Dr. Weeks’ comment: We are all taught in medical school that giving testosterone to a man with prostate cancer, is like “throwing fuel on the fire”. A brief reading of the work of the brilliant and courageous Dr. Abraham Morgentaler, M.D. (Harvard Urology) puts that erroneous myth to rest. Come back later and read THIS and THIS and THIS.
So, what does drive prostate cancer? The answer is: a metabolite of testosterone called estrogen. Estrogen is the culprit. In essence, as men age their testosterone levels decrease for three reasons: firstly, lower production in the testicles commensurate with age; secondly, through endocrine disrupting chemicals (alcohol, fluoride, sodium lauryl sulfafe and triclosan in mouthwash etc. and thirdly, the accelerated degradation of testosterone via the enzyme aromatase which creates an elevated level of estrogen. Estrogen is defined by the National Institute of Health (NIH) as a known carcinogen.
In contrast, there is no evidence that testosterone is a carcinogen… until it metabolizes to estrogen. That is why testosterone should never be given to men without an aromatase inhibitor (just like estrogen should NEVER be given to women without also giving bio-identical progesterone – not the synthetic, dangerous near miss “progestin”) Restated: testosterone is not dangerous for men unless it freely metabolizes to estrogen. The good news is that we have many ways to reduce levels of estrogen while maintaining healthy levels of testosterone in men as they age: 1) exercise does this, 2) reducing belly fat does this and 3) for those who wish to find answers to health challenges by popping a pill, this degradation can be inhibited by drugs which act as aromatase inhibitors. Medications that serve this testosterone preserving function include anastrozole, letrozole and your compounding pharmacy can create an effective cream from the flavone chrysin, When an aromatase inhibitor is taken, testosterone is able to retain its function, and not metabolize as easily to estrogen. Foods that serve as aromatase inhibitors include cruciferous vegetables like Brussel sprouts, cabbage (esp. red cabbage), broccoli and cauliflower as well as vegetables from the alium family: garlic, onions, chives, leeks and scallions. As your mother told you: “Eat your vegetables!”
Did you know that the average 70-year old wife has higher levels of testosterone, then does her 72-year old husband? Would it surprise you to know that her husband typically has higher levels of estrogen than she? You can see it for yourself if you examine his beer belly (estrogen) and her chinny-chin-chin (see that hair?). I call this “regression to the biological mean” because, as you may know male and female alike started out life as female. Then the Y chromosome started to play its own tune in the male genitalia develop. But we males eventually return to our biochemical origins if we live long enough.
So, viva la difference. Have no fear in preserving your testosterone. Read below if you still labor under the delusion that testosterone throws fuel on the fire. And never neglect to think for yourself and use common sense: Ever hear about prostate cancer in testosterone replete 20-40 year old men? Me neither.
J Urol. 2000 Mar;163(3):824-7.
Is low serum free testosterone a marker for high grade prostate cancer?
Purpose: The association of free and total testosterone with prostate cancer is incompletely understood. We investigated the relationship of serum free and total testosterone to the clinical and pathological characteristics of prostate cancer.
Results: After evaluating all 117 patients we noted no correlation of free and total testosterone with prostate specific antigen, patient age, prostatic volume, percent of positive biopsies, biopsy Gleason score or clinical stage. However, in patients with low versus normal free testosterone there were an increased mean percent of biopsies that showed cancer (43% versus 22%, p = 0.013) and an increased incidence of a biopsy Gleason score of 8 or greater (7 of 64 versus 0 of 48, p = 0.025). Of the 117 patients 57 underwent radical retropubic prostatectomy. In those with low versus normal free testosterone an increased mean percent of biopsies demonstrated cancer (47% versus 28%, p = 0.018). Pathological evaluation revealed stage pT2ab, pT2c, pT3 and pT4 disease, respectively, in 31%, 64%, 8% and 0% of patients with low and in 40%, 40.6%, 12.5% and 6.2% in those with normal free testosterone (p>0.05).
Conclusions: In our study patients with prostate cancer and low free testosterone had more extensive disease. In addition, all men with a biopsy Gleason score of 8 or greater had low serum free testosterone. This finding suggests that low serum free testosterone may be a marker for more aggressive disease.
ADULT UROLOGY| VOLUME 68, ISSUE 6, P1263-1267, DECEMBER 01, 2006
Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less
To determine the prevalence of prostate cancer in hypogonadal men with a prostate-specific antigen (PSA) level of 4.0 ng/mL or less.
Cancer was identified in 15.1%. The cancer detection rate was 5.6%, 17.5%, 26.4%, and 36.4% for a PSA level of 1.0 or less, 1.1 to 2.0, 2.1 to 3.0, and 3.1 to 4.0 ng/mL, respectively (P <0.05). Cancer was detected in 26 (30.2%) of 86 men with a PSA level of 2.0 to 4.0 ng/mL. Cancer was detected in 21% of men with a testosterone level of 250 ng/dL or less compared with 12% of men with a testosterone level greater than 250 ng/dL (P = 0.04). Men with free testosterone levels of 1.0 ng/dL or less had a cancer rate of 20% compared with 12% for men with greater values (P = 0.04). The odds ratio of cancer detection for men in the lowest tertile compared with the highest tertile was 2.15 (95% confidence interval 1.01 to 4.55) for total testosterone and 2.26 (95% confidence interval 1.07 to 4.78) for free testosterone.
Prostate cancer was present in more than 1 of 7 hypogonadal men with PSA of 4.0 ng/mL or less. An increased risk of prostate cancer was associated with more severe reductions in testosterone.