Dispelling the Myth that Testosterone Causes Prostate Cancer
Testosterone and Prostate Cancer -Dispelling the Myth that Testosterone Causes Prostate Cancer
One of the more common concerns that many of our new patients have when they first come to Innovative Men’s Clinic for treatment, especially if they have a family history of prostate cancer or other non-cancerous prostate problems, is that being treated with testosterone will increase their chances of having prostate disease in the future. Some have even heard that testosterone actually causes prostate cancer. To make matters worse, these sentiments are often shared with patients by their primary care physicians. The myth that testosterone replacement therapy causes prostate cancer has been deeply rooted in the western medical paradigm for over sixty years.
Where does this myth come from?
In the article Testosterone Replacement Therapy and Prostate Risks: Where’s the Beef? By Abraham Morgentaler, MD, the author writes that more than 60 years ago, researchers studied the effects of castration on people with prostate cancer. They observed that the cancer regressed. Since the testicles were removed, no more testosterone was present. They concluded that since removing testosterone led to regression of prostate cancer that the cause of the cancer must have been the testosterone. The same effect was observed in patients who underwent pharmacological lowering of serum testosterone.
However, we now know that there is a lot more to this. If you’re a testosterone patient at Innovative Men’s Clinic, you may recall being told that the male body produced estrogen by converting testosterone directly into estradiol. Men need some estrogen, but they don’t have ovaries to produce it. Instead, an enzyme called Aromatase converts testosterone into estradiol, a potent estrogen. Normally, as life progresses, the amount of estrogen is kept at a particular level, but when a man with low testosterone has his levels brought to an optimal level very suddenly, the activity of Aromatase can result in drastically high estrogen (estradiol) levels. Well, guess what; Estradiol excess has been linked to prostate cancer in more recent studies like this one (click here). This is just one possible effect of increased estradiol levels in men. Many others can occur, and this is why testosterone patients at Innovative Men’s Clinic take the aromatase inhibitor, Anastrozole (Arimidex). By using this medication along with testosterone, the estradiol levels can be kept to optimal levels for a male patient, especially when blood testing is performed as often as it is at IMC.
So, let us review. Physical or chemical castration results in almost no testosterone, and prostate cancer regresses in individuals who have undergone such castration. However, we can now say that since testosterone was nearly absent, and since men get their estradiol by converting testosterone into estradiol, that there was not enough testosterone present to create the offending estradiol. No testosterone = no estradiol. No estradiol = regression of cancer.
Dr. Edward Friedman has written a book called The New Testosterone Treatment; How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s. In it, he uses the latest research to explain what he calls The Hormone Receptor Model for how prostate (and breast) cancer emerge, and he does so in a language that most people can understand. By understanding the different testosterone and estrogen receptors and their role in prostate cancer, he has determined that prostate cancer can actually be treated with testosterone therapy so long as the estradiol is kept to a minimal level.
There is still a lot of outdated research out there linking testosterone to prostate cancer, but the use of anastrozole to inhibit the aromatase enzyme and thus the overproduction of estradiol is a relatively new practice. To this day the physicians at IMC receive new patients who have been on testosterone therapy elsewhere, either through their primary care doctor, a urologist, an endocrinologist, or a competing “Low-T” clinic, who have not been prescribed anastrozole to control estradiol or even had their estradiol blood levels checked. At IMC we view this practice as irresponsible, but the point is, there are doctors and clinics who are not administering testosterone therapy appropriately, and when it isn’t done appropriately, side effects emerge, possibly including prostate cancer. This contributes to the myth that testosterone causes prostate cancer and other problems. Fortunately there is plenty of research showing that when testosterone therapy is done correctly, the risk of prostate cancer and other potential effects is nearly eliminated.
Ask yourself, how many teenaged post-pubescent boys do you know with prostate problems? It’s fairly well known that teenaged boys have very high amounts of testosterone, yet they don’t have prostate issues. They also have naturally low levels of estradiol.
As men age, even without an improperly administered testosterone treatment where estradiol is not controlled, men tend to be exposed to and/or produce more estradiol than they should. This increase, along with a decrease in the protective testosterone, is part of why prostate cancer is on the rise (after all, most men who suffer from prostate cancer were never on testosterone replacement therapy).
We encourage you to read more on this topic. It is very important that our patients and potential future patients be comfortable with testosterone treatment, so don’t just take our word for it. Please click the links included in this writing. The previously mentioned study and book, along with the links that follow, are all excellent sources for understanding the latest and best research in the area of prostate cancer and the busted myths surrounding the link between testosterone and prostate cancer.