Know the Facts – Does Testosterone Replacement Therapy cause Prostate Cancer?
When considering Testosterone Replacement Therapy (TRT), one of the most common and anxiety-inducing questions men ask is: “Will testosterone cause prostate cancer?”
This concern has deep roots in medical history, but today’s evidence paints a far more nuanced—and reassuring—picture.
Where the Fear Began
The origin of this concern dates to a 1941 study by Huggins and Hodges, which showed that metastatic prostate cancer could be slowed by lowering testosterone levels. This led to the belief that testosterone “feeds” prostate cancer, and thus, raising testosterone levels could initiate or accelerate its development.
But there’s a critical distinction: that study involved men who already had prostate cancer—not healthy men receiving physiologic testosterone therapy.
What Modern Science Says
In the decades since, extensive research has challenged and reshaped our understanding of how testosterone affects the prostate.
Key Takeaways:
- Testosterone does not cause prostate cancer. Large-scale reviews and meta-analyses have not found increased prostate cancer risk in men receiving TRT.
- TRT does not appear to accelerate the growth of existing, undiagnosed prostate cancer. However, this is why baseline PSA testing and digital rectal exams are standard before starting treatment.
- The “Saturation Model” explains that prostate tissue only responds to testosterone up to a certain point. Once that threshold is reached (usually at low-normal levels), additional testosterone does not further stimulate prostate growth.
Supporting Evidence
Here are a few highlights from the medical literature:
- A 2016 meta-analysis published in European Urology found no increase in prostate cancer incidence among men on TRT compared to those not receiving it.
- The TRAVERSE trial, while primarily focused on cardiovascular safety, also monitored prostate outcomes and did not show an increase in prostate cancer diagnoses among men receiving testosterone.
- In clinical practice, rates of PSA elevation or prostate abnormalities among men on TRT are low, particularly with proper screening and monitoring.
So, Should You Be Concerned?
If you are:
- A man with low testosterone symptoms and confirmed low level
- Without a history of prostate cancer
- Willing to undergo regular monitoring
The current body of evidence suggests that TRT does not pose a significant prostate cancer risk.
What if I have a history of Prostate Cancer?
Traditional (Old) View: - Hard No
Historically, any man with a history of prostate cancer—regardless of stage, grade, or time since treatment—was considered ineligible for TRT. This was based on the old paradigm that testosterone “fuels” prostate cancer, and that any increase could cause recurrence or progression. But in the past 15 years, that position has softened considerably, thanks to emerging data.
Modern (Newer) Perspective: - A Carefully Considered Yes
Recent research and clinical experience suggest that TRT may be safe and appropriate in select men who have been treated for localized prostate cancer, particularly if they meet the following criteria:
Good Candidates for TRT After Prostate Cancer:
- Treated with curative intent (e.g., radical prostatectomy, radiation therapy)
- Undetectable or stable PSA over time (typically for 1–2+ years
- Low- to intermediate-risk prostate cancer at diagnosis
- No evidence of biochemical recurrence
- Persistent symptoms and biochemically confirmed low testosterone
Several studies—including work by Morgentaler et al.—have shown no increase in prostate cancer recurrence in carefully selected men on TRT after definitive treatment.
TRT After Prostatectomy
- In men who’ve had radical prostatectomy, PSA should be undetectable before initiating TRT
- Most experts recommend waiting 6–12 months post-op, although some start earlier with close surveillance.
- PSA should be monitored every 3–6 months for the first year.
TRT After Radiation Therapy
- PSA kinetics are more complex after radiation, but a stable and low nadir PSA (typically <0.5 ng/mL) for at least 1–2 years is often considered safe to begin TRT.
- Again, close PSA monitoring is essential.
What About Active Surveillance or Advanced Disease?
- Active surveillance is still considered a relative contraindication for TRT, but some clinicians cautiously consider it in men with very low-risk disease and severe symptoms.
- Metastatic or castration-resistant prostate cancer remains a clear contraindication for TRT.
Guidelines and Expert Opinion:
While there are no official society guidelines that explicitly endorse TRT in men with a history of prostate cancer, several respected bodies and thought leaders have published position papers supporting it in carefully selected, closely monitored patients.
A 2015 review in European Urology stated:
“The historical prohibition against testosterone therapy in men with prostate cancer is not supported by the existing literature.”
Key Takeaway:
Testosterone therapy is not categorically off-limits for men with a history of prostate cancer. In well-selected individuals who have been treated, are cancer-free, and are symptomatic from low testosterone, TRT can be a safe and effective option—with appropriate urologic co-management.
Marshall Lifestyle Medicine Approach:
- All Providers receive advanced training
- All Providers freely Collaborate with urologists and oncologists to eliminate fragmented care
- All Patient receive baseline PSA testing to ensure levels are stable or undetectable
- We Utilize advanced biomarkers to better stratify risk
- We Monitor PSA every 3 months in the first year after reinitiation of therapy
- We Use the lowest effective dose of testosterone
- Educate patients on the risks, benefits, and signs of recurrence
- Incorporate a Lifestyle-Centric Approach to improve the overall health of our patients.
Bottom Line:
No, testosterone therapy does not cause prostate cancer.
This long-standing fear is not supported by modern research. With proper screening and follow-up, TRT can be safely used in men with age-related testosterone deficiency—without increasing the risk of prostate cancer.
Considering TRT?
We take prostate health seriously. Our approach includes comprehensive baseline assessment and ongoing monitoring to ensure your therapy is both effective and safe. We will always promote principles to improve your overall health and wellbeing through a Lifestyle-Centric Approach. We have a Robust Monitoring and Surveillance Program – Patient safety is our #1 priority
Book a consultation today to learn whether testosterone therapy is right for you.
