Posted on Apr 27, 2020, 6 p.m.
Article courtesy of: Thierry Hertoghe, MD., author of “Testosterone, the Therapy for Real Gentlemen”
Starting in the 1950s, it was believed that testosterone therapy increased the risk of prostate cancer in men. This assumption was based on an anecdotal study of one male patient who had undergone castration years earlier and developed prostate cancer after receiving testosterone therapy. It seems indeed that men who have been castrated for a long time are less likely to have prostate cancer because their prostate is almost completely atrophied. When later testosterone therapy is given, the prostate develops again and may become a target for cancer because of the increase in tissue. However, this condition is exceptional, and the great majority of other cases of men with normally well-developed prostate show the opposite: that testosterone protects their prostate. Particularly, men with higher testosterone levels have less risk of aggressive prostate cancer, and testosterone therapy does not increase the risk of prostate cancer.
Recent studies in support of neutral effects of testosterone therapy in prostate cancer patients:
For this reason, top urologists and andrologists from all over the world have started to administer testosterone to men with treated and untreated (still active) prostate cancer. Kardoust Parizi and colleagues in their review of the literature, published in October 2019, found 21 clinical studies. None of these studies showed any increase in risk of recurrence or aggressiveness of prostate cancer with testosterone therapy. One smaller study even showed a fourfold decrease in risk of recurrence of prostate cancer in men receiving testosterone therapy! The data show that it’s time to change our view and lose the fear that testosterone therapy could cause prostate cancer in men.
A small possibility that testosterone therapy could nevertheless increase the risk of prostate cancer:
In my opinion, testosterone therapy can exceptionally increase the risk of prostate cancer when too much of the testosterone converts to the female hormone estradiol. Estradiol is known to cause metaplasia of the prostatic epithelial cells, the cells in which prostate cancer originates. Men who tend to convert testosterone to estradiol too quickly are recognizable. Their body is feminized (breast development, more fat mass, and less hair), and in the serum, they usually have high estrogen levels (estradiol and estrone). They also often drink large amounts of alcohol and coffee. Both drinks increase this conversion.
In men with high estrogen levels, testosterone therapy should be given with an aromatase blocker, a blocker of the enzyme that converts testosterone to estradiol, such as anastrozole. Close monitoring is necessary when physicians treat with such a blocker because low levels of estradiol are linked to osteopenia and increased mortality. The guideline is to avoid excessive levels of estradiol (30 pg/mL or 110 pmol/L or above) and insufficient levels of estradiol (18 pg/mL = 66 pmol/L or lower).
To access the relevant data on testosterone deficiency, testosterone therapy, and their association with prostate cancer on the International Hormone Society website, in the Evidence-based hormone therapies section (available soon).
To get more references and practical information on testosterone therapy, read my 600-page book for physicians, “Testosterone, the Therapy for Real Gentlemen”.
To get practical and in-depth training on testosterone therapy and come attend the hormone therapy workshop in Orlando on August 21-22, 2020. Check out the Evidence-based hormone therapy workshop here, which will be available at the A4M 28th Annual Spring Congress being held in Orlando, Florida on August 20-22, 2020.
Thierry Hertoghe, MD is the President of the International Hormone Society. Born in 1957 and he practices lifespan/reversing aging medicine and hormone therapy. He represents the fourth consecutive generation of physicians who have worked in the field of hormone therapy, where he practices medicine with a team of experienced doctors in Brussels. He is an internationally known authority in medical therapies oriented to correct hormone deficiencies, reduce aging or even in some aspects reverse aging and possibly extend lifespan. He is the Author of various well-referenced medical books, including the international bestseller Hormone handbook and the Atlas of endocrinology for hormone therapy, Testosterone, the therapy for real gentleman, the Textbook of Reversing physical aging (volume 1: the head and the senses), the Textbook of lifespan and anti-aging medicine, the Textbook of Nutrient therapy, the Hormone Solution, Passion, sex, and long life, and the Oxytocin adventure, among others.
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