Can a patient receive testosterone injections if their father has a history of prostate cancer?

Testosterone Therapy for Patients with Family History of Prostate Cancer

Patients with a family history of prostate cancer (such as a father with prostate cancer) can safely receive testosterone injections, as current evidence does not support a causal link between testosterone therapy and the development of prostate cancer. 1, 2

Risk Assessment and Considerations

Having a father with prostate cancer does increase the patient's own risk of developing prostate cancer:

• Having one first-degree relative (like a father) with prostate cancer increases the relative risk to 1.8 1
• This risk is higher if multiple family members are affected (father and brother: RR 5.5; two brothers: RR 7.7) 1

However, this family history is not a contraindication to testosterone therapy, as:

• The European Association of Urology (2024) explicitly states that "hypogonadal men receiving testosterone supplements do not have an increased risk of developing prostate cancer" 1
• The American Urological Association provides a strong recommendation that clinicians should inform patients that there is no evidence linking testosterone therapy to the development of prostate cancer 2

Pre-Treatment Evaluation

Before starting testosterone therapy in a patient with family history of prostate cancer:

1. PSA measurement is mandatory for men over 40 years of age to exclude occult prostate cancer 1, 2

   • If PSA is elevated, a second test should be performed to rule out spurious elevation
   • If both PSA levels raise suspicion, consider reflex testing (e.g., 4K or phi) and prostate biopsy with/without MRI before initiating therapy

2. Measure hemoglobin/hematocrit as testosterone therapy may increase these values 1

   • If hematocrit exceeds 50%, consider withholding therapy until etiology is investigated
   • On therapy, intervention is required if hematocrit exceeds 54%

3. Assess cardiovascular risk factors (both fixed and modifiable) 1

Monitoring During Treatment

For patients on testosterone therapy with family history of prostate cancer:

1. Regular PSA monitoring on the same schedule as men without testosterone deficiency 2

   • Consider increasing frequency of testing given the family history
   • Evaluate PSA increases using standard criteria (>1.0 ng/mL during first six months or >0.4 ng/mL per year thereafter)

2. Regular hemoglobin/hematocrit monitoring to detect polycythemia 1, 3

3. Monitor for potential side effects including:

   • Urinary obstruction in men with BPH
   • Priapism or excessive sexual stimulation
   • Oligospermia with prolonged administration 3

Special Considerations

1. Impact on fertility: Discuss that exogenous testosterone can suppress spermatogenesis 1

   • If future fertility is desired, testosterone should be discontinued well in advance of conception attempts

2. Benefits of therapy: Patients should be informed that testosterone therapy may improve:

   • Erectile function
   • Sex drive
   • Bone mineral density
   • Lean body mass
   • Anemia
   • Depressive symptoms 1

Conclusion

The historical prohibition against testosterone therapy in men with a family history of prostate cancer is not supported by current evidence. While a father's history of prostate cancer does increase the patient's own risk of developing the disease, this is not related to testosterone therapy and should not prevent treatment in hypogonadal men when clinically indicated. Proper pre-treatment evaluation and monitoring are essential to ensure safety.