27. Testosterone and PSA Screening

Chapter 27. Testosterone, PSA and Prostate Cancer, Myths and Misconceptions

Left Image: Prostate and seminal vesicals from Gray's Anatomy lithograph, 1918, courtesy of wikimedia commons.

Benefits of Testosterone Therapy

The Nobel Prize in Chemistry was awarded to Butenandt and Ruzicka in 1939 for the synthesis of testosterone. (1)   Over the last seventy years, thousands of medical studies have shown that testosterone is beneficial for improving health and prolonging life. (2-27) Testosterone can prevent or reduce the likelihood of osteoporosis, type 2 diabetes, cardiovascular disease, obesity, depression and anxiety and the risk of early mortality.(7)  Health benefits include positive effects on mood, energy levels, verbal fluency, strength, increased muscle size, decreased body fat and increased bone density.(2-27)  Testosterone restores and enhances male libido, and is a treatment for male sexual dysfunction.(33)

Low Testosterone Associated With Increased Mortality

The 2007 EPIC study concluded that testosterone level is inversely related to cardiovascular disease risk and all-cause mortality. Thus, low testosterone may be a marker for increased risk of cardiovascular disease.(35)  Low Testosterone levels is also linked to reduced cognitive performance and onset of Alzheimer’s in elderly men. (36)(37)

Testosterone Benefits the Heart

Here are a few studies showing testosterone benefits the heart and circulation.  Dr. Dobrzycki studied men with known coronary artery disease and showed they had significantly lower levels of testosterone (J Med Invest 2003).(22) He also showed that lower testosterone levels was associated with reduced pumping ability of the heart.  Dr. C.J. Malkin showed that testosterone therapy reduced the risk of death from abnormal heart rhythms (arrhythmias).(23)   Dr. Malkin also reported that testosterone improves the pumping action of the heart in patients with Congestive Heart Failure,(24) and acts a protective factor against atherosclerosis and plaque formation in arteries.   Dr. Eugene Shippen presented an impressive study at a medical meeting, in which testosterone therapy was used to successfully reverse diabetic gangrene of the lower legs and avoid amputation in many of the cases.

No Evidence of Adverse Effect on the Prostate

Regarding a hypothetical question of prostate cancer risk from testosterone administration, there is no evidence for this in the medical literature. Here are three of many medical studies reporting no adverse effect on the prostate, and no evidence that testosterone is the cause of prostate cancer.  

Dr Morgentaler says: "It has been part of the conventional medical wisdom for six decades that higher testosterone in some way increases the risk of prostate cancer. This belief is derived largely from the well-documented regression of prostate cancer in the face of surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Specifically, no increased risk of prostate cancer was noted in 1) clinical trials of testosterone supplementation, 2) longitudinal population-based studies, or 3) in a high-risk population of hypogonadal men receiving testosterone treatment. Moreover, hypogonadal men have a substantial rate of biopsy-detectable prostate cancer, suggesting that low testosterone has no protective effect against development of prostate cancer. These results argue against an increased risk of prostate cancer with testosterone replacement therapy." Quoted from Testosterone replacement therapy and prostate risks: where's the beef?  Morgentaler A. Can J Urol. 2006 Feb;13 Suppl 1:40-3. (28)

Dr Morales says: "No evidence exists that appropriate androgen administration with knowledgeable monitoring carries significant or potentially serious adverse effects on the prostate gland." Quoted from Monitoring androgen replacement therapy: testosterone and prostate safety by Morales A. J Endocrinol Invest. 2005;28 (3 Suppl):122-7(29)

Dr Rhoden says: “Despite decades of research, there is no compelling evidence that testosterone has a causative role in prostate cancer.” From Risks of Testosterone-Replacement Therapy and recommendations for Monitoring. N Engl J Med 2004;350:482-92. Rhoden and Morgentaler.(30)

The ADAM Testosterone Questionnaire

This questionnaire is useful for detecting low testosterone levels.  ADAM is an acronym for  Androgen Deficiency in the Aging Male.(43)(44)

If you answered YES to questions 1 or 7, or any 3 other questions, you may have low testosterone.  Next step is a testosterone blood test to determine your level. If low, then testosterone supplementation may be considered.  It is important to work closely with a knowledgeable physician who can do a full evaluation, order the appropriate tests, and prescribe treatment.

For references and links, see my web site: www.bioidenticalhormones101.com

References for Chapter 27. Testosterone, PSA and Prostate Cancer Part One

(1) http://nobelprize.org/nobel_prizes/chemistry/laureates/1939/press.html
The Nobel Prize in Chemistry 1939 Presentation Speech,  Butenandt Discovery of Testosterone.

(2) http://www.hms.harvard.edu/news/pressreleases/mcl/0103testosteronereplace.html
Study Suggests Depressed Men May Benefit from Testosterone Replacement Therapy Belmont--January 1, 2003

(3) http://www.revolutionhealth.com/healthy-living/mens-health/hot-topics/mens-health-101/testosterone-therapy-men Testosterone therapy: The answer for aging men? Date updated: April 14, 2006 Mayo Clinic Revolution Health.

(4) http://www.duj.com/Article/Hellstrom2/Hellstrom2.html Digital Urology Journal. Testosterone Replacement Therapy. Wayne J.G. Hellstrom, M.D

(5) http://www.medscape.com/viewarticle/556617_print Testosterone and Ageing: What Have We Learned Since the Institute of Medicine Report and What Lies Ahead? M. M. Miner; A. D. Seftel Int J Clin Pract. 2007;61(4):622-632. 05/21/2007

(6) http://www.aafp.org/afp/20060501/1591.html Testosterone Treatments: Why, When, and How? American Academy of Family Physicians. May 1, 2006 Katherine Margo, M.D.,

(7) http://www.sciencedaily.com/releases/2006/08/060816083120.htm
Science News Low Testosterone Levels Associated With Increased Risk Of Death In Men

(8) http://www.sciencedaily.com/releases/2008/01/080109111320.htm
Testosterone May Improve Mental Function. ScienceDaily (Jan. 14, 2008

(9) http://www.worldhealth.net/pdf/bookstore/thera6_ch7.pdf Chapter 7 Testosterone, The Male Hormone Connection: Treating Diabetes and Heart Disease. Michael Klentze, M.D., Ph.D.

(10) http://www.hotzehwc.com/attachments/wysiwyg/2/Testosterone101.pdf
Testosterone for Men and Women By Steven F. Hotze, M.D., e-book.

(11) https://secure.pharmacytimes.com/lessons/200410-03.asp
State-of-the-Art Update on Testosterone Replacement: A Clinical and Pharmacological Approach Narinder Duggal Pharmacy Times

(12) http://www.drmirkin.com/men/M227.html Testosterone Replacement for Older Men?,  Gabe Mirkin, M.D.

(13) http://www.endo-society.org/publications/OldContent/testosterone-Feb2004.cfm, Practical Approach to Testosterone Therapy of Elderly Men, Endocrine News Vol 29, N1 Feb 2004.

(14) http://www.hormone.org/Resources/Patient_Guides/upload/patients_guide_low_testosterone.pdf
Patient’s Guide to Low Testosterone (2003 Edition) Glenn R. Cunningham, MD,  Alvin M. Matsumoto, MD, Ronald Swerdloff, MD. From the Family Physicians Inquiries Network.

(15)http://www.healthline.com/sw/hr-nl-a-harvard-expert-shares-his-thoughts-on-testosterone-replacement-therapy An interview with Abraham Morgentaler, M.D.A Harvard expert shares his thoughts on testosterone-replacement

(16) http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1502320 Rev Urol. 2003; 5(Suppl 1): S34–S40. New Advances in the Treatment of Hypogonadism in the Aging Male Christopher P Steidle, MD

(17) http://www.ncbi.nlm.nih.gov/pubmed/15799128 Aging Male. 2004 Dec;7(4):319-24. Testosterone therapy--what, when and to whom? Jockenhövel F.

(18) http://www.ncbi.nlm.nih.gov/pubmed/15329035 Drugs. 2004;64(17):1861-91. Androgen replacement therapy: present and future.Gooren LJ, Bunck MC.

(19) http://www.ncbi.nlm.nih.gov/pubmed/16918944 Clin Endocrinol (Oxf). 2006 Sep;65(3):275-81. Testosterone treatment comes of age: new options for hypogonadal men. Nieschlag E.

(20) http://www.med.unc.edu/~mcoward/urology/Harrison's%20Aging-Related%20Changes%20in%20Male%20Reproductive%20Function.pdf  Harrison's Internal Medicine. Part 14. Aging-Related Changes in Male Reproductive Function.

(21) http://www.andrologyjournal.org/cgi/content/full/27/2/126
Journal of Andrology, Vol. 27, No. 2, March/April 2006. Review Testosterone Replacement Therapy for Older Men. Moshe Wald et al.

(22) http://www.ncbi.nlm.nih.gov/pubmed/13678385 J Med Invest. 2003 Aug;50(3-4):162-9.
An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males.Dobrzycki S et al.

(23) http://www.ncbi.nlm.nih.gov/pubmed/14609611 Am J Cardiol. 2003 Nov 15;92(10):1241-3.
Effect of testosterone therapy on QT dispersion in men with heart failure.Malkin CJ et al.

(24) http://www.ncbi.nlm.nih.gov/pubmed/16093267 Eur Heart J. 2006 Jan;27(1):57-64. Epub 2005 Aug 10. Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Malkin CJ et al.

(25) http://www.drdach.com/wst_page15.html Testosterone Information Page Jeffrey Dach MD

(26) http://drcranton.com/hrt/testosterone_replacement.htm Testosterone Replacement: The Male Andropause, Taken from a chapter in the book, Resetting the Clock, by Elmer M. Cranton, M.D. and William Fryer.

(27) http://archneur.ama-assn.org/cgi/content/abstract/59/11/1750
Beneficial Effects of Testosterone Replacement for the Nonmotor Symptoms of Parkinson Disease Michael S. Okun, MD et al.

(28) http://www.ncbi.nlm.nih.gov/pubmed/16526980 Can J Urol. 2006 Feb;13 Suppl 1:40-3. Testosterone replacement therapy and prostate risks: where's the beef ? Morgentaler A.

(29) http://www.ncbi.nlm.nih.gov/pubmed/16042371 J Endocrinol Invest. 2005;28(3 Suppl):122-7. Monitoring androgen replacement therapy: testosterone and prostate safety. Morales A.

(30) http://www.drdach.com/uploads/testosterone_rhoden.pdf Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D. N Engl J Med 2004;350:482-92.

(31) http://www.ncbi.nlm.nih.gov/pubmed/10415627 Androgens and dry eye in Sjögren's syndrome. Ann N Y Acad Sci. 1999 Jun 22;876:312-24. Sullivan DA et al. 

(32) http://www.ncbi.nlm.nih.gov/pubmed/12114274
Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Sullivan DA et al. Ann N Y Acad Sci. 2002 Jun; 966:211-22.

(33) http://www.aace.com/pub/pdf/guidelines/sexdysguid.pdf Male Sexual Dysfunction, Endocr Pract. 2003;9 (No. 1) January/February 2003 77. A Clin Endo Medical  Guidelines for clinical practice for evaluation and treatment of male sexual dysfunction: 2003 UPDATE AACE Male Sexual Dysfunction Task Force Andre T. Guay, MD, Richard F. Spark, MD, Sudhir Bansal, MD et al.

(34) http://www.fda.gov/medwatch/SAFETY/2003/03SEP_PI/AndroGel_PI.pdf
Androgel FDA approved topical version of testosterone.

(35) http://www.cardiosource.com/cjrpicks/CJRPick.asp?cjrID=3849 Endogenous Testosterone and Mortality due to All Causes, Cardiovascular Disease, and Cancer in Men: European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study 2/6/2008  Khaw KT, Dowsett M, Folkerd E, et al. Circulation. 2007;116:2694-2701.
 
(36) http://www.nih.gov/news/pr/jan2004/nia-26.htm
Low Free Testosterone Levels Linked to Alzheimer’s Disease in Older Men

(37) http://jcem.endojournals.org/cgi/content/full/87/11/5001 The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 11 5001-5007. Longitudinal Assessment of Serum Free Testosterone Concentration Predicts Memory Performance and Cognitive Status in Elderly Men
Scott D. Moffat et al.

 (38) http://www.mbschachter.com/male_andropause.htm The Male Andropause, by Michael B. Schachter M.D., F.A.C.A.M.

(39) http://www.usdoctor.com/Chapter13.html TESTOSTERONE for MEN with DIABETES

(40) http://www.touchbriefings.com/pdf/2782/jones.pdf Testosterone – Clinical Associations with the Metabolic Syndrome and Type 2 Diabetes Mellitus. T Hugh Jones. Consultant Physician and Endocrinologist, Barnsley Hospital NHS Foundation Trust, and Honorary Professor of Andrology, Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield

(41) http://www.svedyn.com/web/revistas/deficit%20androgenos%20adultos.pdf Androgen Deficiency in Men. Daniel S. Tung, MD, Glenn R. Cunningham, MD The Endocrinologist  Vol 17, N 2, April 2007.

(42) http://care.diabetesjournals.org/cgi/content/full/30/4/911 Diabetes Care 30:911-917, 2007 Clinical and Biochemical Assessment of Hypogonadism in Men With Type 2 Diabetes, Correlations with bioavailable testosterone and visceral adiposity. Dheeraj Kapoor, MD, et al.

(43) http://jcem.endojournals.org/cgi/content/full/89/12/5920#R4 The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 12 5920-5926. Prevalence and Incidence of Androgen Deficiency in Middle-Aged and Older Men: Estimates from the Massachusetts Male Aging Study. Andre B. Araujo et al.

(44) http://www.ncbi.nlm.nih.gov/pubmed/11016912
Metabolism. 2000 Sep;49(9):1239-42.Validation of a screening questionnaire for androgen deficiency in aging males. (ADAM) Morley JE, Charlton E et al.

Author Dr Dach Jeffrey Dach MD