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Does testosterone cause prostate cancer?
One of the lingering concerns and questions for men is whether increased testosterone levels, either naturally produced or in the form of prescription replacement therapy, can cause prostate cancer. However not only does testosterone NOT cause prostate cancer, it may actually help protect against it, while another hormone appears to be the main culprit in promoting prostate cancer.
At the May 2015 American Urological Association Annual Meeting, the results of a meta-analysis indicated that natural and prescription testosterone (endogenous and exogenous, respectively) do not cause prostate cancer or trigger increases in level of prostate-specific antigen (PSA). This was the widest review of studies ever undertaken that showed testosterone, on its own, did not cause prostate cancer.
The medical experts who undertook the study conducted two different analyses. One included 18 studies involving 5,091 patients with prostate cancer and 11,930 controls and looked at the impact of endogenous testosterone. No relationship was found between T levels and risk of prostate cancer.
The second analysis reviewed data from 24 placebo-controlled trials involving men with hypogonadism (clinically low testosterone levels) who took testosterone replacement therapy. Again, the experts concluded that testosterone replacement therapy did not appear to increase the risk, nor an increase in PSA levels.
The paradox of testosterone and prostate cancer risk is that prostate cancer risk increases as a man ages at the same time that a man’s normal testosterone levels start to decline. This suggests that having too little testosterone could be a factor and that something else — perhaps too much estrogen — could be a factor as well.
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Does estrogen cause prostate cancer?
Estrogen as a cause of prostate cancer is gaining lots of attention. At least in rats, experts know that testosterone plus estrogen are necessary for the development of prostate cancer. In men, however, the research findings thus far have been mixed, with a few studies indicating an association between estrogens (16) and chronically high estrogens (17) and an increased risk of cancer, but others showing the opposite.
It’s widely accepted that a man’s testosterone:estrogen ratio should be in balance; that is, higher levels of testosterone than of estrogen. Because testosterone can be changed into estrogen via an enzyme called aromatase, the critical point is to adopt habits that help reduce the activity of this enzyme. This includes maintaining a healthy weight, losing excess belly and body fat (as fat promotes estrogen production), limiting or avoiding alcohol (as alcohol is estrogenic and also affects the metabolism of testosterone), maintaining healthy blood sugar levels, and taking natural supplements.
Does high testosterone protect against prostate cancer?
As for evidence that men who have higher levels of testosterone are protected against prostate cancer, the jury is still out. However, a European Urology report noted that numerous reports have shown that men who receive testosterone therapy after treatment for localized prostate cancer have shown no or low recurrence rates. Some men with untreated cancer who have taken T therapy also have not had any progression of their disease.
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One study, for example, involved 98 men with hypogonadism (excessively low T) who were treated with testosterone therapy after they received radiation for prostate cancer. Use of testosterone therapy raised T levels from a mean of 209 ng/dL before treatment to 420 ng/dL. At the same time, there was a nonsignificant increase in PSA levels.
Based on the studies and latest research it does not appear that testosterone causes prostate cancer, nor that it has a negative impact on men who already have the disease. At the same time, another hormone — estrogen — seems to play the main role in the disease. Signs and symptoms of elevated estrogen in men — low libido, breast development, risk of stroke and heart attack, infertility, weight gain — are the same as those associated with low testosterone, so estrogen, not testosterone, is a hormone that needs to be managed and reduced as part of living a healthy and cancer free life. I talk a lot about this in my book – and actually devote a complete chapter to it as it’s so important. You can read more about the topic here if you’re interested in learning more.
By Craig Cooper
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