Does Testosterone Treatment Increase the Risk of Prostate Cancer?
For many years, men were told that raising testosterone (the primary male hormone) would “feed” prostate cancer. This belief came from early studies in the 1940s showing that very low testosterone levels could shrink advanced cancer. Doctors assumed the opposite must also be true — that higher testosterone levels would make prostate cancer grow.
However, modern evidence shows this belief is not correct. In fact, several extensive studies now show no increase in prostate cancer risk in men receiving testosterone therapy.
What the research shows today
- A 2016 meta-analysis of 18 high-quality studies found no link between testosterone treatment and developing prostate cancer (Calof et al., J Clin Endocrinol Metab).
https://academic.oup.com/jcem/article/90/2/747/2835953 - A 2024 European Association of Urology (EAU) review reported that men on testosterone therapy show similar rates of prostate cancer as men not receiving treatment. https://uroweb.org/guidelines/sexual-and-reproductive-health
- A 2023 UK population study of over 25,000 men found no increased long-term prostate cancer risk in those treated with testosterone for up to 10 years.
https://www.bmj.com/content/371/bmj.m3879
In simple terms, modern research does not support the idea that testosterone treatment raises prostate cancer risk.
Why Doesn’t Testosterone Cause Prostate Cancer? Understanding the ‘SaturationModel’
The key concept is the saturation model, which explains how prostate cells respond to testosterone.
How the saturation model works
- Prostate cells need androgen receptors (protein “locks”) to use testosterone (the “key”).
- Once these receptors are “full,”, extra testosterone cannot stimulate the prostate further.
- Studies indicate that these receptors become saturated at quite low testosterone levels—roughly 8–12 nmol/L.
In practice, it means:
- Increasing testosterone from very low to normal levels may stimulate the prostate slightly.
- Increasing testosterone from normal to high levels does not increase growth.
This concept is supported by:
- Morgentaler & Traish’s landmark 2009 review proposing that normal physiological testosterone levels do not promote prostate cancer growth.
https://www.nature.com/articles/nrurol.2009.243
Is Testosterone Therapy Safe for Men With a History of Prostate Cancer?
Men treatedfor low-risk prostate cancer
After treatment such as:
- robotic prostatectomy
- radiotherapy
- brachytherapy
Modern evidence suggests testosterone therapy can be safe when monitored carefully.
Supporting evidence
- A 2020 systematic review reported no increased recurrence rate in men taking testosterone after radical prostatectomy, with recurrence rates of 1–2%, similar to those of men not receiving testosterone. https://wjmh.org/DOIx.php?id=10.5534/wjmh.200073
- A 2022 study of men after radiotherapy showed no significant rise in PSA recurrence during testosterone therapy.
https://academic.oup.com/jcem/article/107/2/e698/6324371
Why testosterone may be safe even after prostate cancer
Low testosterone alone can cause:
- Fatigue
- Erectile dysfunction
- Low mood
- Poor concentration
- Reduced bone strength
- Loss of muscle
Treating these symptoms can significantly improve quality of life. When prostate cancer has been removed or controlled, restoring testosterone to a normal range does not appear to reactivate the disease.
Can Low Testosterone Be Linked With Worse Prostate Cancer?
Yes. Several studies now show that men with low testosterone may have more aggressive prostate cancer.
Key findings
- A 2017 meta-analysis found men with low testosterone had 20–30% higher rates of aggressive prostate cancer.
- Low testosterone has been linked with:
- Higher Gleason scores (a grading system for aggressiveness)
- Higher risk of locally advanced disease
- Higher recurrence after treatment
The theory is that low testosterone may reduce normal prostate cell function, allowing abnormal cells to behave more aggressively.
What Are the Benefits of Testosterone Treatment?
Raising testosterone to a normal physiological level can help with many symptoms. Around 10–40% of men over 50 have symptoms of testosterone deficiency, also known as hypogonadism (low hormone production by the testes).
Typical benefits
- Stronger erections and improved libido
- Higher energy levels and reduced tiredness
- Better mood, confidence and concentration
- Increased muscle strength
- Improved bone density, reducing osteoporosis risk
- Reduced body fat
These benefits usually appear within:
- 6 weeks for energy and libido
- 3–6 months for muscle and strength changes
- 12+ months for bone improvements
The key point: restoring testosterone helps return the body to a normal hormonal range, not an excessive level.
How Testosterone Therapy Given and Why Monitoring Matters
There are several safe and widely used methods:
1. Gels
- Applied daily
- Steady hormone levels
- Easy to adjust
2. Injections
- Short-acting injections every 2–4 weeks
- Long-acting injections every 10–14 weeks
3. Pellets (slower release implants)
- Placed under the skin
- Last around 4–6 months
Why monitoring is essential
Monitoring ensures treatment remains safe and effective. Typical follow-up includes:
- Testosterone level: to confirm it is within the normal range
- PSA (prostate-specific antigen): to monitor prostate health
- Haematocrit: to check the thickness of the blood, as high levels can occur in 3–4% of men
- Liver function: rarely affected but routinely checked
Most guidelines recommend:
- Checks at 3 months, 6 months, then yearly
Regular monitoring allows early detection of changes and ensures testosterone stays within a safe range.
Who Should Not Receive Testosterone Therapy?
Although testosterone treatment is safe for most men, certain conditions require caution.
Not suitable if
- There is active prostate cancer without treatment
- PSA is rising unexpectedly
- There is untreated severe sleep apnoea
- Haematocrit is already elevated
These situations require stabilisation firstbefore therapy is considered.
Is Testosterone Therapy Used in Men on Active Surveillance for Prostate Cancer?
Testosterone use in men with active surveillance is an area of ongoing research.
What know so far
- Small studies suggest no apparent increase in progression for men with low-risk cancer on active surveillance who start testosterone.
- A 2023 study of 120 men found a similar rate of progression (about 10%) between those on testosterone and those not on therapy over 3 years.
However, evidence is still limited, and ongoing trials aim to provide more precise answers.
Should Men With a Family History of Prostate Cancer Avoid Testosterone Treatment?
A family history (for example, a father or brother with prostate cancer) can double your risk. However, testosterone therapy itself has not been shown to increase this risk.
Recommended approach
- Baseline PSA before starting treatment
- Regular monitoring
- Awareness of symptoms such as urinary difficulty or blood in the urine
Staying proactive with screening is the most essential factor.
Frequently Asked SEO-Friendly Questions About Testosterone and Prostate Cancer
Does testosterone make prostate cancer grow faster?
Current evidence shows no significant increase in growth once testosterone levels reach the normal range due to receptor saturation.
Can you take testosterone after prostate cancer treatment?
Yes, many men can safely do so with close PSA monitoring.
Does low testosterone increase prostate cancer risk?
Low testosterone is linked with more aggressive forms in several studies.
Is testosterone therapy linked to higher PSA levels?
PSA may rise slightly when correcting low testosterone, but this does not mean cancer. A stable PSA pattern is key.
How long is testosterone treatment needed?
Most men remain on therapy long-term because symptoms return when treatment stops.
Testosterone Treatment and Prostate Cancer – The Latest Evidence Explained Simply
Modern research shows that testosterone therapy does not increase prostate cancer risk, does not cause prostate cancer to return after treatment, and may even be appropriate for selected men with a history of the disease. When monitored properly, testosterone therapy can improve energy, mood, sexual function and overall well-being without raising the risk of prostate cancer.
