Testosterone, PSA and Prostate Cancer,
Myths and Misconceptions
Left Image: Prostate and seminal vesicals
from Gray's Anatomy lithograph, 1918, courtesy of wikimedia commons.
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)
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)
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.
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
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
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)
ADAM Testosterone Questionnaire
This questionnaire is useful for detecting low
testosterone levels. ADAM is an acronym
for Androgen Deficiency in the Aging
The ADAM Testosterone Questionnaire
Do you have a decrease in libido (sex drive)? Yes No
2. Do you have a lack of energy? Yes No
3. Do you have a decrease in strength and/or endurance? Yes No
4. Have you lost height? Yes No
5. Have you noticed a decreased "enjoyment of life" Yes No
6. Are you sad and/or grumpy? Yes No
7. Are your erections less strong? Yes No
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner? Yes No
10. Has there been a recent deterioration in your work performance? Yes No
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
The Nobel Prize in Chemistry 1939 Presentation Speech, Butenandt Discovery of Testosterone.
Study Suggests Depressed Men May Benefit from Testosterone Replacement Therapy
Belmont--January 1, 2003
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Author Dr Dach Jeffrey Dach MD