Testosterone Replacement Therapy Increase The Risk of Prostate Cancer Significantly

 

Promoters of prescription testosterone products promise that the hormone is nothing less than a fountain of youth for men of a certain age. And sales of these testosterone pills, gels, and patches have soared, nearly quadrupling in the United States between 2000 and 2011.

Many claims from drug companies and “anti-aging” clinics are directed at men who hope to regain their youthful vigor and improve their strength, sexual prowess, athletic performance, and appearance. Natural levels of the sex hormone normally decline with age. As they ebb, sex drive often slips into low gear, youthful energy fades, bones get thin and brittle, and physical ability sags, among other changes.

Some doctors began to surmise that testosterone replacement therapy could reverse certain age-related changes men experience, or at least hold them off for a while. But many men prescribed testosterone replacement therapy don’t have an abnormally low blood level of testosterone—or haven’t even had the hormone measured.

Until recently, there has been little scientific evidence to support testosterone replacement, except for men whose bodies don’t produce enough of the hormone, a medical condition called hypogonadism, or androgen deficiency. It differs from the natural process of decreasing testosterone that comes with normal aging, sometimes referred to as late-onset hypogonadism.

The testosterone trials

To test whether testosterone replacement offered older men any benefits, the National Institutes of Health sponsored a series of seven rigorously controlled, randomized trials, known as the Testosterone Trials, or TTrials, the largest of their kind.

Findings from four clinical trials were published in February 2017 by JAMA and JAMA Internal Medicine. Findings from the first three trials appeared in February 2016 in The New England Journal of Medicine.

The TTrials have gone a long way in separating the hype from the real benefits testosterone replacement therapy may offer. But one important question remains unanswered: Is long-term testosterone replacement therapy use safe?

Because the TTrials were only one year long, they don’t shed light much on the therapy’s risks. Some long-term studies have associated testosterone replacement therapy with prostate cancer, whereas others report no evidence that testosterone replacement therapy in men with low testosterone levels increases prostate cancer risk. And concern remains about the effects of testosterone replacement therapy on cardiovascular health over time.

In 2015, the U.S. Food and Drug Administration began requiring testosterone products to carry a warning about their associated risk for heart attack and stroke. Other risks associated with testosterone replacement therapy include erythrocytosis (an abnormal increase of red blood cells) and benign prostatic hyperplasia (an enlarged prostate), or BPH. Testosterone replacement therapy side effects include acne, breast enlargement, unwanted hair growth, and infertility.

Men who have prostate or breast cancer, sleep apnea, BPH, or heart failure shouldn’t use testosterone replacement therapy because it can worsen those conditions. Most experts agree that doctors should consider testosterone replacement therapy only for men with proven low levels of testosterone who have symptoms that might improve with treatment, such as anemia, bone loss, or loss of sexual desire or function.

The only sure way to know whether your testosterone is low is to be diagnosed by a doctor, who will perform a physical exam, take your medical history, test your blood on at least two separate days, and rule out other conditions.