The belief that testosterone causes cancer of the prostate is a myth from the old school. I was also taught this myth 45 years ago in medical school. If it were true then men at twenty when testosterone is highest would have prostate cancer. It is now known that it is estrogen [especially in excess]that contributes to the cause of prostate cancer in men and not testosterone.
All fetuses at first are female and have a uterus until the genes kick in to change an individual to a male. At this point the prostate becomes the organ instead of a uterus. However what would have been the uterus now exists inside the prostate as a vestige of the uterus called a utricle that has estrogen receptors. (This is the same hormone that contributes to women to have breast and uterine cancer ). This is why we need to get estrogen levels prior to initiating testosterone therapy and then again months latter to see if the client is converting the testosterone to estrogen, so that we can stop this aromatization.
While there is a continuing difference of opinion among doctors as to whether testosterone will speed the growth of an already existing cancer of the prostate, since it is a growth hormone, it does not cause the original cancer (www.medaus.com, “Testosterone and prostate cancer: an historical perspective on a modern myth”, April 13, 2007).
I always recommend certain tests before beginning a person on testosterone and then repeating them in the near future. The latter depends on the client and circumstances. These are:
2.PSA (if male)
3.Liver function tests (the liver detoxifys any excess estrogens which can occur with a poorly functioning liver.)
4.Estradiol (for men and women)
5.Testosterone – both free (to see what will get into the cells) and total
6.SHBG-(sex hormone binding globulin)-which can tie up the testosterone if too high. I often get this when I repeat these tests in about 4-6 weeks.
I believe a short history of how the myth of Testosterone replacement therapy (TRT) and prostate cancer (pCA) evolved. It started in 1941 with a poorly unscientific study by C. Huggins and CV Hodges (Cancer Res. 1941; 1:293-297) with a a study on two men. One being castrated and the other on estrogen therapy. They stated that the administration of testosterone (of coarse it was synthetic testosterone) caused the pCA to grow. Actually what they showed was that acid phosphatase increased in these two men when a daily injection of testosterone proprionate was given. There was no following of PSA or free PSA in 1941. (Acid phosphate being a product of the prostate that goes up with pCA). Therefore, their conclusion was based on acid phosphatase and not other evidence. For another the men already had very aggressive and metastatic pCa. For another these studies have never been able top be duplicated. Unfortunately from this non-evidence based study and (no control done with it) the medical community has traveled down a path that is in definitely contra to the scientific method.
This pCA as stated already is rare in in men in their younger years when testosterone is at peak levels. The rebuttal or thought about this may be that it takes many many years for the cancer to manifest itself. This latter statement maybe true but because of the restraint of doing research on this by the National Cancer Institute and the US National Institutes of Health we do not know the answer to this. But if it does take 30-40 years tor testosterone to cause pCA then obviously there should be no problem in offering it to men in their 60s and older if they are manifesting the symptoms and signs of testosterone deficiency which could be quite depressing both mentally and physically (see other blogs on testosterone therapy). Also, I wish the reader to keep in mind when I write about hormone replacement therapy I only use human bio-identical hormones and not synthetics such as testosterone proprionate, ciprioantaen or ethonate which are commonly used in studies.
The studies so far have been scant and synthetic T is the T of choice. Also the studies are most often done with men that already have invasive pCA or even metastatic pCA. There have been, however, some studies showing that pCA is not related to the use of T hormone therapy. For example, Prout and Brewer (Cancer. 1967;20:1871-1878) showed that T injections on men with pCA “Most of these individuals experienced an increase in sense of well being and some noticed vague diminution in pain.” The same two also stated that the acid phospahtase response to T injections was “extremely variable.”
So to summarize why T is scary to the medical profession and the myth is the following
1. No reliable marker was used that started this myth such as PSA
2.Control groups were not incorporated too often in the different studies.
3.In the past 25 years there have been no studies that replicate the findings that have brought the original myth into the medical field showing that T causes pCA.
4.Synthetic T is the testosterone that is used in studies which of itself could cause pathologies. Human Identical Testosterone (HIT) made by a an experienced compounding pharmacist is what our bodies have evolved to recognize and use.
5.More studies using bio-identical testosterone on men with pCA both new pCA and advanced and also in men without pCA (the latter in long term studies to see its effects compared to long term non users of testosterone) need to be done.