Is cancer a contraindication for Testosterone (T) replacement therapy?

From the Guidelines

Cancer is not an absolute contraindication for testosterone replacement therapy (TRT), but it requires careful consideration and caution, particularly in cases of prostate cancer. According to the American Urological Association (AUA) guideline 1, clinicians should inform patients that there is no evidence linking testosterone therapy to the development of prostate cancer. However, for patients with a history of prostate cancer, the decision to start testosterone therapy should be made with caution, as there is inadequate evidence to quantify the risk-benefit ratio 1.

Key Considerations

• Patients with testosterone deficiency and a history of prostate cancer should be informed about the potential risks and benefits of testosterone therapy 1.
• The decision to commence testosterone therapy in men with in-situ prostate cancer on active surveillance or previously treated prostate cancer should be made with caution, as stated by the AUA guideline 1.
• For other types of cancer, the decision to use TRT should be individualized based on the specific cancer type, its hormone sensitivity, treatment status, and prognosis.

Clinical Approach

• A thorough evaluation by both an oncologist and endocrinologist is necessary before considering TRT in patients with a history of cancer.
• Patients with active cancer or recent history should have their testosterone levels monitored regularly if TRT is deemed necessary, and therapy should be immediately discontinued if cancer recurrence is suspected.
• The AUA guideline 1 provides a framework for clinicians to discuss the potential risks and benefits of testosterone therapy with patients, but ultimately, the decision to use TRT in patients with cancer requires careful consideration of individual circumstances.

From the FDA Drug Label

Testosterone gel is contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate [see Warnings and Precautions (5.1)]. Men with known carcinoma of the breast or known or suspected carcinoma of the prostate. (4,5.1) Testosterone gel is contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate [see Warnings and Precautions (5.1)].

Cancer is a contraindication for testosterone replacement therapy, specifically carcinoma of the breast or known or suspected carcinoma of the prostate 2, 2, 2.

From the Research

Testosterone Replacement Therapy in Prostate Cancer Patients

• The use of testosterone replacement therapy (TRT) in patients with prostate cancer is a topic of ongoing debate, with some studies suggesting that it may be safe and beneficial for hypogonadal patients with a history of prostate cancer 3, 4, 5.
• A study published in 2005 found that TRT did not cause recurrent prostate tumor in hypogonadal patients who had undergone radical retropubic prostatectomy for organ-confined prostate cancer, and actually improved their quality of life 3.
• Another study published in 2011 reviewed the available data on the use of TRT in patients with prostate cancer and suggested that it may be safe to use in select patients, but more research is needed to fully understand its effects 6.
• A 2006 study discussed the taboo of offering TRT to men with a prior history of prostate cancer, but suggested that there is little modern evidence to support the idea that TRT poses an increased risk of prostate cancer growth in men with or without prior treatment 4.
• A systematic review published in 2020 found that the evidence on the safety of TRT in patients with previous or active localized prostate cancer is limited, and more research is needed to determine its effects on the risk of prostate cancer progression 7.
• A 2018 review of the literature on the role of testosterone therapy in the setting of prostate cancer found that the fears of TRT causing or worsening prostate cancer do not appear to be well supported by available data, and consideration should be given to treatment of hypogonadal men with a history of prostate cancer 5.

Key Findings

• TRT may be safe and beneficial for hypogonadal patients with a history of prostate cancer, but more research is needed to fully understand its effects 3, 4, 5.
• The evidence on the safety of TRT in patients with previous or active localized prostate cancer is limited, and more research is needed to determine its effects on the risk of prostate cancer progression 7.
• The use of TRT in patients with high-risk prostate cancer should be approached with caution, as the evidence in this setting is very limited 5.