High Testosterone Linked to Prostate Cancer Risk
There is significant evidence that androgens promote prostate cancer in .. They measured morning serum testosterone and examined the relationship to PrCa. received testosterone as hormone replacement therapy were not at increased During the study period, about men developed prostate cancer. between testosterone levels and prostate cancer risk, and the link might. However not only does testosterone NOT cause prostate cancer, it may actually help protect against it, while another hormone appears to be.
As such, we examine the role of endogenous testosterone in patients without PrCa, the role of endogenous testosterone in PrCa patients, and the potential oncologic risks of exogenous testosterone from TRT in PrCa patients. Other aspects of TRT, including the potential benefits to hypogonadal men and risk of adverse cardiovascular effects are beyond the scope of our review and have been expertly reviewed elsewhere [ Swerdloff and Wang, ; Spitzer et al.
Androgens and prostate physiology Androgens play a critical role in male sexual development and prostate physiology.
Testosterone, prostate cancer, and balding: Is there a link? - Harvard Health
In circulation, testosterone is bound primarily to sex hormone-binding globulin SHBG while the unbound, or free testosterone, is the most bioavailable and active form.
In the second trimester, fetal testosterone induces development of the epididymis, vas deferens and seminal vesicles, while DHT mediates development of the prostate, urethra and external genitalia [ Siiteri and Wilson, ]. From birth through puberty, the prostate remains small and immature, while in postpubertal males the surge in androgens drives gland development and an increase in prostate volume up to 10 times its prepubertal size [ Swyer, ].
DHT also plays a well-established role in promoting continued growth of the adult prostate, leading to benign prostatic hypertrophy BPH [ Huggins, ; Andriole et al. LOH Serum androgen levels in men steadily decline with age, beginning in the fourth decade of life [ Harman et al.
While age-related decline in testosterone is common among US populationsit is not universal.
For instance, Ellison and colleagues demonstrated young adult elevations in testosterone and subsequent age-related declines in US and Congo populations, but not in Nepal or Paraguay [ Ellison et al.
In a subset of men, the age-related decline in androgens will lead to signs and symptoms of hypogonadism, termed LOH or androgen deficiency in the aging male ADAM. Male hypogonadism may be caused by testicular primary or hypothalamic—pituitary secondary dysfunction. LOH is typically characterized by mixed testicular and hypothalamic—pituitary dysfunction [ Vermeulen and Kaufman, ; Wang et al.
Testicular changes with aging include loss of Leydig cells, decreased testosterone production, and decreased responsiveness of the testes to luteinizing hormone LH [ Rubens et al.
The resulting amplitude of peak morning testosterone is decreased in older men, making morning testosterone measurement a useful laboratory marker in the diagnosis of LOH [ Bremner et al. Older men also demonstrate decreased amplitude and slowing of LH pulses and this hypothalamic dysfunction in LOH is characterized by low-normal LH levels, even in the presence of low testosterone [ Bremner et al. The decline in total testosterone is further influenced by an increase in SHBG that occurs with aging, which may lower bioavailable testosterone [ Vermeulen and Kaufman, ; Muller et al.
While common symptoms of hypogonadism in postpubertal men include decreased muscle mass, decreased energy, depressed mood, decreased libido, decreased spontaneous erections and erectile dysfunction, these symptoms can be considered subjective [ Wang et al.
Compared with constitutional symptoms, sexual symptoms of decreased morning erections, decreased libido and erectile dysfunction were most closely associated with low testosterone levels [ Wu et al.
Does Testosterone Cause Prostate Cancer?
Prevalence estimates of LOH vary widely depending on study methods, populations and diagnostic criteria used. The laboratory diagnosis of LOH, including guideline recommendations, has been reviewed elsewhere [ Matsumoto, ; Wang et al. Importantly, the inclusion of symptoms in the diagnosis of LOH helps to separate the pathologic condition of LOH from normal, and expected, age-dependent declines in testosterone Figure 1.
Using both laboratory and symptoms for diagnosis, the Massachusetts Male Aging Study estimated that 2.
One included 18 studies involving 5, patients with prostate cancer and 11, controls and looked at the impact of endogenous testosterone. No relationship was found between T levels and risk of prostate cancer. Advertisement The second analysis reviewed data from 24 placebo-controlled trials involving men with hypogonadism clinically low testosterone levels who took testosterone replacement therapy. Again,the experts concluded that testosterone replacement therapy did not appear to increase the risk of prostate cancer, nor an increase in PSA levels.
This suggests that having too little testosterone could be a factor and that something else—perhaps too much estrogen—could be a factor as well. Does estrogen cause prostate cancer? Estrogen as a cause of prostate cancer is gaining lots of attention. At least in rats, experts know that testosterone plus estrogen are necessary for the development of prostate cancer. In men, however, the research findings thus far have been mixed, with a few studies indicating an association between estrogens 16 and chronically high estrogens 17 and an increased risk of prostate cancer, but others showing the opposite.
Because testosterone can be changed into estrogen via an enzyme called aromatase, the critical point is to adopt habits that help reduce the activity of this enzyme.
This includes maintaining a healthy weight, losing excess belly and body fat as fat promotes estrogen productionlimiting or avoiding alcohol as alcohol is estrogenic and also affects the metabolism of testosteroneand maintaining healthy blood sugar levels. Does high testosterone protect against prostate cancer?