 6,826 men who did not receive testosterone therapy. The findings were reassuring:

  1. No prostate cancer-related deaths were reported in men receiving TRT.
  2. No patients developed metastatic disease during follow-up periods ranging from 2.3 to 6.1 years.
  3. Cancer grade progression occurred in 10.7% of men receiving TRT compared with 9.4% in untreated patients, showing no statistically significant difference.
  4. Overall biopsy progression rates were 32.1% in the TRT group versus 44.7% among comparison groups.

Does Testosterone Therapy Increase The Need For Cancer Treatment?

Current evidence suggests it may not. Large real-world studies found that men receiving testosterone replacement therapy were not more likely to require definitive treatment such as surgery or radiation. Some analyses even reported lower treatment conversion rates among men receiving TRT, although researchers caution that careful patient selection may partly explain these findings.

Propensity-matched studies also showed similar three-year and five-year treatment-free survival between men who received testosterone therapy and those who did not.

Also read: Is Your Testosterone Low? 5 Symptoms Every Man Should Watch For

What About PSA Levels?

Prostate-specific antigen (PSA) remains an important marker during prostate cancer monitoring. Studies found that although testosterone levels increased significantly after treatment, PSA values generally remained stable. Researchers also observed that PSA changes did not consistently predict tumour progression. For this reason, experts recommend that men receiving TRT continue routine monitoring, including:

  • Regular PSA testing
  • Scheduled prostate biopsies when indicated
  • MRI scans when appropriate
  • Ongoing follow-up with both a urologist and endocrinologist
  • PSA alone should not replace comprehensive cancer surveillance.

Is Testosterone Therapy Safe For Everyone?

Current evidence applies only to carefully selected men with low-risk, localised prostate cancer who are under active surveillance and have clinically confirmed testosterone deficiency. Testosterone replacement therapy is not routinely recommended for men with advanced, metastatic or high-risk prostate cancer unless advised by a specialist within a carefully monitored treatment plan.

Growing evidence suggests that testosterone replacement therapy may be safely considered in selected men with hypogonadism and low-risk localised prostate cancer without significantly increasing cancer progression in the short to intermediate term. However, treatment decisions should always involve shared decision-making between the patient and their healthcare team. Careful selection, regular PSA monitoring, imaging, biopsies and long-term follow-up remain essential until larger randomised clinical trials provide stronger evidence.



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