From the Guidelines
No, lower testosterone levels do not increase the risk of prostate cancer in men over 50. In fact, the relationship between testosterone and prostate cancer is complex, but current evidence does not support the notion that low testosterone increases prostate cancer risk. Historically, there was concern that testosterone therapy might promote prostate cancer growth, which led to caution in prescribing testosterone replacement therapy (TRT) to men with or at risk for prostate cancer. However, more recent research, such as the study published in the New England Journal of Medicine 1, suggests that men with low testosterone levels are not at higher risk for developing prostate cancer compared to men with normal levels. Some studies even indicate that men with very low testosterone might have more aggressive prostate cancers when diagnosed, though this doesn't mean low testosterone causes these cancers. For men concerned about prostate health, regular screenings including PSA testing and digital rectal exams are recommended, particularly for those over 50 or with risk factors such as family history. Maintaining overall health through diet, exercise, and avoiding smoking can benefit prostate health regardless of testosterone levels.
The most recent and highest quality study on this topic is from 2020, published in the Annals of Internal Medicine 1, which provides guidance on testosterone treatment in adult men with age-related low testosterone. This study suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone. However, it does not support the initiation of testosterone treatment to improve energy, vitality, physical function, or cognition.
Key points to consider:
- Lower testosterone levels do not increase the risk of prostate cancer in men over 50.
- Regular screenings, including PSA testing and digital rectal exams, are recommended for men concerned about prostate health.
- Maintaining overall health through diet, exercise, and avoiding smoking can benefit prostate health regardless of testosterone levels.
- The relationship between testosterone and prostate cancer is complex, and more research is needed to fully understand the association. As noted in the study published in the New England Journal of Medicine 1, despite decades of research, there is no compelling evidence that testosterone has a causative role in prostate cancer.
From the Research
Relationship Between Testosterone Levels and Prostate Cancer
- The relationship between testosterone levels and the risk of prostate cancer in men over 50 is complex and has been studied extensively 2, 3.
- A study published in 2012 found that low testosterone levels are related to poor prognosis factors in men with prostate cancer, such as higher prostate-specific antigen (PSA) levels and higher Gleason scores 2.
- Another study published in 2010 found that higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men 3.
- However, the evidence suggests that the relationship between testosterone levels and prostate cancer risk is not straightforward, and more research is needed to fully understand this relationship.
Detection of Prostate Cancer
- Digital rectal examination (DRE) and serum prostate-specific antigen (PSA) testing are commonly used methods for detecting prostate cancer 4, 5, 6.
- A study published in 2017 found that PSA testing detected significantly more tumors than DRE, and that the combination of both methods increased the detection of organ-confined disease 4.
- Another study published in 2018 found that DRE demonstrated prognostic usefulness when PSA levels were greater than 3 ng/ml, but had limited usefulness for lower PSA levels 5.
- A study published in 1999 found that DRE had a positive predictive value for detecting cancer in men with low serum PSA levels, and that the majority of cancers detected by DRE had features of clinically important and potentially curable disease 6.
Testosterone Levels and Prostate Cancer Risk
- The evidence suggests that low testosterone levels may be associated with a higher risk of prostate cancer, particularly among older men 2, 3.
- However, the relationship between testosterone levels and prostate cancer risk is not fully understood, and more research is needed to determine the potential mechanisms underlying this relationship.
- Further studies are needed to investigate the relationship between testosterone levels and prostate cancer risk, and to determine the potential implications for prostate cancer screening and prevention.