The belief that testosterone causes cancer of the prostate is a myth from the old school. I was also taught this myth 50 years ago in medical school. If it were true then men at twenty when testosterone is highest would have prostate cancer or at least starting to show differentiation of cells that could be a precursor to 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: and of course life style. There are many reasons that a male can have higher then normal estrogen levels which I wrote about in my book and in a blog on anti-aging (holisticsecondopinion.net/vampires).
All fetuses at first are female and have a uterus until the genetics 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 breast and uterine cancer in women ). 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, called aromatization due to the aromatase enzyme that does this. We do this even sooner if there are any signs or symptoms that suggest this aromatization so that we can stop it.
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 (anabolic 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 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) in 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 propionate 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. Another fault in this paper was the men already had very aggressive and metastatic pCa. For another these studies were able to 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 definitely contra to the scientific method.
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. After a long interview I determine if other laboratory tests are necessary besides those below. These are:
CBC with differential
PSA (if male)
Liver function tests (a healthy liver detoxifys any excess estrogens which can occur with a poorly functioning liver.)
Estradiol (for men and women)
Testosterone – both free (to see what will get into the cells) and total. A total T is a waste by itself since like any hormone it is what gets into the cells (free T) that is important.
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.
This pCA as stated already is rare 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 for testosterone to cause pCA then obviously there should be no problem in offering it to men ( especially if they have no symptoms nor signs of pCA) 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, ciprioante or ethonate which are commonly used in studies.
The studies so far have been scant and synthetic T is the T of choice for the studies.. 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.” Remember that men not taking T supplementation get pCa. There now is a lot of literature suggesting that in most cases surgical intervention is not necessary. Still I believe that certain tests should be done if the patient and the physician have any doubts if pCa is present and of the aggressive type. (See blog on BPH and prostate cancer at holisticsecondopinion.net/vampires).
As I wrote in my book, T developed a bad reputation for side effects because of athletes taking huge doses of synthetic T with other growth enhances. A good holistic physician does the appropriate lab work and studies it so that he can individualize the dose and have it made by a compounding pharmacist so the it is a bio-identical testosterone for the individual.
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
Control groups were not incorporated often in the different studies.
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.
Synthetic T is the testosterone that is used in studies which of itself could cause pathologies. An example of this is the Woman’s Health Initiative study done on women with synthetic estrogen and progestin. Progestin is not a really progesterone) which had to be stopped very early due to all the dangerous cardiovascular and cancer side effects that the women were getting. The study was stoped early with these synthetics but the FDA still has them on the market and physicians are using them instead of bio-identical hormones. Human Identical Testosterone (HIT) made by a an experienced compounding pharmacist is what our bodies have evolved to recognize and use.
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.
Alan J. Sault MD, ABHM-Diplomat
Book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it