Testosterone and Prostate Cancer

Dr. Weeks’ Comment:  Dr. Abraham Morgentaler, in his intriguing book Testosterone for Life clarifies that the stigma of giving testosterone to men with prostate cancer is like “throwing fuel on the fire” is based on weak science from 1941. At that time, Drs. Huggins and Hodges reported on giving  testosterone to 3 men with prostate cancer and reported worsening based on the acid phosphatase test which in 2015 is considered somewhat unreliable. So let’s go back to the 1941 article where we learn that of the 3 men referenced, only 2 men were reported on and of the 2 men, 1 of 2 had been castrated and one had received not treatments.  So the “gas on the fire” stigma resulted from giving testosterone to one man who had not received prior hormonal manipulation.  So, for the past 74 years, the fact that your urologist and oncologist think that testosterone is bad for men with prostate cancer is a conclusion based upon one case (anecdotal medicine) of one man getting “worse” per an unreliable test: acid phosphatase.

To be fair, in  1981 Drs Willet Whitmore and Jackson Fowler  at Memorial Sloan Kettering published that 45 out of 52 men experienced unfavorable response to testosterone but if you read the article and not just the title, you learn that  all but 4 had been castrated or had their testosterone lowered by estrogen therapy or androgen blockers. So let’s look at they 4 men who had normally functioning endocrine systems (which mimics most closely the men now seeking testosterone for andropause). What do we find? Of the 4  men, one actually improved with testosterone and 3 were treated for over 310 days with no problem (no worsening of cancer).

The telling and quite intriguing conclusion was “Normal endogenous testosterone levels may be sufficient to cause near maximal stimulation of prostate cancer tumors.”

 The last stickler which Dr. Morgenthaler reports  concerns the “testosterone flare” whereby  LHRH agonists are given to lower circulating testosterone but consistently do cause a transient flare of testosterone. Of interest to the scientific mind reading this book is the fact that any bad outcomes happened at least a month out  so they could not related to testosterone levels flaring since that rise in circulating testosterone happened well before a month. Furthermore, during this time of “flare” the PSA did not rise so testosterone had no effect on prostate cancer cells. Another paradoxical finding is that raising dose of testosterone increased serum testosterone but did not effect testosterone levels in prostate (biopsy) because the prostate cells are easily saturated with testosterone and elevating the serum level does not effect prostate’s experience of testosterone.

In addition to publishing his own findings of giving testosterone to men with prostate cancer (with great benefit) he also cites the work of other doctors who give testosterone to men with prostate cancer to great benefit and no recurrence. Drs. Joel Kauffman and James Graydon   J. Urology 2004  who report on 7 men given testosterone  s/p prostatectomy who showed no recurrence of  cancer  during a 12 year follow-up.  An author at Case Western reserve reported the same result for 10 men  and at Baylor University another 21 men experience the same result so a total of 38 men given testosterone after prostate cancer showed no recurrence.  Lastly, he references Dr. Michael Sarosdy  who gave 31 men brachytherapy (radioactive beads) testosterone and showed no recurrence over  5 years. 


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