Relationship between Testosterone and Prostate Cancer

Recently I had the pleasure of giving a keynote presentation at the Illinois Naturopathic Association Physicians (ILANP) conference. The topic was on Men and Hormones. The following is an overview of my lecture on the relationship between Testosterone (T) and prostate cancer:

Brief Overview of the Relationship between Testosterone and Prostate Cancer
Dr. Huggins, a urologist at the University of Chicago, circa 1940’s, began experimenting with the effects of castration on dogs with an enlarged prostate (BPH) since dogs are the only species we know of other than humans that naturally develop prostate problems on a regular basis. Huggins observed the dogs’ prostates shrunk after castration. But that was not all he saw. Dr. Huggins also noticed that dogs with cancerous-appearing areas also demonstrated shrinkage of their prostates. When their prostates were taken out, the dogs had no further evidence of the cancerous-appearing regions.
Huggins and his research team, as an experiment, then removed the testicles or applied estrogen to a group of men who had metastatic prostate cancer to their bones. At the time the PSA test did not exist. A blood test called acid phosphatase, typically high in men with prostate cancer gone to bones, was used to determine disease progression. Indeed, Huggins and his team showed that acid phosphatase dropped substantially within days of lowering testosterone – and injecting testosterone to men with prostate cancer caused acid phosphatase to rise. They, therefore, concluded that reducing testosterone levels caused prostate cancer to shrink and raising testosterone levels caused “enhanced growth” of prostate cancer. His experiment was flawed in many ways. One, the acid phosphatase blood test is an extremely poor blood marker for prostate cancer, to the point that physicians have not used it for over 30 years. Two, Dr. Huggins experiment included five subjects, to low of a number to make any hard conclusions, plus only one survived from prostate cancer from lowering testosterone.
For over seventy years medical doctors and scientists alike concluded that testosterone feeds prostate cancer development and progression.
Interestingly, I gave this talk at National University of Health Sciences, just a few miles from where Dr. Huggins performed his experiments.
Where are we now with the relationship of Testosterone with Prostate Cancer
The universal belief that T would lead to prostate cancer development is slowly losing steam. While older guys lose their vim back in the day, going for T was assumed to be a trade-off - feel better with T therapy but promote prostate cancer development.
Recent research, however, shows no evidence that T promotes the development of new cancer of the prostate.
Some evidence suggests normal testosterone levels play a protective role in of prostate cancer. Many studies have demonstrated that a low testosterone level before treatment is an independent predictor of a more aggressive, high-grade cancer. (Massengill et al. 2003)
In other words, not only does T not feed the development of prostate cancer, low levels of T may increase the risk of aggressive, and likely deadly prostate cancer.
Lastly, some patients can benefit from testosterone therapy after prostate cancer.
One study looking at about 2300 men with prostate cancer, delivered by skin application T showed that TT short-term safety and does not promote prostate cancer development or progression. Long-term data is needed to make firm conclusions. (Cui et al. 2014) 
Takeaways on the Testosterone / Prostate cancer connection and suggestions for you:
  1. Ask your doctor to check your total Testosterone and free testosterone level especially if you are over 50 and have low energy, low sexual desire, and the decline in memory. These are symptoms do not necessarily prove low T is the problem but it may.
  2. If low T is found by your doctor, T therapy may be appropriate under medical supervision – not by the local muscle head trainer at your local gym
  3. Better yet, look for natural ways of improving T levels such as weight resistant training, improved sleep, and low carbohydrate diet.
  4. T therapy by itself is a ‘Band-Aid’ to the problem - a good temporary solution but still not the cure. Dealing with the cause is the best cure.
  5. Cause of low T is stress, poor sleep habits, lack of physical activity, being overweight, etc. – you know, the typical culprits to most health problems.
  6. If you have had prostate cancer and have had successful treatment with an undetectable PSA for two years or more, you may be a candidate for T therapy (naturally or medically) under medical supervision.
Massengill JC, Sun L, Moul JW, Wu H, McLeod DG, Amling C et al. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 2003; 169: 1670-1675.
Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):132-43.