Testosterone and Prostate Cancer
Testosterone and Prostate Cancer
The relationship between testosterone and prostate health is a topic that is commonly a source of fear in men seeking testosterone replacement. Today, let me shine some light on the matter...
For decades, the medical community believed that high testosterone levels contributed to prostate cancer risk, while low testosterone was thought to be protective. This idea originated from a 1941 study by urologists Dr. Huggins and Dr. Hodges, which suggested that testosterone could accelerate prostate cancer growth. Their study became widely accepted, forming the foundation of the "androgen hypothesis."
However, a closer look at their research reveals major flaws:
The study was conducted on men with metastatic prostate cancer.
Testosterone injections were only administered to three men.
Data was only reported for two patients, one of whom had been surgically castrated before receiving testosterone.
The conclusion that "testosterone activates prostate cancer" was based on one patient’s results over just 18 days, with data fluctuations that were ultimately inconclusive.
Despite these limitations, the medical community widely accepted these findings due to the lack of experience with testosterone therapy at the time. For decades, this belief remained unchallenged.
Modern Research Challenges the Androgen Hypothesis
In the 1990s, Harvard urologist Dr. Abraham Morgentaler began questioning this long-held belief. While treating men with sexual dysfunction and low testosterone, he observed significant improvements in both their physical and mental health. However, his approach conflicted with mainstream medical practice, as testosterone therapy was then only prescribed for specific conditions like Klinefelter’s syndrome, pituitary disorders, or absent testes.
To investigate further, Dr. Morgentaler began conducting prostate biopsies on men with low testosterone before initiating treatment. His findings were groundbreaking:
In a study of 77 men with low testosterone, 11 had undiagnosed prostate cancer, despite the assumption that low testosterone was protective.
The incidence rate of prostate cancer in these men was similar to that of men with traditional risk factors (elevated PSA or abnormal digital rectal exams).
These findings, published in The Journal of the American Medical Association (1996), disproved the notion that low testosterone protects against prostate cancer.
Dr. Morgentaler then examined whether high testosterone levels were truly harmful. A 2004 study published in The New England Journal of Medicine analyzed global research on testosterone and prostate cancer from 1985 to 2004. He found no evidence that TRT increased prostate cancer risk or contributed to cancer progression.
Furthermore, the widespread adoption of testosterone therapy after the release of AndroGel in 2001 did not result in a surge of prostate cancer cases, contradicting the androgen hypothesis. If testosterone fueled prostate cancer, the rising number of prescriptions should have led to increased diagnoses, but that did not happen.
The Androgen Saturation Model - What is that?
In 2007, Dr. Morgentaler introduced the saturation model to explain the complex relationship between testosterone and prostate health. The model is based on the principle that androgens (male hormones) can only stimulate prostate tissue up to a certain point—once that threshold is reached, additional testosterone has no further effect.
Androgens must bind to androgen receptors in prostate cells to exert an effect.
These receptors become fully saturated at a low testosterone level (~250 ng/dL).
Beyond this level, increasing testosterone has no further impact on prostate growth.
A helpful analogy is a houseplant: If deprived of water, it shrinks. When watered, it grows. But once its needs are met, adding more water will not make it grow into a tree. Similarly, testosterone can only stimulate prostate tissue up to a limited point—beyond that, additional testosterone does not contribute to excessive growth or cancer development.
What does the literature say today?
Extensive research has now debunked the outdated belief that testosterone fuels prostate cancer. Studies have shown the following...
Testosterone therapy does not increase the risk of prostate cancer, even in high-risk individuals.
Higher testosterone levels may actually suppress the growth of prostate cancer.
Men with low testosterone are more likely to develop aggressive prostate cancer.
And contrarily, low testosterone is actually associated with...
Higher-grade prostate cancer
More advanced cancer at the time of surgery
Increased recurrence rates after treatment
Lower survival rates
Contrary to past assumptions, it is not high testosterone that poses a risk—it is low testosterone that correlates with poorer prostate cancer outcomes.
Furthermore, research confirms that TRT does not increase the risk of prostate cancer progression in men undergoing active surveillance. In fact, some studies suggest that testosterone therapy may even reduce the risk of recurrence after radiation therapy or surgery.
Given that approximately 1 in 6 men will develop prostate cancer, it is likely that many men undergoing TRT are unknowingly managing active prostate cancer—yet no evidence suggests that TRT worsens their condition.
Take Away
Decades of misinformation have led to unnecessary fear surrounding testosterone therapy. The outdated androgen hypothesis, based on flawed research, has deprived countless men of a treatment that could improve their quality of life. Modern science has demonstrated that testosterone therapy is not only safe but may also play a protective role against high-grade prostate cancer.
As our understanding of testosterone and prostate health continues, it is important that the medical community moves beyond outdated dogma and embraces evidence-based approaches to men’s health.
I Hope this article was helpful at alleviating any fears regarding testosterone and prostate cancer.
