Testosterone and Prostate

Research published in the Journal of Steroid Biochemistry and Molecular Biology says “Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.”

Raynaud JP. Prostate cancer risk in testosterone-treated men.
J Steroid Biochem Mol Biol. 2006 Dec;102(1-5):261-6.

Men with classical androgen deficiency have reduced prostate volume and blood prostate-specific antigen (PSA) levels compared with their age peers. As it is plausible that androgen deficiency partially protects against prostate disease, and that restoring androgen exposure increases risk to that of eugonadal men of the same age, men using ART should have age-appropriate surveillance for prostate disease. This should comprise rectal examination and blood PSA measurement at regular intervals (determined by age and family history) according to the recommendations, permanently revisited, published by ISSAM, EAU, Endocrine Society….

Testosterone replacement therapy is now being prescribed more often for aging men, the same population in which prostate cancer incidence increases; it has been suggested that administration in men with unrecognised prostate cancer might promote the development of clinically significant disease.

In hypogonadal men who were candidates for testosterone therapy, a 14% incidence of occult cancer was found. A percentage (15.2%) of prostate cancer has been found in the placebo group (with normal DRE and PSA) in the prostate cancer prevention study investigating the chemoprevention potential of finasteride.

The hypothesis that high levels of circulating androgens is a risk factor for prostate cancer is supported by the dramatic regression, after castration, of tumour symptoms in men with advanced prostate cancer. However these effects, seen at a very late stage of cancer development, may not be relevant to reflect the effects of variations within a physiological range at an earlier stage. Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.

A study on a large prospective cohort of 10,049 men, contributes to the gathering evidence that the long standing “androgen hypothesis” of increasing risk with increasing androgen levels can be rejected, suggesting instead that high levels within the reference range of androgens, estrogens and adrenal androgens decrease aggressive prostate cancer risk.

Indeed, high-grade prostate cancer has been associated with low plasma level of testosterone.

Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels.

During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.

Low Testosterone Levels and Mortality

Researchers writing in the Annals of Internal Medicine examined “whether low testosterone levels are a risk factor for mortality in male veterans.”

Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum testosterone and mortality in male veterans.
Arch Intern Med. 2006 Aug 14-28;166(15):1660-5.

BACKGROUND: Low serum testosterone is a common condition in aging associated with decreased muscle mass and insulin resistance. This study evaluated whether low testosterone levels are a risk factor for mortality in male veterans.

METHODS: We used a clinical database to identify men older than 40 years with repeated testosterone levels obtained from October 1, 1994, to December 31, 1999, and without diagnosed prostate cancer. A low testosterone level was a total testosterone level of less than 250 ng/dL (<8.7 nmol/L) or a free testosterone level of less than 0.75 ng/dL (<0.03 nmol/L). Men were classified as having a low testosterone level (166 [19.3%]), an equivocal testosterone level (equal number of low and normal levels) (240 [28.0%]), or a normal testosterone level (452 [52.7%]). The risk for all-cause mortality was estimated using Cox proportional hazards regression models, adjusting for demographic and clinical covariates over a follow-up of up to 8 years. RESULTS: Mortality in men with normal testosterone levels was 20.1% (95% confidence interval [CI], 16.2%-24.1%) vs 24.6% (95% CI, 19.2%-30.0%) in men with equivocal testosterone levels and 34.9% (95% CI, 28.5%-41.4%) in men with low testosterone levels. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P<.001) while equivocal testosterone levels were not significantly different from normal testosterone levels (hazard ratio, 1.38; 95% CI, 0.99%-1.92%; P=.06). In a sensitivity analysis, men who died within the first year (50 [5.8%]) were excluded to minimize the effect of acute illness, and low testosterone levels continued to be associated with elevated mortality.

CONCLUSIONS: Low testosterone levels were associated with increased mortality in male veterans. Further prospective studies are needed to examine the association between low testosterone levels and mortality.

Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth

Morgentaler A.

Eur Urol. 2006 Jul 26

CONCLUSIONS: This historical perspective reveals that there is not now-nor has there ever been-a scientific basis for the belief that T causes pCA to grow. Discarding this modern myth will allow exploration of alternative hypotheses regarding the relationship of T and pCA that may be clinically and scientifically rewarding.

Read More
Testosterone replacement therapy and the risk of prostate cancer
The article says “The belief that testosterone increases the risk of prostate cancer is so widely accepted that study after study that tries to show it and can’t keeps getting repeated over and over,” says Dr. Abraham Morgentaler, a Boston urologist and author of the 2004 review. “People don’t believe it.”

Link Between Testosterone and Prostate Cancer

March 14, 2006
Testosterone Replacement Therapy and the Risk of Prostate Cancer. Is there a link?

Writing in the Canadian Journal of Urology, Researcher Abraham Morgentaler of the Division of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, says that “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.

Morgentaler A.Testosterone replacement therapy and prostate risks: where’s the beef? Can J Urol. 2006 Feb;13 Suppl 1:40-3. Read the abstract

From our December 6, 2005 Newsletter
An article by Susan Brink of the Los Angeles Times recently appeared in newspapers around the country discussing the link between testosterone and prostate cancer.

The article says “The belief that testosterone increases the risk of prostate cancer is so widely accepted that study after study that tries to show it and can’t keeps getting repeated over and over,” says Dr. Abraham Morgentaler, a Boston urologist and author of the 2004 review. “People don’t believe it.”

Here is a press release from the Harvard Medical School.

“Boston–January 2004, Harvard Medical School affiliate Beth Israel Deaconess Medical Center–A retrospective analysis by researchers at Beth Israel Deaconess Medical Center published in The New England Journal of Medicine found no causal relationship between testosterone replacement and prostate cancer or heart disease risk. The comprehensive review of 72 studies, addresses the current controversy about testosterone replacement therapy and its potential health risks to men.”

Low Testosterone and the Pro-Inflammatory State in Aging Men

Researchers writing in the Journal of Endocrinological Investigation “suggest that a close relationship exists between the development of a pro-inflammatory state and the decline in Testosterone levels” and that “observational and interventional studies suggest that Testosterone supplementation reduces inflammatory markers in both young and old hypogonadal men. ”

Maggio M, Basaria S, Ceda GP, Ble A, Ling SM, Bandinelli S, Valenti G, Ferrucci L. The relationship between testosterone and molecular markers of inflammation in older men. J Endocrinol Invest. 2005;28(11 Suppl 2):116-9.

Other Links
Testosterone for Men
Testosterone and Bone Loss in Elderly Men
Older Men and Testosterone
More Testosterone Research Concerning Older Men
Testosterone replacement therapy and the risk of prostate cancer
Testosterone, Estrogen and Bone Loss
Risk factors for testosterone loss in aging men

The medicinal value of testicles have been documented in the Bible, the writings of the ancient Egyptians and from India. Indeed, nearly every ancient culture believed that the testicles held some form of masculine power. From our Age Management Booklet…read more

Testosterone replacement therapy and the risk of prostate cancer. Is there a link?

An article by Susan Brink of the Los Angeles Times recently appeared in newspapers around the country discussing the link between testosterone and prostate cancer.

The article says “The belief that testosterone increases the risk of prostate cancer is so widely accepted that study after study that tries to show it and can’t keeps getting repeated over and over,” says Dr. Abraham Morgentaler, a Boston urologist and author of the 2004 review. “People don’t believe it.”

Here is a press release from the Harvard Medical School.

“Boston–January 2004, Harvard Medical School affiliate Beth Israel Deaconess Medical Center–A retrospective analysis by researchers at Beth Israel Deaconess Medical Center published in The New England Journal of Medicine found no causal relationship between testosterone replacement and prostate cancer or heart disease risk. The comprehensive review of 72 studies, addresses the current controversy about testosterone replacement therapy and its potential health risks to men.”

Testosterone for Men Studies and News Items

Testosterone replacement therapy and the risk of prostate cancer
The article says “The belief that testosterone increases the risk of prostate cancer is so widely accepted that study after study that tries to show it and can’t keeps getting repeated over and over,” says Dr. Abraham Morgentaler, a Boston urologist and author of the 2004 review. “People don’t believe it.”

Testosterone and Reduction in Cardiovascular Risk
Researchers writing in the European Journal of Endocrinology say that “Testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypogonadal men with type 2 diabetes. Improvements in glycaemic control, insulin resistance, cholesterol and visceral adiposity together represent an overall reduction in cardiovascular risk.”

Testosterone, Diabetes, and Cardiovascular Disease
New research says Testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men.

Testosterone’s favorable effects on an important metabolic component of chronic heart failure
Researchers writing in the European Journal of Heart Failure say that testosterone improves fasting insulin sensitivity in men with chronic heart failure and may also increase lean body mass, these data suggest a favorable effect of testosterone on an important metabolic component of CHF.

Low Testosterone and men over 45
Researchers writing in the International Journal of Clinical Practice, studied the prevalence of hypogonadism (testosterone deficiency) in men age 45 and over.

Androgen Deficiency, Metabolic Syndrome and Non-Obese Men
Researchers writing in The Journal of Clinical Endocrinology and Metabolism report that “Low SHBG, total testosterone, or AD (Androgen Deficiency) may be early markers of MetS (Metabolic Syndrome) in nonobese men.

More Body Mass…Diminished Testosterone
Researchers writing in the medical journal Archives of Andrology say total testosterone and SHBG concentrations proportionally diminished with both the increase of BMI (body mass index) and insulin resistance index.

Low testosterone levels – higher risk of anemia
Researchers writing in the Archives of Internal Medicine say that Older men and women with low testosterone levels have a higher risk of anemia.

Low Testosterone and the Pro-Inflammatory State in Aging Men
Researchers writing in the Journal of Endocrinological Investigation “suggest that a close relationship exists between the development of a pro-inflammatory state and the decline in Testosterone levels, two trends that are often observed in aging men”

Testosterone Replacement Therapy and the Risk of Prostate Cancer. Is there a link?
Writing in the Canadian Journal of Urology, Researcher Abraham Morgentaler of the Division of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, says that “there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer.

Testosterone’s favorable effects on an important metabolic component of chronic heart failure
Researchers writing in the European Journal of Heart Failure say that testosterone improves fasting insulin sensitivity in men with chronic heart failure and may also increase lean body mass, these data suggest a favorable effect of testosterone on an important metabolic component of CHF.

Testosterone, Alzheimer’s, Mood and Quality of Life
A study suggets that that testosterone replacement therapy improved overall quality of life in patients with Alzheimers Disease.

Estradiol, Testosterone, and Hip Fractures in Men
Researchers writing in The American Journal of Medicine say “Men with low estradiol levels are at an increased risk for future hip fracture. Men with both low estradiol and low testosterone levels seem to be at greatest risk for hip fracture.” Read more

Testosterone and Prostate Cancer
Is there a link between testosterone and prostate cancer?
According to a new study, “there is not now-nor has there ever been-a scientific basis for the belief that Testosterone causes pCA (Prostate Cancer) to grow.”

Testosterone and Prostate Cancer
A new paper published in the medical journal Current Treatment Options in Oncology says that “there is a varied and extensive literature indicating that TRT (testosterone replacement therapy) does not pose any increased risk of PCa (Prostate Cancer) growth in men with or without prior treatment.”

Low testosterone levels are associated with coronary artery disease
Researchers say that low testosterone levels are associated with
coronary artery disease in male patients with angina.

Low Testosterone Levels and Mortality
Researchers writing in the Annals of Internal Medicine examined “whether low testosterone levels are a risk factor for mortality in male veterans.”

Subclinical Hypothyroidism and Testosterone Deficiency
Researchers writing in the International Journal of Andrology say that there is “a direct association between subclinical hypothyroidism and hypoandrogenaemia. Testosterone deficiency and its symptoms should be kept in view while managing subclinical hypothyroidism in male patients.”

Testosterone and Prostate
Research published in the Journal of Steroid Biochemistry and Molecular Biology says “Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.”

Testosterone and Cognitive Function
A new study in the European Journal of Endocrinology says “Low endogenous levels of testosterone may be related to reduced cognitive ability, and testosterone substitution may improve some aspects of cognitive ability.”

Testosterone and Muscle Strength in the Elderly
Researchers writing in the Journal of the American Geriatric Society suggest that testosterone/DHT therapy may produce a moderate increase in muscle strength in men.

Testosterone and the Aging Male
A published report in the medical journal Aging Male says “The wide-ranging benefits of testosterone therapy in young and old men are clear and it appears that the route of administration (intramuscular, oral, or transdermal) does not alter this fact, but future work could illustrate even more profound effects of testosterone (e.g., in reducing cardiovascular risk) that could result in its recommended use in a wider range of patients.”

Testosterone-insulin sensitivity and men with heart failure
Researchers writing in the European Journal of Heart Failure say “Testosterone improves fasting insulin sensitivity in men with CHF and may also increase lean body mass, these data suggest a favourable effect of testosterone on an important metabolic component of CHF”

Testosterone, Diabetes, Metabolic Syndrome
Recent research in the International Journal of Impotence Research say testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men. However, clinical trials are needed to confirm this assumption.

Hypoandrogen-metabolic syndrome in men
Researchers writing in the International Journal of Clinical Practice say Men with (Hypoandrogen-metabolic syndrome) and symptoms of androgen deficiency may be managed by, in the absence of contraindications, testosterone replacement therapy along with weight reduction and other measures to normalise glucose, lipid and blood pressure control.

Testosterone and Ischemic Heart Disease
Researchers writing in Cardiovascular & Hematological Disorders Drug Targets examined lower testosterone levels in patients with ischemic heart disease.