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September is National Prostate Cancer Awareness Month, making it the perfect time to revisit one of the most persistent myths in men’s health: the relationship between testosterone and prostate cancer. For decades, men have been cautioned that testosterone could fuel prostate cancer, particularly in the context of testosterone replacement therapy (TRT). But how much of that concern is supported by science, and how much is outdated fear?
Here’s what you really need to know about testosterone supplementation and prostate cancer, including insights from the latest large-scale research.
Where the Myth Came From: A Historical Perspective
The belief that testosterone increases the risk of prostate cancer dates back to research in the 1940s. Scientists observed that lowering testosterone through surgical castration or hormone-suppressing drugs could slow the progression of prostate tumors. This led to the assumption that testosterone itself was a direct fuel source for cancer growth.
These assumptions, paired with the fact that there were no comprehensive studies on how TRT affects prostate cancer risk until recently, meant doctors and men alike were hesitant to consider TRT for hypogonadism (low testosterone).
Fortunately, with the results of the TRAVERSE study, the largest safety trial on TRT to date, we now have a clearer understanding.
What the TRAVERSE Study Tells Us
The TRAVERSE study, published in 2023 in the New England Journal of Medicine, was a randomized, placebo-controlled trial that enrolled 5,246 men aged 45-80 years old with preexisting or increased cardiovascular risk and testosterone deficiency.
Men with a history of prostate cancer and men at increased prostate cancer risk were excluded, leaving 5,204 participants.
Over a treatment duration of around 22 months, researchers carefully monitored cardiovascular and prostate health outcomes in both the testosterone and placebo groups.
Key Findings on Prostate Safety
No increase in prostate cancer risk was found in men receiving testosterone therapy compared to placebo. The incidence of prostate cancer in the testosterone group was 0.46%, while the incidence in the placebo group was 0.42%.
PSA levels rose slightly more in the testosterone group, but there was no significant between-group difference in PSA levels after month 12.
These results suggest that, for men who are appropriately screened and monitored, testosterone therapy does not appear to raise prostate cancer risk during the average two-year follow-up period.
Myths vs. Facts: Testosterone and Prostate Cancer
Let’s break down some common misconceptions using current evidence, especially what we’ve learned from the TRAVERSE study.
Myth: Testosterone therapy causes prostate cancer.
The TRAVERSE study found no significant difference in prostate cancer rates between men who received testosterone and those who did not.
Myth: Elevated testosterone levels automatically increase prostate cancer risk.
There’s no clear evidence that higher testosterone within the normal physiological range increases prostate cancer risk. Prostate cancer can occur in men with low, normal, or high testosterone.
Myth: Men on TRT don’t need prostate monitoring.
PSA testing is still important. Even though TRT doesn’t appear to increase risk, regular screening helps detect any prostate issues early.
Myth: If you’ve had prostate cancer, you can’t take testosterone.
This is a nuanced topic. In select men with treated, localized prostate cancer and no evidence of recurrence, testosterone therapy may be considered under close medical supervision. This decision must be made with a urologist or oncologist.
How TRT and the Prostate Are Monitored in Practice
Although the TRAVERSE study offers reassurance, responsible testosterone replacement therapy includes ongoing prostate monitoring. Before starting TRT, providers will:
- Evaluate PSA (Prostate-Specific Antigen) levels
- Review personal and family history of prostate issues or cancer
During treatment, routine follow-ups ensure that PSA levels stay within a healthy range and that no new symptoms develop.
These steps are not just about cancer; they also help detect other prostate issues like benign prostatic hyperplasia (BPH), which can affect urination and quality of life as men age.
Who Should Be Cautious?
TRAVERSE excluded men with active or very high-risk prostate cancer. So while the study is reassuring for men with low testosterone and no current prostate disease, it doesn’t necessarily apply to everyone.
Men who may need more careful evaluation before starting TRT include:
- Those with a personal history of prostate cancer
- Those with elevated baseline PSA levels
- Those with significant urinary symptoms
The decision to begin TRT should always be made with a healthcare provider who can weigh the benefits and risks in your specific case.
So…Is Testosterone Therapy Safe for Your Prostate?
The answer, based on the latest evidence, is: it can be.
For men with low testosterone and no active prostate disease, testosterone replacement therapy does not appear to increase the risk of prostate cancer.
In fact, restoring testosterone to normal physiological levels may improve many aspects of health, including energy, mood, body composition, and sexual function.
However, prostate safety still matters. Regular monitoring and working closely with your doctor are key to ensuring you stay healthy while on TRT.
If you’d like to check your testosterone and PSA levels, order our At-home Men’s Health Panel today. You can see eight key men’s health indicators, including total and free testosterone, PSA, FSH, SHBG, and more.
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