Does Testosterone Cause Prostate Cancer?

While testosterone replacement therapy has become increasingly popular in recent years, questions persist about its relationship to prostate health and cancer risk. For men considering TRT, understanding the science behind testosterone and prostate cancer is essential for making informed decisions about their health.

The Evolution of Understanding: From Fear to Evidence

For decades, the medical community operated under the assumption that testosterone "fed" prostate cancer like gasoline on a fire. This belief stemmed from Nobel Prize-winning research by Dr. Charles Huggins in 1941, which showed that androgen deprivation could slow advanced prostate cancer. However, closer examination reveals this conclusion was based on observations from a single patient. 

Modern research has fundamentally challenged this long-held belief, revealing a far more nuanced relationship between testosterone and prostate cancer.

What Current Research Shows

Recent studies demonstrate that there is no direct correlation between normal testosterone levels and the development of prostate cancer. Testosterone does not initiate cancer. The old "androgen hypothesis", that higher testosterone levels proportionally increase cancer risk, has been largely debunked.

However, the relationship isn't completely neutral. In cases of advanced, metastatic prostate cancer, high androgen levels may accelerate tumor spread. This is why doctors prescribe androgen-blocking medications for patients with locally advanced cancer.

The Saturation Model: A Breakthrough in Understanding

One of the most important developments in testosterone research is the saturation model, introduced by Dr. Abraham Morgentaler and colleagues in 2009. This model revolutionized how we understand the relationship between testosterone and the prostate.

The saturation model explains that prostate tissue responds dramatically to testosterone changes at very low levels (near-castrate range), but becomes essentially insensitive to testosterone changes once levels reach the normal physiological range. Think of it like watering a plant: a thirsty plant responds dramatically to water, but once adequately hydrated, additional water produces minimal additional growth.

At the molecular level, this occurs because:

• The prostate has a limited number of androgen receptors that would bind to testosterone

• These receptors become saturated at testosterone levels around 250 ng/dL

• Once saturated, additional testosterone cannot produce further stimulation or growth

This model explains why androgen deprivation therapy works for advanced cancer (dropping levels below saturation) while raising testosterone from low to normal levels doesn't increase prostate cancer risk.

Does TRT Increase Prostate Cancer Risk?

Based on current evidence, testosterone replacement therapy does not increase the risk of developing prostate cancer in men with normal prostates. Multiple studies have shown:

• No increased cancer detection rates in men receiving TRT versus placebo

• The 2018 American Urological Association guidelines state there is an "absence of evidence linking testosterone therapy to the development of prostate cancer"

• Men receiving TRT for hypogonadism show prostate cancer rates similar to the general population

For men who have undergone screening and have no evidence of prostate cancer, TRT is not a cancer risk factor, although it can reduce fertility while on treatment. 

Modern Medical Practice: What Urologists Actually Do

The landscape of testosterone therapy in men with prostate cancer has shifted dramatically. A 2024 survey revealed that approximately 75-80% of urologists would now consider testosterone therapy in appropriately selected men with a prostate cancer history. Let’s reiterate this: a man with a history of prostate cancer may consider TRT. This is a complete reversal from just 20 years ago.

The Modern Approach: Individualized Care

Today's urologists don't automatically stop testosterone when prostate cancer is diagnosed. Instead, they assess:

• Cancer grade and stage (Gleason score, T-stage)

• Treatment status and PSA response

• Patient symptoms and quality of life impact

• Individual patient anxiety and preferences

For most men with early-stage, well-controlled prostate cancer, continuing TRT with appropriate monitoring is now considered acceptable medical practice.

Understanding Prostate Cancer Risk: The Role of Age

While testosterone doesn't cause prostate cancer, age is the single most significant risk factor. Understanding this context is crucial:

Age-Related Statistics:

• Prostate cancer is rare before age 40 (incidence < 1%)

• Risk increases dramatically after age 50

• 60% of prostate cancer cases are diagnosed in men 65 or older

• The median age at diagnosis is 66-68 years

• By age 80, approximately 80% of men have cancer cells in their prostate (though most never develop clinical disease)

The key takeaway: age-related cancer risk exists independently of testosterone levels. Men considering TRT should undergo appropriate age-based screening regardless of their testosterone therapy status.

TRT in Men with Existing Prostate Cancer: What You Need to Know

The guidance for men already diagnosed with prostate cancer differs significantly:

For localized, treated disease: Current evidence from 2024-2025 studies suggests:

• TRT does not appear to increase biochemical recurrence rates after radical prostatectomy

• Some studies suggest TRT may actually delay recurrence by 1.5 years

• Careful patient selection and monitoring are essential

• Regular PSA monitoring and potentially advanced imaging (PSMA PET) should be part of follow-up

For advanced or metastatic disease: TRT is generally not recommended, as androgen-sensitive cancer cells at advanced stages may respond to elevated testosterone with increased growth.

The bottom line: Individual circumstances matter enormously. Risk, benefits, and personal health goals should be discussed thoroughly with a qualified urologist who stays current with the latest evidence.

TRT with Lucidity Health: Our Approach

At Lucidity Health, we take an evidence-based, patient-centered approach to testosterone replacement therapy:

Our Process:

1. Comprehensive initial evaluation with blood testing to confirm low testosterone levels

2. Cancer screening appropriate for your age and risk factors, including PSA testing

3. Individualized treatment planning based on your unique health profile, goals, and risk factors

4. Regular monitoring with periodic blood work to ensure safety and efficacy

5. Ongoing education about the latest research and best practices

We understand that questions about testosterone and prostate cancer can be concerning. Our team stays current with the latest clinical evidence and guidelines from the American Urological Association, European Association of Urology, and other leading medical organizations.

Getting Started

If you're interested in testosterone replacement therapy, we encourage you to reach out for more information. Our evaluation process begins with comprehensive blood testing to confirm that your testosterone levels are genuinely low before we can prescribe treatment.

For men with concerns about prostate cancer risk, we work closely with urologists and incorporate appropriate screening protocols based on your age, family history, and individual risk factors.

Ready to learn more? Contact Lucidity Health today to schedule your initial consultation and take the first step toward optimizing your health.

The benefits of TRT often start to manifest soon after treatment begins, including increased muscle mass and weight loss.  

References

Hsing AW, Chu LW, Stanczyk FZ. Androgen and prostate cancer: is the hypothesis dead? Cancer Epidemiol Biomarkers Prev. 2008;17(10):2525-30. (link added) 

Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009;55(2):310-320. (link added) 

Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432. (link added) 

Kaplan-Marans E, Zhang TR, Hu JC. Oncologic Outcomes of Testosterone Therapy for Men on Active Surveillance for Prostate Cancer: A Population-based Analysis. Eur Urol Open Sci. 2024;60:36-43.

Walia A, et al. Testosterone Replacement, Where Are We in 2025? Trends Urol Men's Health. 2025;16(6).