Testosterone Treatment in Men With Prostate Cancer-The Controversy


I have been a proponent of testosterone replacement therapy in men

with documented low levels of testosterone. Men with low testosterone

present with lethargy, malaise, decrease in libido, erectile

dysfunction, falling asleep after meals and loss of muscle mass. The

diagnosis is easily made with a blood test, the serum testosterone

level, and is easily treated with injections of testosterone or the

application of testosterone gels to the skin. The medical textbooks in the 1990’s state that the treatment is

contraindicated in men with difficulty with urination, untreated

obstructive sleep apnea, high blood counts, and in men with prostate


But now there are a few doctors who question the advice of avoiding

testosterone in men who have been successfully treated for prostate

cancer. For decades the prevailing treatment for men with prostate

cancer that spread beyond the prostate gland was to decrease the

testosterone produced by the testicles. This was accomplished by

removing the testicles or orchiectomy, or medically castrating the men

with drugs that produced castrate levels of testosterone in the blood.

Dr. Abraham Morgentaller, a urologist a Beth Israel Deaconess

Hospital in Boston, began treating men with prostate cancer, who had

symptoms of low testosterone and confirmed by the blood testosterone

test, with supplemental testosterone. This was certainly against the

previous advice of other urologists.

What is the evidence to support this new approach to testosterone

deficiency in men with prostate cancer? Dr. Morgantaler published a

report that men who developed prostate cancer had a statistically

lower testosterone level than men who were free of prostate cancer.

He also started treatment of a select group of men with prostate

cancer with testosterone and followed them closely with PSA tests and

found that there was no increase in the PSA test but marked

improvement in the men’s libido, energy level, and over all quality of


So what is a man to do? Talk to your doctor. If your doctor agrees

that there may be a roll for testosterone in men with prostate cancer,

you can receive therapy with testosterone replacement. In my practice

I select men who have zero, or near zero, PSA tests for at least one

year after treatment for prostate cancer. They receive testosterone

replacement under close scrutiny and must agree to getting a PSA test

every month. If the PSA rises, then they must agree to discontinue

the testosterone replacement therapy.


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