Testosterone, PSA and Prostate Cancer Myths and Misconceptions
Benefits of Testosterone Therapy by Jeffrey Dach MD
This article is Part One
For part two, Click HERE.
The Nobel Prize in Chemistry was awarded to Butenandt and Ruzicka in 1939 for the synthesis of testosterone (1) Since then, seventy years ago, thousands of medical studies have shown benefits of testosterone for improving health and prolonging life.(2-27)
Benefits of Testosterone Therapy
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 Alzheimers in elderly men. (36)(37)
Two additional studies show that low testosterone levels are associated with increased mortality.
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. (J Endocrin 2003).
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.
For more information on testosterone for aging males, see my web site testosterone information page.(25)
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 causes 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.”
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.” 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.” Risks of Testosterone-Replacement Therapy and recommendations for Monitoring. N Engl J Med 2004;350:482-92. Rhoden and Morgentaler.(30)
For more information see my web page on Testosterone Safety and Benefits. (25 )
The ADAM Testosterone Questionnaire
This questionnaire is useful for detecting low testosterone levels. ADAM is short for Androgen Deficiency in the Aging Male.(43)(44)
1. 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? Yes No
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.
Testosterone for Dry Eyes in Women
Among other things, some post-menopausal women have a chronic dry eye problem with redness and irritation of the eyes. This is called the evaporative dry eye and is usually a sign of testosterone deficiency, which can be confirmed by blood test for testosterone level, and rapidly resolves with topical testosterone cream in appropriate dosage.(31)(32)
This article is Part One, For part two, Click HERE.
Articles with Related Content
Testosterone for Dry Eye Syndrome
PSA Screening for Prostate Cancer, the Failed Medical Experiment
Jeffrey Dach, M.D.
The Nobel Prize in Chemistry 1939 Presentation Speech The following account of Butenandt’s work has been made.
Benefits of Testosterone
Study Suggests Depressed Men May Benefit from Testosterone Replacement Therapy Belmont–January 1, 2003, Harvard Medical School affiliate McLean Hospital — A preliminary study published today in the American Journal of Psychiatry suggests that transdermal testosterone replacement gel, in conjunction with conventional antidepressants, may improve mood, anxiety, libido and other aspects of depression in difficult-to-treat men who fail to respond to antidepressants alone. Researchers from McLean Hospital in Belmont, MA, conducted the study in treatment-resistant depressed men with low testosterone levels.
Testosterone therapy: The answer for aging men? Date updated: April 14, 2006 Content provided by MayoClinic.com Mayo Foundation for Medical Education and Research (MFMER)
Digital Urology Journal. Testosterone Replacement Therapy. Wayne J.G. Hellstrom, M.D. Tulane University Medical Center New Orleans, LA
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
The possible relationship of testosterone to risk of prostate cancer remains a concern; however, no new evidence has emerged to suggest that testosterone replacement therapy increases the risk. Recent studies have demonstrated that hypogonadism in men may be more prevalent than previously thought, is strongly associated with metabolic syndrome, and may be a risk factor for type 2 diabetes and cardiovascular disease. Clinical studies have shown that testosterone replacement therapy in hypogonadal men improves metabolic syndrome indicators and cardiovascular risk factors. Maintaining testosterone concentrations in the normal range has been shown to contribute to bone health, lean muscle mass, and physical and sexual function, suggesting that testosterone replacement therapy may help to prevent frailty in older men. Based on current knowledge, testosterone replacement therapy is unlikely to pose major health risks in patients without prostate cancer and may offer substantial health benefits.
Testosterone Treatments: Why, When, and How? American Academy of Family Physicians.May 1, 2006 KATHERINE MARGO, M.D., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ROBERT WINN, M.D., Jefferson Medical College, Philadelphia, Pennsylvania
Science News Low Testosterone Levels Associated With Increased Risk Of Death In Men
ScienceDaily (Aug. 17, 2006) — Men who have a low testosterone level after age 40 may have a higher risk of death over a four-year period than those with normal levels of the hormone, according to a report in the August 14/28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals (Arch Intern Med. 2006;166:1660-1665.
Testosterone May Improve Mental Function. ScienceDaily (Jan. 14, 2008) — When we think about the powers of testosterone, we usually do not consider mental processes. However, research suggests that testosterone levels may affect men’s cognitive performance, reports the January 2008 issue of Harvard Men’s Health Watch.
Chapter 7 Testosterone, The Male Hormone Connection: Treating Diabetes and Heart Disease Michael Klentze, M.D., Ph.D. Medical Director, Klentze Institute of Anti-Aging, Munich,
(10) Testosterone for Men and Women By Steven F. Hotze, M.D., e-book.
(11) State-of-the-Art Update on Testosterone Replacement: A Clinical and Pharmacological Approach Narinder Duggal Pharmacy Times
TESTOSTERONE REPLACEMENT FOR OLDER MEN? Gabe Mirkin, M.D.
Treating With Testosterone: Endocrine Society Audioconference Spotlights IOM Report, Practical Approach to Testosterone Therapy of Elderly Men
Endocrine News Volume 29, Number 1 – February 2004
(14) PATIENT’S GUIDE to Low Testosterone 2003 Glenn R Cunningham MD Baylor College of Medicine PATIENT’S GUIDE to Low Testosterone (2003 Edition)
Editors:Glenn R. Cunningham, MD, Alvin M. Matsumoto, MD, Ronald Swerdloff, MD. From the Family Physicians Inquiries Network. Do testosterone injections increase libido for elderly hypogonadal patients? Krupa Shah, MD; Cathy Montoya, MLS Baylor College of Medicine, Houston, Texas. The Evidence-based answer, Yes, testosterone therapy is effective in improving libido for elderly hypogonadal males.
An interview with Abraham Morgentaler, M.D.A Harvard expert shares his thoughts on testosterone-replacement
Rev Urol. 2003; 5(Suppl 1): S34–S40. New Advances in the Treatment of Hypogonadism in the Aging Male Christopher P Steidle, MD
Aging Male. 2004 Dec;7(4):319-24. Testosterone therapy–what, when and to whom?Jockenhövel F.
Drugs. 2004;64(17):1861-91. Androgen replacement therapy: present and future.Gooren LJ, Bunck MC.
Clin Endocrinol (Oxf). 2006 Sep;65(3):275-81. Testosterone treatment comes of age: new options for hypogonadal men. Nieschlag E.
20) Harrison’s Endocrinology HArrison Endocrinology
Journal of Andrology, Vol. 27, No. 2, March/April 2006
Review Testosterone Replacement Therapy for Older Men
MOSHE WALD*, RANDALL B. MEACHAM, LAWRENCE S. ROSS AND CRAIG S. NIEDERBERGER
Testosterone and the Heart
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, Serwatka W, Nadlewski S, Korecki J, Jackowski R, Paruk J, Ladny JR, Hirnle T.
Am J Cardiol. 2003 Nov 15;92(10):1241-3. Links
Effect of testosterone therapy on QT dispersion in men with heart failure.Malkin CJ, Morris PD, Pugh PJ, English KM, Channer KS.
Department of Cardiology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
The effects of testosterone on cardiac electrophysiology are poorly described. In this study we report the effect of physiologic testosterone therapy in 2 cohorts of men, the first with stable coronary disease and the second with congestive heart failure. Testosterone reduced QT dispersion in the heart failure cohort; no other effects were observed.
Eur Heart J. 2006 Jan;27(1):57-64. Epub 2005 Aug 10. Links
Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Malkin CJ, Pugh PJ, West JN, van Beek EJ, Jones TH, Channer KS. Testosterone replacement therapy improves functional capacity and symptoms in men with moderately severe heart failure.
Testosterone Information Page Jeffrey Dach MD
(26) Testosterone Replacement: The Male Andropause, Resetting the Clock, by Elmer M. Cranton, M.D. and William Fryer Testosterone Replacement The Male Andropause Resetting the Clock Elmer M. Cranton William Fryer
Beneficial Effects of Testosterone Replacement for the Nonmotor Symptoms of Parkinson Disease Michael S. Okun, MD; Benjamin L. Walter, MD; William M. McDonald, MD; Joyce L. Tenover, MD; Joanne Green, PhD; Jorge L. Juncos, MD; Mahlon R. DeLong, MD Arch Neurol. 2002;59:1750-1753.
Risks of Testosterone
Can J Urol. 2006 Feb;13 Suppl 1:40-3. Testosterone replacement therapy and prostate risks: where’s the beef? Morgentaler A. Division of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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.
J Endocrinol Invest. 2005;28(3 Suppl):122-7. Monitoring androgen replacement therapy: testosterone and prostate safety. Morales A. No evidence exists that appropriate androgen administration with knowledgeable monitoring carries significant or potentially serious adverse effects on the prostate gland.
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.
Androgens and dry eye in Sjögren’s syndrome. Ann N Y Acad Sci. 1999 Jun 22;876:312-24. Sullivan DA et al. Our results demonstrate that androgens regulate both lacrimal and meibomian gland function, and suggest that topical androgen administration may serve as a safe and effective therapy for the treatment of dry eye in Sjögren’s syndrome.
Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Sullivan DA et al. Ann N Y Acad Sci. 2002 Jun;966:211-22. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjögren’s syndrome.
Male Sexual Dysfunction, Endocr Pract. 2003;9 (No. 1) January/February 2003 77 AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF MALE SEXUAL DYSFUNCTION: A COUPLE’S PROBLEM–2003 UPDATE AACE Male Sexual Dysfunction Task Force Andre T. Guay, MD, Richard F. Spark, MD, Sudhir Bansal, MD et al.
Androgel FDA approved topical version of testosterone.
(35) Khaw, Kay-Tee, et al. “Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men.” Circulation 116.23 (2007): 2694-2701. Endogenous testosterone mortality cardiovascular disease cancer men EPIC Khaw KayTee Circulation 2007
The authors concluded that endogenous testosterone concentrations are inversely related to cardiovascular disease and all-cause mortality. Thus, low testosterone may be a marker for increased risk of cardiovascular disease.
Low Free Testosterone Levels Linked to Alzheimer’s Disease in Older Men
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, Alan B. Zonderman, E. Jeffrey Metter, Marc R. Blackman, S. Mitchell Harman and Susan M. Resnick. These results suggest a possible beneficial relationship between circulating free T concentrations and specific domains of cognitive performance in older men.
The Male Andropause, by Michael B. Schachter M.D., F.A.C.A.M.
NATIONAL FEATURED ARTICLE TESTOSTERONE for MEN with DIABETES
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
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. Testosterone levels are frequently low in men with type 2 diabetes, and the majority of these men have symptoms of hypogonadism.
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.
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.
Jeffrey Dach, M.D.
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Joe from SC says:
I read info on your website; I am a family physician and wanted to ask your opinion re: finasteride and TRT in patients whos psa rises with testosterone, and returns to baseline with stopping testosterone; can finasteride be used to prevent the rise(safely) thanks , joe.
Propecia and finasteride have been associated with some pretty awful adverse effects, so I stay away from that. In my opinion the expected slight increase in PSA when starting testosterone is self limited, minimal and requires no treatment. We usually give a botanical such as saw palmetto along with the testosterone program.
regards, jeffrey dach md
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I just started trt, my first injection was 1-2-18 t level at injection time 247 with psa .04, CBC and psa preformed a day ago, t level 74 ( yes 74) and psa 20.2, 1200white count. I am positive for factor v 7.mg daily warfarin for life. After dvt/pe in 08. Inr 1 week after injection 2.5. The question is it normal to see such a drop in T and a dramatic increase in psa, blood work since 08 has had steady decline in T to its current low, I can answer yes to all but 1 question above.
From RS In PA
Comments : Thank you for this article!
It has more good information and links than any where on the web!
An excellent resource!
Thanks again! RS
(Testosterone, PSA and the Prostate, Myths and Misconceptions Benefits of Testosterone Therapy)