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Overall 10 patients at one point in the study had a velocity greater than 0.4 ng/ml, yet no cases of prostate cancer were observed. The authors concluded that overall, and particularly in trials not funded by the pharmaceutical industry, exogenous T increased the risk of cardiovascular-related events Xu et al. 2013. Two meta-analyses found no differences in cardiovascular events between TRT and placebo groups Fernandez-Balsells et al. 2010; Calof et al. 2005, while a more recent meta-analysis found that TRT increased the risk of cardiovascular events, although the data seemed to vary by source of research trial funding. Low endogenous T levels correlate with an increased risk of adverse CVD events, and endothelial dysfunction and increased atherosclerosis are means by which male hypogonadism may contribute to an increased risk of death Jackson et al. 2010. While TRT may increase serum prostate-specific antigen levels in some men, it often remains within clinically acceptable ranges, and has not been shown to increase the risk of prostate cancer. This approach must be carefully tailored to the individual to minimize the risk of recurrent allergic reactions.
Close monitoring for signs of an allergic response is particularly important in the initial stages of testosterone treatment. Given that testosterone is often administered in various forms, including injections, patches, and gels, the likelihood of an allergic reaction may vary depending on the formulation. Testosterone therapy is often used to treat low testosterone levels in men and sometimes in women. However, the potential for allergic reactions necessitates a cautious approach. Mild reactions might include skin irritation, itching, or redness at the site of application or injection. For instance, topical gels, injections, and patches each carry different risks of allergic responses. Testosterone Replacement Therapy (TRT) has become a pivotal treatment for American males experiencing hypogonadism, a condition characterized by abnormally low levels of testosterone.
While the primary outcomes of the study focused on the metabolic syndrome, secondary outcomes included various prostate parameters. They also found favorable results with regard to prostate cancer specific outcomes, including tumor grade and clinical staging. However, prior literature has failed to definitively demonstrate an increased risk in a cause-and-effect relationship. This model also explains how castration results in dramatic regression of prostate cancer, as there is no longer an available substrate for the androgen receptors Morgentaler and Traisch, 2008.
Aside from the most common side effects of testosterone therapy, some nasal gels may also cause nasal congestion or irritation. Some people who take topical testosterone may also be at an increased risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE). Beyond these side effects, there may be additional, more serious risks from using topical testosterone. Most males can tolerate testosterone treatment quite well, but a small number develop emotional side effects from the hormonal changes. Follow the application directions on the package carefully and report any skin reactions to your doctor. While testosterone is not known to cause prostate cancer, it may fuel its growth if already present. If you have a history of such conditions or are considered at high risk, talk with your doctor about whether topical testosterone is safe for you to use.
One observation that should be considered is the increase in prostate volume demonstrated in the studies by Page and Yassin and colleagues described above. This study adds to the mounting evidence that suggests TRT may in fact improve LUTS; however, this study is limited in that men with severe LUTS by IPSS and evidence of obstruction were excluded. There was no difference in IPSS scores when adjusted for weight loss during the study period or concomitant use of vardenafil. A recent prospective longitudinal observational registry of 259 men investigated the effects of TRT on LUTS in men with TD Yassin et al. 2014. A randomized, double-blind, placebo controlled trial of 53 men aged 51–82 years old with symptomatic BPH, prostate volume 30 cm3 or greater, and serum total T less than 280 ng/dl were randomized to daily transdermal 1% T gel plus oral placebo or dutasteride for 6 months Page et al. 2011. One randomized controlled trial of 46 men evaluated the effects of intramuscular T administration on LUTS in men with known BPH Shigehara et al. 2011.
The FDA has issued a warning of the potential increased risk of cardiovascular events among people using testosterone products. The supportive argument posits that by treating men with TRT, thereby increasing PSA levels and administering T to a steroid responsive cancer, a man’s risk of development of prostate cancer is significantly increased. It has been demonstrated in several trials that TRT increases serum PSA levels in some men, while androgen deprivation therapy can be used in the successful treatment of prostate cancer. While TRT for treatment of TD may cause elevations in serum PSA in some men within safe parameters (as outlined in the Endocrine Society Guidelines), it has not been definitively shown to lead to a significantly increased risk of prostate cancer Bhasin et al. 2010.
Close monitoring for signs of an allergic response is particularly important in the initial stages of testosterone treatment. Given that testosterone is often administered in various forms, including injections, patches, and gels, the likelihood of an allergic reaction may vary depending on the formulation. Testosterone therapy is often used to treat low testosterone levels in men and sometimes in women. However, the potential for allergic reactions necessitates a cautious approach. Mild reactions might include skin irritation, itching, or redness at the site of application or injection. For instance, topical gels, injections, and patches each carry different risks of allergic responses. Testosterone Replacement Therapy (TRT) has become a pivotal treatment for American males experiencing hypogonadism, a condition characterized by abnormally low levels of testosterone.
While the primary outcomes of the study focused on the metabolic syndrome, secondary outcomes included various prostate parameters. They also found favorable results with regard to prostate cancer specific outcomes, including tumor grade and clinical staging. However, prior literature has failed to definitively demonstrate an increased risk in a cause-and-effect relationship. This model also explains how castration results in dramatic regression of prostate cancer, as there is no longer an available substrate for the androgen receptors Morgentaler and Traisch, 2008.
Aside from the most common side effects of testosterone therapy, some nasal gels may also cause nasal congestion or irritation. Some people who take topical testosterone may also be at an increased risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE). Beyond these side effects, there may be additional, more serious risks from using topical testosterone. Most males can tolerate testosterone treatment quite well, but a small number develop emotional side effects from the hormonal changes. Follow the application directions on the package carefully and report any skin reactions to your doctor. While testosterone is not known to cause prostate cancer, it may fuel its growth if already present. If you have a history of such conditions or are considered at high risk, talk with your doctor about whether topical testosterone is safe for you to use.
One observation that should be considered is the increase in prostate volume demonstrated in the studies by Page and Yassin and colleagues described above. This study adds to the mounting evidence that suggests TRT may in fact improve LUTS; however, this study is limited in that men with severe LUTS by IPSS and evidence of obstruction were excluded. There was no difference in IPSS scores when adjusted for weight loss during the study period or concomitant use of vardenafil. A recent prospective longitudinal observational registry of 259 men investigated the effects of TRT on LUTS in men with TD Yassin et al. 2014. A randomized, double-blind, placebo controlled trial of 53 men aged 51–82 years old with symptomatic BPH, prostate volume 30 cm3 or greater, and serum total T less than 280 ng/dl were randomized to daily transdermal 1% T gel plus oral placebo or dutasteride for 6 months Page et al. 2011. One randomized controlled trial of 46 men evaluated the effects of intramuscular T administration on LUTS in men with known BPH Shigehara et al. 2011.
The FDA has issued a warning of the potential increased risk of cardiovascular events among people using testosterone products. The supportive argument posits that by treating men with TRT, thereby increasing PSA levels and administering T to a steroid responsive cancer, a man’s risk of development of prostate cancer is significantly increased. It has been demonstrated in several trials that TRT increases serum PSA levels in some men, while androgen deprivation therapy can be used in the successful treatment of prostate cancer. While TRT for treatment of TD may cause elevations in serum PSA in some men within safe parameters (as outlined in the Endocrine Society Guidelines), it has not been definitively shown to lead to a significantly increased risk of prostate cancer Bhasin et al. 2010.
