cancel
Showing results for 
Search instead for 
Did you mean: 

BLOG: The controversy around testosterone therapy

Chris_McNamara
Community Manager
Community Manager
0 0 98

Banner_testosterone therapy2.jpg

The controversy around testosterone therapy

Like the ageing woman develops menopause due to the waning levels of oestrogen so too does the ageing man develop andropause or testosterone deficiency. Some men remain symptom free despite this change while others develop significant symptoms. These symptoms may include mood changes (depression), memory and sleep disturbances and lower energy levels. This condition may result in osteoporosis (increased risk of fractures), anaemia, loss of libido, sexual dysfunction and increased risk of metabolic syndrome (diabetes, cardiovascular disease, stroke, high cholesterol). Many other conditions can cause this group of symptoms and thorough investigation by a general practitioner is required. If a diagnosis is confirmed, then referral to an endocrinologist (doctor who manages conditions related to hormones) is required for testosterone replacement therapy.

As discussed in numerous blogs up until now, testosterone is thought to drive the growth and spread of prostate cancer. This is why androgen deprivation therapy is used to starve the cancer of testosterone by blocking its production and effect in those with advanced stages of disease or in combination with radiation therapy. However, the testosterone therapy used as treatment for testosterone deficiency is different to the testosterone naturally found in the body. For almost 80 years it has been believed that testosterone therapy could cause progression of cancer in those not diagnosed with prostate cancer yet or worsening of disease in those already diagnosed. Emerging evidence over the last decade says otherwise. 

Morgentaler and Traish found that prostate cancer grows despite having low testosterone levels such as in those who are medically or surgically castrated or on oestrogen treatment1. Its also been shown that raising serum testosterone levels did not raise testosterone levels within the prostate2. Reports from men treated with testosterone therapy for localised cancer have shown low to absent recurrence rates3. Natale et al reported that those treated previously with either radical prostatectomy or radiation therapy don’t seem to have an elevated risk of cancer recurrence or progression because of testosterone therapy2. Some evidence even suggests that a low testosterone state may have adverse effects on oncological outcomes with another study suggesting that bipolar androgen treatment may even be used to control prostate cancer through normalisation of testosterone concentrations4. Current thought is based on the saturation model which postulates that prostate cancer response to variations in testosterone levels at castration or near castration range reaches a point of maximal prostate stimulation beyond which further increases produce little or no further effect on the prostate4.

Testosterone therapy still remains controversial and a careful approach should be considered balancing risk of cancer with undue harm caused by failing to address sexual health, metabolic, cardiovascular, and other effects of testosterone deficiency. There is a need for long-term large-scale placebo-controlled trials to definitively assess the safety of this therapy but in the interim a useful set of guidelines may include5:

  • Clinicians should confirm that the clinical history is consistent with a laboratory diagnosis of testosterone deficiency
  • Disclosure that there are limited data confirming testosterone safety and that the true risks are unknown
  • Confirm that there are no medical contraindications to therapy (e.g erythrocytosis [High red blood cell count])
  • PSA should be either undetectable (after prostatectomy) or stable (after radiation) for at least 6-12 months
  • Be aware there may be prostate cancer recurrence (this may or may not be related to the testosterone therapy)
  • It should be used with extreme caution in men at high risk for prostate cancer recurrence or progression
  • It should not be administered at the same time as ADT.

References

  1. 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; 55:310-321.
  2. Natale C, Carlos C, Hong J, et al. Testosterone replacement therapy after prostate cancer treatment: A review of literature. Sex Med Rev 2021;9:393e405.
  3. Khera M, Crawford D, Morales A, et al. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol 2014;65:115-123.
  4. A. Yassin, K. AlRumaihi, R. Alzubaidi, S. Alkadhi & A. Al Ansari. Testosterone, testosterone therapy and prostate cancer, The Aging Male 2019; 22:4, 219-227.
  5. Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montoris F. Testosterone therapy in men with prostate cancer. Eur Uro 2016; 69:894-903.

 

Chris_McNamara_0-1622520551637.jpeg

 

 

 

 

 About the Author

Kalli Spencer

MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC)

Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality.

Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups.

 

Help is Available
 

Prostate Cancer Specialist Telenursing Service:

If your life has been impacted by prostate cancer, our Specialist Telenursing Service is available to help. If you would like to reach out to the PCFA Prostate Cancer Specialist Telenurse Service for any questions you have about your prostate cancer experience, please phone 1800 22 00 99 Monday - Friday 9am - 5pm, Wednesday 10am-8pm (AEST).

 

Prostate Cancer Support Groups:

PCFA is proud to have a national network of affiliated support groups in each state and territory of Australia consisting of men and women who have a passion for assisting others who encounter prostate cancer. This network is made up of over 170 affiliated groups who meet locally to provide one-to-one support, giving a vision of life and hope after treatment. Call us on 1800 22 00 99 to find your local group.

 

MatesCONNECT Telephone-based peer support:

MatesCONNECT is a telephone-based peer support program for men affected by prostate cancer. If you’ve recently been diagnosed with prostate cancer, our MatesCONNECT service can connect you to a trained volunteer who understands what you’re going through. All of our volunteers have been through prostate cancer. Simply call us on 1800 22 00 99 to be connected with a volunteer.

 

Newly diagnosed? or need to find more information -Access the PCFA resources here!

House Rules

To help keep this community a welcoming, supportive and caring place we have put together a small list of dos and don'ts for you to think about when posting on our forum, research blog or video gallery. For further information please see our  terms and conditions.

Adhere to PCFA’s five core values of Integrity, Optimism, Compassion, Respect and Commitment.

Our online forum is for you to share experiences with others and does not contain specific medical, counselling or legal advice.  If you require professional advice specific to your individual circumstances we encourage you to see a medical professional, legal professional or counsellor.

No commercial or promotional activity. While members may share information about resources they have found helpful, the PCFA Online Community forum should not be used for the promotion of goods and services. This includes commercial entities passing themselves off as individuals and people who frequently post links to external health professionals or other services.

Be kind to each other - many people using the community are going through a difficult time. A few kind words can go a long way. Please welcome new posters – it can be very nerve-wracking to post on the forum for the first time.

If you or someone you know is suffering from mental health issues, such as depression or anxiety, we encourage you to seek assistance and contact Beyond Blue Tel:1300 224 636 or Lifeline Tel:13 11 14

Speak your mind freely, but please be sensitive to the feelings and experiences of others - you might not always agree, but you can agree to disagree in a peaceful manner.

Don't use offensive language -if a user is found to be using offensive language during their conversations the moderators reserve the right to edit the thread, without warning.

Don't use all capital letters in your posts - it's considered ‘shouting' online and it makes posts difficult to read.

Give each other the benefit of the doubt - please remember that it is all too easy for the tone and meaning of posts to be misinterpreted. Think carefully before replying to a discussion. it It is important to remember that things written rather than said can feel much stronger, so please bear this in mind when reading other people's messages.

Please respect the moderators - their job is to keep the forum safe and constructive so that everybody gets to have his or her fair say.

Stay on topic - try to focus on the original topic. In particular, don't change subject in the middle of an existing thread - just start a new thread.

Read what's already on the forum before posting - you may be repeating what others have already said or asked.

We want PCFA's Online Community to be a secure and helpful environment for all of the community. So please remember that by using PCFA's Online Community you are agreeing to follow our terms and conditions.