Physician taking notes as he consults a male patient in a doctor’s office

Is Testosterone Therapy Safe for Prostate Health?

We must be vigilant, even of each other,

but mostly of ourselves

Viet Thanh Nguyen

Find out below how this treatment affects the prostate, and how Cenegenics takes precautions to ensure your utmost safety. We wanted to thank everybody that posted questions on our social media regarding prostate cancer and testosterone therapy. Exploring the potential risk behind medical treatments is part of being an informed and vigilant patient, and a key criterion for leading a life of optimized wellness.

Yet, there tends to be a lot of misinformation that circulates when it comes to prostate health and testosterone replacement therapy. To put your mind at ease about any risk, we’re here to set the record straight. Find out below how this treatment affects the prostate, and how Cenegenics takes precautions to ensure your utmost safety.

What is a Prostate?


Illustration of normal male prostate

In men, the prostate is a small gland roughly the size of a walnut. It is located between the bladder and the penis, just in front of the rectum. Oftentimes, we hear very little about the prostate until something goes wrong with it. Prostatitis, or inflammation of the prostate, for example, is sometimes caused by infection but can usually be treated with antibiotics. Additionally, prostate cancer is the most common form of cancer in men outside of skin cancer, though few men die of the condition.

Yet, aside from the potential issues that may develop with the gland, it plays an important role in men’s reproductive health. The prostate secretes fluid to nourish and protect the sperm, which it squeezes into the urethra during the ejaculation. This fluid is a component that combines with sperm to make up semen.

With this understanding of the prostate’s function in mind, let’s move on to briefly discuss testosterone therapy. 

What is Testosterone Replacement Therapy?


Syringe pulling testosterone from prescription vial

Testosterone is a male sex hormone produced in the testes. It helps to maintain the production of sperm as well as a man’s sex drive, along with facial and body hair. Yet, it also plays an important role on a cellular level: testosterone aids in red blood cell production and also helps to promote healthy muscle and bone mass.

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By their middle ages, men’s testosterone production begins to slow. Many men experience symptoms of low testosterone, which could include:

As a result, many men turn to testosterone replacement therapy to address these symptoms and to promote better long-term health.

With that said, early studies raised questions about the potential link between prostate cancer and testosterone replacement therapy. This has led many men to avoid what could be a life-changing treatment. Yet, for most populations and with the right clinical oversight, testosterone therapy does not increase the risk of prostate cancer — find out why below.

How is the Prostate Affected by Testosterone Replacement Therapy?


Some studies have suggested that testosterone therapy could contribute to prostate enlargement, or what’s known as benign prostatic hyperplasia (BPH). Yet, this effect is most notable in patients who are markedly hypogonadal, or significantly deficient in testosterone. In patients with normal testosterone (eugonadal) levels, the effect becomes statistically insignificant. Moreover, the use of testosterone therapy does not show any statistically significant worsening of flow rates, post void residual volumes, or other symptoms affecting prostate health as measured by the International Prostate Symptom Score. [1]

The Myth of Prostate Cancer Risk

Initial reports that testosterone levels were directly associated with prostate cancer were misunderstood and largely based on a single case report. Research in the 1940s performed by Charles Brenton Huggins and Clarence Hodges suggested that lowering testosterone caused prostate cancer to stop growing. Further reports in the 1990s supported the belief that prostate cancer is caused by increased total testosterone levels. The erroneous conclusion drawn by the general medical community based on these studies was that high testosterone levels lead to prostate cancer. [2]

Yet, upon taking a closer look, other researchers identified another factor in the mix. When patients with prostate cancer underwent androgen suppression followed by testosterone, the cancer progressed rapidly. Patients who did not receive androgen suppression (and were thus not made severely hypogonadal) did not see a progression of their cancers when administered testosterone. This finding suggests that prostate cancer survivors who have not received androgen suppression may be eligible for testosterone replacement therapy. [3]

Further research was done at a cellular level. It showed that testosterone supplementation increases testosterone in the prostate gland of hypogonadal men, but in eugonadal men, there is no statistical increase in total testosterone within the prostate gland. Additional markers for prostatic disease, including prostate-specific antigen (PSA), prostatic volume, androgen-related genes, and genes associated with prostatic proliferation, were also studied. They were not significantly elevated beyond expected levels for eugonadal patients. [4]

Studies Show Low Testosterone May Increase Risk

There is strong evidence that prostate cancer is less likely to occur in men with levels of testosterone comparable to young eugonadal men, and that lower testosterone levels are at risk for prostate cancer (and prostate cancer with more aggressive features). In a large study of men in Norway, Sweden, and Finland, men with the highest total testosterone levels (in the fifth quintile) showed an overall risk of 0.80 for being diagnosed with prostate cancer — a 20% reduced risk compared to the lowest quintile. [5]

Ultimately, nearly half a million men have been studied in investigations, with no association shown between increased testosterone and increased prostate cancer. Instead of elevated testosterone, low total testosterone is associated with increased prostate disease in general, including cancer. [6]

Moreover, baseline testosterone levels are not predictive of prostate cancer. These facts strongly argue against increased total testosterone levels playing any causative role in prostate cancer. In fact, the estimated prevalence of prostate cancer in patients treated with testosterone therapy was reported to be 1.1% across aggregate studies, or less than the general population statistic of 1.7% prevalence as of 2013. [7]

In other words, evidence shows that the risk of prostate cancer in a patient undergoing testosterone therapy is equal to or less than that for the general population. The only patients who may be at risk for a recurrence of prostate cancer are those who have already had it and been treated with androgen deprivation. Coincidentally, this is the exact condition that occurred in the original study responsible for raising the generalized, misdirected fear of prostate cancer risk in testosterone therapy patients.

How Cenegenics Monitors Prostate Health


Mature man standing on boat

Now, nearly 80 years following the publication of the original study, medical experts are far more informed about testosterone therapy as it relates to prostate health. Ultimately, the therapy is considered safe for prostate health under the conditions described above—but with one more caveat. It must be monitored closely by trained physicians, such as Cenegenics’ age management physicians.

At the start of each patient experience, Cenegenics performs comprehensive screenings to tap into many different measures of health. This comprehensive assessment is not only useful but necessary for determining whether you’re a candidate for HRT, or if there are other medical factors at play which must be addressed. From dietary gaps and nutrient deficiencies to previously undiagnosed allergies, our clinical team looks at all of the potential barriers to wellness optimization.

Moreover, as a team of ethical and responsible physicians, we perform ongoing monitoring to identify and mitigate risk proactively. If needed, we course-correct as treatment takes place instead of waiting until any adverse symptoms manifest. While routine monitoring is the cornerstone of effective HRT, the majority of low-T clinics do not offer this practice. While these clinics may perform lab work when subjective symptoms arise, Cenegenics is proactive in measuring the impact of bioidentical hormones on prostate, kidney, and liver health, as well as other biomarkers. We also perform all of our phlebotomy activities in-house to minimize the risk of errors and oversights, and to ensure all of your lab work, pharmacy items, and prescriptions are handled exclusively by our panel of specialists.

Patients should be wary of any “low-T clinics” that simply prescribe testosterone without monitoring. While testosterone is indeed a very important component when it comes to male health, it is only one piece of the puzzle. Not only is testosterone replacement therapy without clinical monitoring dangerous, but it also fails to recognize the other critical aspects of wellness optimization that shape long-term health.

At Cenegenics, we guide our patients into an improved lifestyle, maximizing health potential to enjoy a more vibrant, rewarding life. While we understand that symptoms associated with low testosterone may be one of the primary reasons why patients seek us out, our physicians also understand that a “one size fits all” modality is ineffective for successful treatment. Instead, the complex interplay among nutrition, exercise, sleep, and genetic factors, among others, must all be considered and accounted for when developing a robust and effective wellness optimization plan.

If you’re interested in seeing what an individualized wellness optimization program from Cenegenics could do for you, contact your nearest location today.

Next Steps to Receiving Individualized Prostate Health Plan

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About the Contributor

Rudy Inaba 
Global Director of Nutrition & Exercise

Rudy Inaba is Cenegenics’ Global Director of Nutrition & Exercise. He is a recognized fitness and sports nutrition consultant with nearly 15 years of experience in clinical exercise physiology and lifestyle management. After pursuing his Master of Science in Clinical Exercise Physiology at the University of Nevada Las Vegas, Rudy joined Cenegenics where he leads 20 clinical locations nationwide in their advancements in kinesiology, nutritional biochemistry, and their analyses of industry research & market trending.

Key Resources

This guide was produced with contributions from the following key resources: 

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

The Cenegenics Education and Research Foundation  

The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Click to purchase

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

References

[1] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS. Textbook of Age Management Medicine: Volume 2. Leake-Greenberg Ventures, LLC, 2015.

[2] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[3] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[4] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[5] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[6] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

[7] Leake, Jeffery Park, M.D., CPT, and Greenberg, Todd David, M.D., CSCS; see above.

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