The Risk of Prostate Cancer in Men Being Given Testosterone Therapy

Abraham Morgantaler, MD, is another warrior hero of health.  He is a Harvard undergraduate, received his MD from Harvard, specialized in Urology at Harvard, and is now an attending and professor at Harvard in Urology.  In other words, he lives at Harvard!  His passion early on in residency was Testosterone!

Morgantaler has since done the benchmark research responsible for shifting the current paradigm from high Testosterone levels as a cause of prostate cancer and cardiovascular disease, to high Testosterone levels has either no impact or improves prostate cancer and cardiovascular disease.  His talk at the Age Management Medicine Group, AMMG, was entitled,

“Can We Now Offer Testosterone Therapy to Men with Prostate Cancer?”

Why is Testosterone Deficiency not Treated More Often?

Testosterone deficiency and its treatment is a super exciting field in which to be involved, both for men and women especially when it comes to healing the brain.  Testosterone deficiency is a condition not recognized by traditional doctors.  Even, Gynecologists and Urologists often steer clear of treating testosterone deficiency because of the fear of causing prostate cancer, or cardiovascular disease.   FDA, Insurance companies and most traditional physicians feel Testosterone deficiency is a normal aging process, and therefore, does not need to be treated.  In addition, testosterone was declared a controlled substance by the FDA.  Hence, Testosterone deficiency is a very under-treated condition.

Old paradigm teaches testosterone causes prostate cancer and cardiovascular disease are now being disproven.

Morgantaler is a leader in shifting traditional thinking to thinking the exact opposite when it comes to testosterone!  He opened the door for physicians to treat patients with testosterone deficiency without fear.  This blog reviews literature on Prostate Cancer and Testosterone based on Morgantaler’s recent lecture at AMMG.

Traditional Teaching of Testosterone (T) and Prostate Cancer (PCa) for over 75 years Is…

  • High T causes PCa
  • Low T is protective against PCa
  • Raising T levels in a man with PCa is like “feeding a hungry tumor” or “pouring gasoline on a fire”
  • T therapy is contraindicated in men with PCa

What is the Basis for Believing the Dangerous Link between T and PCa as stated Above?

  • We treat advanced PCa with T deprivation
  • We use anti-androgens to block T flares
  • There are warning labels by the FDA, ‘use of Testosterone products contraindicated in men with, or even suspicion, of Prostate Cancer’
  • In vitro (in the petri dish), there is evidence higher T concentrations cause greater growth of Testosterone-sensitive Prostate Cancer cell lines

However,  Nearly everything MD’s learned in Medical School  and are still learning in Medical School about T and PCa turned out to be wrong!  

Unfortunately, lay people are subjects in this controversy having to make their own decisions as to who is right and who is wrong.  Often their life depends on that decision.  Here is the story of testosterone therapy in the US as told by Morgentaler.

1988. Morgantaler graduated from Urology Residency and found…

  • T Therapy was Rare
  • T injections were being done with testosterone cypionate or enanthate every 4 weeks
  • T therapy restricted to young men with Klinefelter’s, resected pituitary tumors and, testes destroyed from trauma or cancer
  • Reason T was not used more was the fear of Prostate Cancer taught since the 1940’s

1989. Morgantaler started offering successful T therapy to men with sexual problems

  • They were generally healthy men, with normal testicles, over 50 years old.
  • This had never been done before!  

1990. T was declared a controlled substance making its use more difficult

1992. Because the accepted fear of prostate cancer being caused by “dangerous” T therapy,

  • Morgantaler started doing prostate biopsies prior to offering T therapy to healthy men

1996. Morgantaler published his biopsy results. PCa was found in 11/77 (14%) of nl men

  • PCa was proven by biopsies he had done prospectively on symptomatic but otherwise normal men
  • The results were not an just an observation, they began to the real story of PCa in Testosterone deficient men!
  • These men had normal exams, PSA <4, and low total and free Testosterone levels. (LT and FT). In other words, no indication or evidence of PCa until they were biopsied.
  • This data suggested exam and PSA levels are insensitive indicators of prostate cancer in men with low T levels*

2004. Morgantaler reviewed extensively all PCa research around the world from 1985 to 2004

  • To find why it was taught T is the causative factor for Pca.
  • He found NO articles supporting a relationship between high T and PCa
  • Only one article published in1941 by Huggins and Hodges, heralded the ‘Origin of Prohibition Against T therapy in Men with PCa.**
    • The fear testosterone causes PCa was based on one patient who had advanced prostate cancer whose cancer screening level regressed with castration.
    • For this, Huggins won the Nobel Prize in 1966 for showing “the course of disease can be affected by hormones. If the production of male sex hormone is prevented through castration or if female sex hormone is added, the cancer could be counteracted.” ***
    • Subsequently, Huggins has been proven wrong!
    • After 30 years of research proving Huggins wrong, the current treatment of prostate cancer is still based on Huggins theory T therapy causes cancer and PCa should be treated by castration and/or female hormone therapy.  This is standard of care as per FDA, Pharmaceutical companies, Insurance companies, and traditional medicine. Please consider the human suffering and travesty propagated by this current standard of care.

2005. No Difference between T therapy and placebo in PCa

  • Meta-analysis of 19 placebo- controlled T therapy studies in men with low or low nl T therapy vs placebo
  • No difference in incidence of PCa

2007 Hormonal Predictors of Prostate Cancer

  • When normal ranges for free and total T levels were defined as 9 pg/ml and 300 ng/dl, respectively,
  • Patients with low free and total T levels had significantly higher cancer detection rates than patients with high T levels: 40.8% (40/98) vs 25.6% (29/113).
  • Data suggested patients diagnosed with prostate cancer have low levels of serum testosterone …
  • No support was found for the theory high levels of T increase prostate cancer risk.****

2008No significant relationship between T therapy and PCa.

  • 3886 men with PCa vs 6448 age matched controls.
  • No difference between Highest 20%T vs Lowest 20% T*****

2016. T Therapy is associated with decreased rate of PCa

  • 10, 311 T treated men vs 28.029 untreated men
  • 5 yr cumulative incidence PCa diagnosed in:
    • 3.2% controls
    • 2.8% T treated
  • There was a greater reduction in PCa risk with greater duration T therapy ******

“Nearly everything we learned about T and PCa was wrong”

Does High endogenous T increase risk of PCa?  No

Does T therapy increase risk of PCa? No

Higgins has been proven wrong over and over again and yet traditional physicians still treat PCa according to Higgins’ protocol of castration and female hormone therapy.  Why?  Why does it take years in this time and age to precipitate change that could create a better life for someone rather than destroying a life by depriving one of hormones that heal.  Why does Fear trump Science?  Why are medical protocols based on solid scientific research not always accepted, posing potential harm to patients?  Is this happening during the Covid Pandemic?

Next week will answer the questions,  How is it possible raising T doesn’t increase PCa risk,  if lowering T is used to treat advanced PCa?   Can we really treat men with Prostate Cancer with Testosterone?

*JAMA 1996 Dec 18;276(23):1904-6. Occult prostate cancer in men with low serum testosterone levels  A Morgentaler 1C O Bruning 3rd,
** Studies of Prostatic Cancer, Huggins and Hodges, Mar22,1941
***Morgentaler A, Testosterone and prostate cancer: An historical perspective on a modern myth. Eur Urology, 50:935-9, 2006
****   Calof et al, J Gerontology 2005;60A:1451-7
******Wallis et al Lancet Diab Endocrin 2016

1 Comment

  1. John Durbin on May 3, 2021 at 12:02 pm

    I’m learning a lot from these articles and really enjoying the reviews you’ve posted on here. If possible, could someone send me the link to the last study (Wallis et al Lancet Diab Endocrin 2016) I want to read it and I cant find it anywhere. Thanks!