A Recent Study Concludes: Testosterone DOES NOT Cause Prostate Cancer

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For decades the medical community accepted the fact that testosterone replacement therapy (TRT) should never be prescribed for aging men due to the increased risk of prostate cancer.

This was especially true for men that were diagnosed with the dreaded disease. It was considered by many urologists that treating men suffering from prostate cancer with testosterone would be “like throwing gasoline on a raging bonfire.”

However, this long-held view has been challenged. Ever hear of robot-assisted radical prostatectomy (RARP)? This is when doctors use a robot to perform surgery on the prostate, with more precision, control, and better visuals. A recent study has shown that men who follow a testosterone replacement therapy program (TRT) will have better outcomes from this surgery than if they were not on TRT.

In this study, 824 patients underwent RARP as the treatment protocol for prostate cancer. Some of the patients were found to have low testosterone prior to the surgery and were given testosterone injections in order to increase their levels as well as improve their sexual function after surgery. This group included 18% of the patients. Therefore, the findings were totally unexpected since they were not directly looking at the effects of TRT on RARP recovery.

And these findings were that the group who had taken testosterone injections had fewer instances of recurrence, meaning there were fewer biochemical signs of prostate cancer coming back. In addition, in the patients who did experience recurrence, the ones on TRT experienced a longer timespan without recurrence and a delay in the progression of the cancer.

These results are contrary to the long-held belief that men suffering from prostate cancer shouldn't ever, ever, ever go near testosterone replacement therapy!

Doctors used to think that testosterone therapy would promote the development of prostate cancer and the growth of tumors. As a result, typical treatment was designed to lower a man's testosterone levels, in order to inhibit cancer growth. They did this using a technique called androgen deprivation therapy (ADT), which could also be called "chemical castration." That sounds horrific!

"It's very hard to overturn guidelines and black box warnings on drugs, but I think this research is important for doing just that. We need to expand the growing body of evidence that testosterone replacement is safe and possibly beneficial for these patients," Maxwell Towe stated a clinical research fellow at the University of California.

Francesco Montorsi, MD, director of the urology unit at San Raffaele Hospital in Milan, Italy, was asked to comment on the study by Medscape Medical News, even though he did not participate directly in the research. Montorsi thinks that these remarkable findings, "emphasize the importance of checking testosterone levels as a part of the management of patients with sexual disorders following radical prostatectomy.”

"Obviously, selection of the right patients is vital, but if confirmed, this may have immediate benefits on quality of life," Montorsi also concluded. "The possibility of reducing mortality would be an unexpected bonus."

The intriguing research was presented at the European Association of Urology Congress in 2019. The senior author of the study, Thomas Ahlering, took the time to explain the justification for the research.

"The whole thing actually started because, of the men that I was seeing, enough of them were not having recovery of sexual function. I did the same operation — why were these guys not doing as well? That's what prompted me to start measuring total and free testosterone back in 2009 on everybody," Dr. Ahlering stated.

Dr. Ahlering made it a point that free testosterone is the active form of testosterone in the body, meaning that it can interact with cells and tissues. There are other forms of testosterone that is bound to other molecules in the blood stream and cannot interact with cells. Dr. Ahlering and his fellow researchers discovered that low free testosterone levels is actually a very high risk for aggressive prostate cancer.

"We saw this really clear situation where, as the testosterone levels continued to drop, the grade — grade group in particular — started to go up, so the lower your testosterone, the more aggressive your cancer was," Dr. Ahlering added.

The beginning of the “testosterone causes prostate cancer” myth

The whole "testosterone causes prostate cancer" myth actually started way back in 1941 (yes, it's definitely time for updated research and data on this topic!). Dr. Charles B. Huggins was the man who started using hormone therapy to treat prostate cancer and was a Nobel Prize winner for his work. Unfortunately, it seems like his findings were not quite as conclusive as we once thought.

Today, the scientists who took part in the said study, and many other medical professionals, have come to different conclusions. They seem to think that men who have low testosterone levels already in conjunction with low-risk disease, and at the same time of the surgery, may actually benefit from testosterone replacement therapy. TRT can increase their lean muscle mass, reduce triglycerides, and improve sexual performance and function -- all issues that arise when a man has low-T.

Study Methodology

As stated previously, the study group was composed of a total of 824 subjects, all of who had RARP for treating of prostate cancer.

Before the surgery, the levels of sex hormone-binding globulin (SHBG) were measured via blood tests, and free testosterone levels were calculated from this data.

Almost 18% of the men, a total of 152 patients, had low free testosterone levels before surgery. It was recommended that these men get started with testosterone injections in order to improve sexual functioning post-surgery. The 152 men continued with TRT throughout their follow-up testing timeline or until a biochemical recurrence was detected.

What surprised Dr. Ahlering was that after the follow-up which lasted about 3.1 years, there was a 53% relative reduction in risk of a biochemical recurrence of the cancer in the group of men who had taken testosterone injections. Also, it was noted that any recurrence of the cancer was prolonged by 1.5 years when testosterone was involved.

Researchers also concluded that TRT, on its own, was a predictor for reduced risk of prostate cancer biochemical recurrence.

Maxwell Towe also said that he hopes that a clinical trial could be conducted soon to really test this revolutionary idea that TRT can truly help men suffering from prostate cancer and help them recover from RARP or other prostate surgery.

Other urologists have even come forward and said that the results of this study were very similar to what they had found in their practice over the course of standard treatment for prostate cancer.

A doctor in France noted that when they had patients suffering from hypogonadism (another word for low testosterone), their diagnosis of prostate cancer was almost always of a higher grade, or more aggressive. This also would lead to an increased incidence of biochemical recurrence.

The effects of testosterone replacement therapy on the prostate: a clinical perspective.

Overestimating the significance of these findings is hard. The complicated relationship between testosterone and prostate cancer has still not been conclusively settled. As with so many medical issues, more research is needed.