Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

28. Testosterone and PSA Screening, Part Two

Chapter 28. PSA and Testosterone  - Part Two - A Medical Myth

A common medical myth is that Testosterone is somehow causative of prostate cancer.  This is incorrect, as we will see below.  Rather than elevated Testosterone being associated with prostate cancer, it is LOW testosterone that is associated with aggressive prostate cancer with poor outcome.  Indeed, lower testosterone has been found to be associated with increased all cause mortality in males in the EPIC study.

PSA and Testosterone Observations (see references 1-16)

(1) Lower Testosterone Levels  (not higher levels) are associated with increased risk for aggressive prostate cancer.  Higher levels within the normal range are associated with less risk for Prostate CA.  This is directly opposite to the ingrained urology dogma, and was demonstrated by biopsy studies by Morgentaler and Rhoden. (7)

(2) PSA level will go down when testosterone is withdrawn or given DHT blockade with finasteride.

(3) PSA will rise transiently after starting Testosterone, and then stabilize at new level.(1-19)

(4) Hypogonadal symptomatic patients following treated prostate cancer having undetectable PSA of zero, may be safely treated with testosterone therapy. (9-15)

For references and links, see my web site:

References for Chapter 28.  PSA and Testosterone, Part Two

(1)  Rev Urol. 2004; 6 (Suppl 6): S41–S43.  Rising PSA during Testosterone Replacement Therapy, John Gore, MD and Jacob Rajfer, MD

2) The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 2 416-417. Guideline for Male Testosterone Therapy: A Clinician’s Perspective - Abraham Morgentaler Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts .

(3)  Volume 50, Issue 5, Pages 935-939 (November 2006)  Urologic Clinics. Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth? Abraham Morgentaler

(4) Journal of Andrology, Vol. 24, No. 3, May/June 2003. Managing the Risks of Prostate Disease During Testosterone Replacement Therapy in Older Men: Recommendations for a Standardized Monitoring Plan. Shalender Bhasin et al.

(5) Testosterone Update, Presentations held at the 2008 American   Urological Association Annual Meeting .  May 17-20, 2008, Orlando, Florida.

(6) J Steroid Biochem Mol Biol. 2006 Dec;102(1-5):261-6. Prostate cancer risk in testosterone-treated men. Raynaud JP.

(7) Cancer Epidemiol Biomarkers Prev. 2006 Jan;15(1):86-91.  Circulating steroid hormones and the risk of prostate cancer. Severi G, Morris HA, MacInnis RJ, English DR,

(8)  Urology. 2006 Dec;68(6):1263-7.
Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Morgentaler A, Rhoden EL.

(9) Urol Int. 2007;79(1):13-8.  Hormonal predictors of prostate cancer. Sofikerim M, Eskicorapci S, Oruç O, Ozen H.

(10) BJU Int. 2009 May;103(9):1179-83. Epub 2008 Dec 23. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. Coward RM, Simhan J, Carson CC 3rd.

(11) JAMA. 2006 Nov 15;296(19):2351-61. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial.  Marks LS, Mazer NA,

(12) Cancer. 2007 Feb 1;109(3):536-41.
Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Sarosdy MF.South Texas Urology and Urologic Oncology, San Antonio, Texas 78229, USA.

(13) J Urol. 2005 Feb;173(2):533-6.
Testosterone replacement therapy after primary treatment for prostate cancer. Agarwal PK, Oefelein MG. 

(14) J Androl. 2002 Nov-Dec;23(6):922-6. Prostate-specific antigen changes in hypogonadal men treated with testosterone replacement.  Gerstenbluth RE, Maniam PN, Corty EW, Seftel AD.

(15) Curr Treat Options Oncol. 2006 Sep;7(5):363-9.
Testosterone therapy for men at risk for or with history of prostate cancer. Morgentaler A.

(16)  Urologe A. 2009 May;48(5):516-22. Testosterone replacement therapy and prostate cancer. The current position 67 years after the Huggins myth] [Article in German] Rinnab L et al.

(17) Urol Clin North Am. 2007 Nov;34(4):549-53, vi.
The role of testosterone replacement therapy following radical prostatectomy. Khera M et al.

(18) J Sex Med. 2009 Feb;6(2):574-7
Two years of testosterone therapy associated with decline in prostate-specific antigen in a man with untreated prostate cancer. Morgentaler A. Harvard Medical School, Urology,

(19) J Steroid Biochem Mol Biol. 2009 Mar;114(1-2):96-105. Epub 2009 Jan 30. Testosterone deficiency syndrome: treatment and cancer risk. Raynaud JP.

Author Dr Dach  Jeffrey Dach MD

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