Is Testosterone Therapy Safe? Part 2: Prostate Health

The first post in this series (Part 1) explored the cardiovascular precautions that must be taken while on Testosterone Replacement Therapy (TRT), and how we at FreshRx minimize risk for our patients with thorough assessments and close monitoring during treatment.

In part 2, we explain why prostate monitoring is part of TRT programs and how we at FreshRx keep our patients safe and worry-free while on TRT with us.

Before approving patients for TRT, we record a thorough medical history including any personal or family history of prostate cancer to assess risk for developing prostate cancer in the future. A set of labs is also drawn to assess the patient's current prostate specific antigen (PSA). PSA is a protein that is made only by the prostate. PSA gets released (and therefore is elevated in the blood) when the prostate has either grown in size, has undergone trauma of some kind, or is experiencing growth of cancer. Certain medications are also known to cause elevated PSA, so we also record a full medication list for each patient before starting treatment.

Believe it or not, prostate monitoring is done because of a presumptive risk, not an evidence-based risk. This means that TRT has not actually been shown to cause prostate cancer growth. The reason PSA is monitored during treatment is because back in the 1940s, a study observed that depriving prostate cancer patients of testosterone will shrink the cancer. It was NOT demonstrated, however (back in the 1940s or ever since then), that the addition of testosterone causes cancer to grow. So to simplify this concept, the relationship does not work both ways. In fact, studies since then have been conducted to explore the safety of TRT in prostate cancer patients, and the results have been extremely promising. Just two years ago, a literature review was published in the medical journal Current Opinion in Urology that looked at all of the evidence from the previous 80 years on this topic. The review concluded that even many men with prostate cancer are safe to receive TRT because the addition of testosterone to these patients does not cause progression of prostate cancer, nor does it increase rates of recurrence of prostate cancer.

With all of this reassuring evidence to rely on, most responsible providers still want to monitor PSA periodically. We don't do this because of fears associated with TRT, we do it because of the overall "sneaky" nature of prostate cancer. Many prostate cancer patients do not seek medical attention because early on, it is completely asymptomatic. Symptoms of prostate cancer don't start to show until the disease has progressed to a point that is more difficult to treat. At FreshRx, we draw PSA levels periodically because any man can develop prostate cancer, and increasing PSA level is often the first sign. If we can identify increasing PSA levels early, then we can refer patients to the proper specialists before they are ever symptomatic. Prostate cancer is actually a very slow growing cancer that is easy to treat when identified early, so why wouldn't we check PSA levels along with the other labs?!

If you're interested in learning more about Testosterone Replacement Therapy, reach out to us at FreshRx for a free consultation!