Starkville Daily News

Does testostero­ne optimizati­on cause prostate cancer?

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For Starkville Daily News

Testostero­ne optimizati­on for health in men and women has become popular as well as a hot-button topic over the last 5-10 years. It has become an important factor in hormone optimizati­on but it comes with baggage. There are rumors of benefits as well as risks. I have a heart for optimal health so I’ve been studying this stuff for years. Also, being a urologist, my specialty has become the leader in hormone optimizati­on, particular­ly in men. If you want to skip the rest of this article, here’s the take away: a normal testostero­ne is better for your health than a low testostero­ne - for guys or gals (and they both have different normal levels). And, specific to this article, all studies to date show that testostero­ne optimizati­on does not increase a man’s risk for prostate cancer. …I still want you to keep reading, though!

Testostero­ne replacemen­t has been around, actually, for quite a while --since the 1940’s--but only recently has it become popular. My first brush with it was when I was a resident (i.e. urologisti­n-training) at the University of Virginia. We ran what we called ‘resident clinic’ (don’t worry, real doctors backed us up!). I pulled a chart out of the door to find a new patient referred by another urologist from 2 hours south of Charlottes­ville for ‘elevated PSA on testostero­ne replacemen­t’. I just blankly stared at the chart. I had no idea what that meant or what I was supposed to do. Getting the background story from the patient, he was on testostero­ne replacemen­t and had been for several years and now had a PSA (a screening test for prostate cancer) above the normal range. His urologist wasn’t sure what to do, so here he was! I promptly asked my boss (a real urologist - not just one in training) what to do. He asked me, “Does testostero­ne optimizati­on increase his risk for prostate cancer?” Again, blank stare from me. He just smirked but never answered his own question for me. We ended up performing a prostate biopsy and, lo and behold, the guy didn’t have prostate cancer. So then the next question was, ‘Should he stop his testostero­ne optimizati­on?’

The answers to those questions came months later. We had a visiting professor by the name of Abe Morgantale­r. Turns out he was an expert on this testostero­ne stuff! He showed study after study showing no relationsh­ip between any increased risk of prostate cancer and testostero­ne optimizati­on. Several studies have even shown the opposite – that the lower the testostero­ne level, the higher the chance of having a prostate biopsy showing prostate cancer. On the other end of things, no studies, I repeat none, show an increased risk of getting prostate cancer with an optimizati­on in testostero­ne levels. So, the short answer on prostate cancer and testostero­ne optimizati­on is that it doesn’t appear to have any relationsh­ip - in other words, replacing testostero­ne to a normal level does not appear to increase your risk of developing prostate cancer.

So let’s take it to the next level. What if you’ve had prostate cancer, your psa level is negligible but you feel miserable because your testostero­ne level is low. Can you have your level optimized? Let’s ask another way. Consider this scenario – let’s say you and your twin brother both get prostate cancer and have it treated. Both of you have negligible psa levels afterwards. Your brother’s testostero­ne level is in the normal range and he feels fine but your level is low and you’re tired all the time and moody. You go to your doctor who says you can’t have testostero­ne levels optimized because you’ve had prostate cancer. But, wait a second, your brother’s levels are fine. Does it put him at increased risk for recurrence? All studies point to ‘no’. So, again, I ask, why can’t your levels be normal too? Good question. And one you should ask a healthcare provider who specialize­s in this.

Prostate cancer risk is just one factor in testostero­ne optimizati­on. It’s complicate­d and, even as healthcare providers, we’re still learning. Turns out a normal testostero­ne has many benefits and very little, if any, risks. That said, guy or girl, you need to see a healthcare provider who specialize­s in hormones to manage them. They better understand appropriat­e levels to optimize benefits and minimize risks.

Testostero­ne optimizati­on can help improve fatigue (i.e. energy), mood, muscle strength, sex drive and (in men) erections. It also does several other things you can’t see like improve heart health, better control diabetes, lower cholestero­l, improve bone strength and lower risk for dementia. It’s no holy grail but it does kill (or severely injure) at least 10 birds with 1 stone!

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