Archive for the ‘low testosterone’ Category

There’s More To Testosterone Replacement Than Meets the Eye

February 9, 2017

Today, it is very common for middle aged men to have symptoms of low testosterone.  Many times these men will complain of decreased libido and decrease in their erections.  The treatment is hormone replacement therapy.  In addition to improving your libido, there are other advantages to hormone replacement therapy.  This blog will discuss the other benefits of testosterone replacement therapy.

Breast Formation. Male breast formation, also known as gynecomastia, is a source of anxiety for most men when they start to sprout. Men can form breasts during infancy, adolescence, old age, or anywhere in between. It all start with lowered testosterone and increased estrogen levels. Male breasts can be reduced or removed through gynecomastia surgery, but in other cases a simple adjustment of body sex hormone levels may be enough to provide the change desired.

Bone Density. Men start to lose bone mass as testosterone levels go south.  The same thing happens to women (though by a different mechanism), and typically starts to be noticed during old age. However, the groundwork for bone strength  starts in young adulthood, when your body starts to store calcium that will last for the rest of your life. If you don’t have sufficient testosterone, you can’t form bones that are strong enough to last until you die. Get tested for testosterone now to learn about how your health will be as you age.

Libido and Sexual Development. Testosterone has an enormous impact on secondary sex characteristics like body hair, but it’s absolutely central to sexual desire and performance. If you are having trouble with sexual intimacy, you may need to get checked for testosterone. Many men have seen improvement that changes their lives for the better after getting testosterone replacement therapy, without ever having to resort to pills for erections like Viagra, Levitra, Cialis.

Red Blood Cell Formation. Red blood cells are necessary for oxygen transportation in the body.  Testosterone increases the red blood cell production.  However, it is important to check the red blood cell count every 4-6 months if you are using testosterone replacement therapy as too high a level of red blood cells can be harmful.  Therefore, it is imperative to have a testosterone level, a PSA test (a screening test for prostate cancer), and a red blood cell count on a regular basis if you are using testosterone replacement options.

Bottom Line:  If you are middle age and complain of lethargy, weakness, loss of muscle mass, and alternation of your moods, then you may have testosterone deficiency.  The diagnosis is easily made with a simple blood test.  Treatment consists of injections, topical gels, patches and even small rice-sized pellets inserted under the skin.  For more information speak to your doctor.

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Testosterone, Depression, and SSRI’s or Anti-Depressants-What’s the Connection?

December 21, 2015

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have abnormally low testosterone. So what does this all mean? Did the initial low testosterone lead the individual to become depressed and go on an antidepressant? Or did the treatment with an antidepressant actually slowly reduce the individual’s natural ability to produce testosterone?

It really is a “chicken vs. egg” type argument in regards to whether low T caused depression or an antidepressant caused low T. Unfortunately there is no clear-cut scientific answer as to whether the antidepressant you took caused your testosterone to be lowered.

With that said, new research comes out all the time finding new things about antidepressants (SSRI’s) – they really aren’t well understood. Many antidepressants medications are now linked to development of diabetes, birth defects, etc. Although there are no formal studies to link antidepressants with low testosterone, many people taking these drugs are convinced that they are the root cause.

It could have been that the lower testosterone was what caused the person to feel depressed in the first place. The low T could have also merely been a coincidence among those who are depressed – after all, having low T is a pretty common issue.

Antidepressants and Testosterone: Many people taking antidepressants experience low testosterone. Similarly, many people with low testosterone are taking antidepressants. These two factors could also occur independently. In other words a person may develop low testosterone while on an antidepressant without the antidepressant being the cause. 



Depression and Testosterone: Many people may be experiencing depression as a result of low testosterone. Similarly many people may be experiencing low testosterone as a result of depression. Additionally, these two factors could be totally unrelated and independent of each other. In other words the depression could have nothing to do with low T and vice versa.
Depression and sex drive – Many people with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. People may be in such a depressed, low level of arousal, that they don’t feel like having sex. Therefore in this case, it could be that the depression and not testosterone is causing reduced sexual interest.
Testosterone and sex drive – It is well known that healthy testosterone levels are linked with a healthy sex drive. Men that have low T tend to have less fuel for sex, erectile dysfunction, and other performance issues. If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.
Low testosterone causing depression? – Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression. For this reason it is important to rule out all causes of depression (including low T) before you get on an antidepressant.
Antidepressants and low testosterone – It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many people that have taken SSRI’s believe that the drugs they took lowered their testosterone.
Bottom Line: There is no question that there is a relationship between testosterone and depression. I cannot say for certain that low testosterone is a result of the use of SSRIs. However, if you are taking SSRIs and you are experience a low sex drive or libido, it is very easy to ask your doctor to obtain a blood testosterone test. If it is low, treatment is easily accomplished with either testosterone injections, topical gels or pellets.

Low Testosterone And Depression: there is a relationship

September 27, 2015

Testosterone is more important that sex drive\libido, erections, and energy levels. A new study has documented low testosterone and testosterone that is the lower limits of normal may be associated with depression.

The study from the George Washington School of Medicine and Health Sciences in Washington, DC. included 200 adult men, who were referred for borderline total testosterone levels between 200 and 350 ng/dL. Doctors typically treat men for hypogonadism or low T if they have symptoms of low testosterone and their testosterone levels are below 300 ng/dL.

The results show that more than half (56%) of the men had depression or depressive symptoms, which is significantly higher than rates seen in general populations. A recent survey of US adults found that 6% of those who are overweight or obese were depressed. One-quarter of the men used antidepressants.

Also worth noting, the men had high rates of overweight or obesity and physical inactivity. Common symptoms were erectile dysfunction, decreased libido, fewer morning erections, low energy, and sleep disturbances.

The study authors concluded that clinicians should consider screening for depression/depressive symptoms and overweight and unhealthy lifestyle risk factors in men referred potential hypogonadism.”

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men who have documented low testosterone levels.

The researchers published their results online on July 1, 2015 in the Journal of Sexual Medicine.

Low Testosterone May Be Risk Factor for Prostate Cancer

August 7, 2015

For many years it has been thought that testosterone fuels prostate cancer and should be avoided at all costs regardless of a man’s symptoms of low libido, lack of energy and a decrease in muscle mass, just to name a few of the symptoms of low T.
Low testosterone levels predict an increased likelihood of high-grade prostate cancer being found as a result of a prostate biopsy.

A South Korean team studied 681 men who underwent an initial 12-core transrectal prostate biopsy. Of these, 86 had low testosterone levels (less than 300 ng/dL) and 143 had normal levels (300 ng/dL or higher). In addition, 143 men had a positive biopsy and 99 had high-grade prostate cancer.

Compared with a normal testosterone level, a low testosterone level was not significantly associated with a prostate cancer diagnosis overall, but it was associated with a significant 2.1 times increased risk for high-grade prostate cancer.

Bottom Line: Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out.
Reference
Park J et al. BJU Int. 2015;doi:10.1111/bju.13206.

Warning Signs of Low T (testosterone)

February 21, 2015

Millions of American men suffer from low T or low testosterone. Often they suffer in silence and not aware that there are treatment options for this common condition. This blog will discuss some of the most common symptoms that are associated with low T. In the next blog I will discuss the treatment options.

Men like to make jokes about testosterone, but testosterone deficiency is no laughing matter. The latest research suggests that men without enough of the hormone face a higher risk of several serious illnesses, including diabetes, osteoporosis, and cardiovascular disease. A simple blood test can reveal whether a man has low T.

Testosterone is what fuels a man’s sex drive. If a man is low on T, he’s likely to have a decrease or loss of his libido. Testosterone is what’s responsible for a man’s sex interest. For men with low testosterone, it’s significantly deficient or completely absent.

A testosterone deficiency can cause significant medical problems, including diabetes, osteoporosis and heart disease Three parts of a man’s body work together to produce the sperm-containing fluid that’s released when a man ejaculates. A man with waning testosterone may notice a sharp decline in his volume of his ejaculate. Men with low testosterone often complain of feeling numbness in their penis and scrotum. They may not be completely numb, but a touch of the penis or scrotom fails to elicit that feeling of electricity needed to spark sexual encounters – and make sex so pleasurable. It’s perfectly normal for a man to feel tired at the end of a busy day. But men with low T feel completely depleted. These men complain of being more tired than they think they ought to be. They seem to run out of gas in the late afternoon or early even. They often remark that “My tank is empty.”

Decreased energy level
In addition to feeling severe fatigue, guys with low testosterone often lose their drive and initiative. Guys who used to be up and at ’em all day long are sidelined on the sofa.

Even if they’re not experiencing clinical depression, men with low testosterone often feel down or blue. They feel less optimistic than they used to feel.

Low testosterone can cause guys to be irritable. Sometimes the problem is more apparent to partners, friends, family members and colleagues – than to the men themselves

It’s not like they become weaklings, but men with low testosterone often feel that they’re not as strong as they once were. Some men actually notice shrinkage in their arm and leg muscles, and in their chest. And if they try to build muscles with weight-lifting, they often find it frustratingly difficult to build muscle mass.

Low testosterone often results not only in reduced muscle mass, but also in increased body fat. Some men add weight around the middle. Others develop gynecomastic, a.k.a as breast development.

Low testosterone can cause them to shrink a bit and feel softer than normal.

The good news about low testosterone is that it’s easily treated – commonly with testosterone skin gels or under-the-skin pellets that release testosterone slowly. And in addition to helping resolve problems with sexuality, mood and appearance, testosterone therapy can help protect men against several serious medical problems, including diabetes, osteoporosis, and cardiovascular disease.

Bottom Line: Testosterone deficiency can affect millions of American men. This blog has provided some of the common symptoms of low T and in the next blog I will discuss treatment options.

Everything You Wanted to Know About Low T (Testosterone) But Afraid To Ask

February 21, 2015

Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.

Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.

The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.

My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Obesity
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
Hormonal disorders
Infections

What is the treatment for low testosterone (Low-T)?

Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.

Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.

Injections: Testosterone can be delivered by direct injection.

Pellets: Pellets can be implanted into the soft tissue and release the testosterone.

I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.

Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Skin reactions
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.

Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.

In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.

Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.

Low T-Is Clomid a Solution For Men Who Wish To Have Children?

February 19, 2015

I am now seeing many younger men with low testosterone levels who have symptoms of lethargy, decreased libido, and problems with their erections. Upon further testing, many of these men are found to have low testosterone levels or low T. This blog will discuss the use of Clomid for the management of younger men with low T levels.

Whether you are a 30, 50, 80 or even 110 year old man, having low testosterone levels (hypogonadism) is neither fun nor healthy. The symptoms of low testosterone in men range from lack of energy, depressed mood, loss of vitality, muscle loss, muscles aches, low libido, erectile dysfunction, and weight gain.
Low testosterone in men may be caused by problems in the testes (or gonads). This is called primary hypogonadism and can be brought on by the mumps, testicular trauma, or testicular cancer, etc., and is often treated with testosterone replacement therapy.

Traditionally, if low testosterone is diagnosed, testosterone replacement therapy is prescribed, and it most commonly comes in the form of a cream, gel, pellet, patch, and by injection. And although these types of therapy are effective, some methods are better than others, and there are side-effects with all of them. For example, testicular shrinkage, gynecomastia (breast enlargement), low sperm count/sterility, and polycythemia (overproduction of red blood cells) are common side-effects of testosterone replacement therapy.
However, specifically due to the risk of sterility and low sperm count, such testosterone treatments aren’t a good option for men who want to have children. In these young men, clomiphene citrate (or Clomid) and/or human chorionic gonadotropin (HCG) have been used for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help stimulate the testes to produce testosterone and thereby increase testosterone levels.

Clomid works by stimulating the pituitary gland to make more LH and there is an increased production of testosterone by the testes. HCG works by mimicking LH, which also increases the release of LH to produce more testosterone in the testes. I caution you that using testosterone in a young man wishing to have more children does the opposite of what clomiphene and HCG do and can shut off the release of LH and thus affect the testicles production of testosterone and affect sperm production.

With traditional testosterone replacement therapy, the brain (hypothalamus and pituitary) gets the message that there is plenty of testosterone being made in the testes, so much so that it doesn’t need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases, which is why traditional testosterone replacement results in testicular shrinkage and low sperm count. Clomiphene citrate and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some hypogonadal men require continuous use of clomiphene, for others it can be used for a 3-6 month time period and then discontinued. And, the checks and balances system is not interrupted, so there aren’t the testosterone replacement side-effects which may occur with tstosterone injections, gels, or pellets.
The 5 Main Reasons Clomiphene Citrate (Clomid) May be a Good Alternative to Testosterone Replacement Therapy in Men with Low Testosterone Due to Secondary Hypogonadism:
1. Clomiphene citrate stimulates the body’s own production of testosterone
2. Clomiphene citrate doesn’t interfere with the body’s checks and balances of testosterone
3. Clomiphene citrate comes as a pill easily administered by mouth
4. Clomiphene citrate is generic and very cheap
5. Clomiphene citrate has little side-effects and low risk of developing these side-effects

Bottom Line: Clomid is a treatment option in young men with low T who wish to continue to have children.

Low T (Testosterone) May Mean No Baby

February 19, 2015

I am often seeing men with symptoms of low testosterone levels who are still planning to have children. These men need to know that the standard treatment of hormone replacement may not apply to those men who are still interested in having children. This blog will discuss the management of men with low T and who wish to continue to have children.

Testosterone replacement therapy (TRT) can bring your testosterone levels back to normal and restore your sex drive.
But if you want to have children, there’s one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you’re on it.
Testosterone replacement therapy has a profound impact on a man’s reproductive potential.

Approximately 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you’re not going to increase fertility.

Testosterone, the hormone produced in the testicles, plays an important role in making sperm. Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count. When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods such as pellets placed under the skin. Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don’t make more testosterone, your sperm production goes down.
Therefore, a low sperm count makes it harder to conceive a child. My advice is that if you have any kind of reproductive goal, you should not be using TRT.

If you have low testosterone, one way to improve sperm count is with gonadotropin injections. This stimulates the production of sperm. It may be considered as a way to increase a man’s fertility when your partner are having trouble conceiving a child.
It’s standard practice to check a man’s sperm count when a couple has difficulty getting pregnant. If your sperm count is low, the next step is to measure your testosterone. If it’s below normal, we can then inject the signal to produce more testosterone by giving a gonadotropin.

You should also make sure to follow a lifestyle of regular exercise and a healthy diet if you want to father a child. Overweight and obese men tend to have lower testosterone levels because excess belly fat converts testosterone to estrogen, another hormone that can impact sperm production. Shedding those extra pounds will likely have a positive effect on your fertility. Losing weight can definitely increase testosterone.

Bottom Line: If you have symptoms of low testosterone levels or if you have an abnormal sperm count, hormone replacement with testosterone is not the treatment of choice. You should consider gonadotropin injections as a solution.

Testosterone and the Prostate Gland-It’s Not Gasoline On a Fire

November 3, 2014

For the past two years I have made the decision of treating prostate cancer patients who are documented to be hypogonadal with testosterone replacement therapy. Many of my colleagues have asked me about this decision and I would like to provide you with the evidence that this treatment of hypogonadal men who have been treated for localized prostate cancer with either radical prostatectomy or radiation therapy is safe.

In the late 1980s Dr. Abraham Morgentaler, a urologist in Boston, Massachusetts, began researching the relationship between testosterone and prostate cancer.  Since the early 1940s testosterone had been believed to be a key contributor to the development of prostate cancer, and once cancer was established, testosterone was believed to be its fuel.  As a result, generations of medical students around the world were taught that providing additional testosterone to a man with prostate cancer was “like pouring gasoline on a fire.” On the flip side, it was similarly believed that low levels of testosterone protected a man from ever having prostate cancer.

As one of the first physicians in the modern era to offer testosterone therapy to otherwise healthy men with sexual problems, Dr. Morgentaler was concerned that this treatment, while effective, might precipitate rapid growth of undetected, “occult” prostate cancers in his patients.  In order to avoid causing more harm than good, Dr. Morgentaler took the bold step of performing prostate biopsies in these men to exclude the possibility that these men harbored an undetected prostate cancer, even though they had none of the standard indications for a biopsy, such as elevated PSA or a nodule.  Although it had been assumed these men were at extremely low risk for prostate cancer because of their low testosterone levels, Dr. Morgentaler and his colleagues found exactly the opposite. One in seven of these “normal” men that underwent biopsy was found to have cancer, a rate similar to that seen in men known to be at increased risk.

Dr. Morgentaler presented his findings at the annual meeting of the American Urological Association in 1995.  At the end of the presentation an influential chairman of a major urology department came to the microphone and loudly described this work as “garbage.” “Everyone knows high testosterone causes prostate cancer and low testosterone is protective,” he proclaimed in a booming voice.  The research was published the following year in the prestigious Journal of the American Medical Association.

As the testosterone and prostate cancer link became less persuasive, Dr. Morgentaler began to offer testosterone to men with pre-cancerous abnormalities on prostate biopsy, and reported no increased rate of subsequent cancer. Yet at his own hospital, the Beth Israel Deaconess Medical Center, a senior endocrinologist complained to the administration that this research was “dangerous”.

However, Dr. Morgentaler prevailed and went on to publish clinical research on the safety of testosterone in men with actual prostate cancer, some treated with radiation or surgery, and even in selected men with untreated prostate cancer.

Dr. Morgentaler’s results were difficult to accept initially because a longstanding treatment for advanced prostate cancer has been androgen deprivation, a surgical or medical treatment designed to permanently reduce testosterone levels as much as possible. Numerous studies in these men had shown improvement in prostate cancer with this treatment, so it seemed logical that raising testosterone would cause prostate cancer progression.

Dr. Morgentaler’s elegant solution to this apparent paradox was the saturation model, based on studies in humans, animals, and in prostate cancer cell lines in the laboratory. It turned out that prostate tissue does indeed require testosterone for optimal growth, but that it can only use a limited amount of testosterone (or its metabolite, dihydrotestosterone) before it reaches a maximum. In biological terms, this is called saturation.  Once saturation is achieved, additional testosterone has little or no capability to stimulate further growth. And saturation occurs at very low levels of testosterone, approximately 20ng\dl. This explained why testosterone treatments did not appear to harm men with existing or treated prostate cancer, namely because the cancers already had seen all the testosterone they could use.

The Evidence

A number of physicians have treated patients with testosterone despite the fact that they’d been treated for prostate cancer in the past. The first to publish their experience with doing this were Drs. Joel Kaufman and James Graydon, whose article appeared in the Journal of Urology in 2004.

In this article, Drs. Kaufman and Graydon described their experience in treating seven men with T therapy some time after these men had undergone radical prostatectomy as treatment for prostate cancer, with the longest follow-up being 12 years. None of the men had developed a recurrence of his cancer. Soon afterward, there was another paper by a group from Case Western Reserve University School of Medicine describing a similar experience in 10 men with an average follow-up of approximately 19 months. Then another group from Baylor College of Medicine reported the same results in 21 men.

In all these reports, not a single man out of the 38 treated with testosterone developed a cancer recurrence. It is important to emphasize that all these reports included only men who were considered good candidates because they were at low risk of recurrence anyway. And in some cases, the duration of time the men received T therapy was relatively short. But it was reassuring that none of the 38 men who had suffered from prostate cancer in the past and who were treated for years with testosterone had developed a recurrence of prostate cancer.

This reassuring experience was bolstered by the published experience of Dr. Michael Sarosdy, who reported the results of T therapy in a group of 31 men who had received prostate cancer treatment in the form of radioactive seeds, called brachytherapy. This less-invasive form of treatment does not remove the prostate, so theoretically there is the possibility that a spot of residual cancer might still be present. With an average of five years of follow-up in these men, none of the 31 men had evidence of cancer recurrence.

My Approach

Men who have low-grade prostate cancer, i.e., Gleason score of <6, and low stage disease, T1 or T2, and have a nadir of their PSA following curative treatment with either surgery or radiation for 9-12 months, and have symptoms of hypogonadism and documented low testosterone levels, are candidates for hormone replacement therapy. I provide them with educational materials similar to what is in this newsletter and request that they return every month to monitor their PSA levels. Any increase in PSA levels for two successive months results in cessation of their hormone replacement therapy. Of the several dozen patients that meet this criteria and have received testosterone replacement therapy, none have had a rise in their PSA or evidence of recurrence of their prostate cancer.

Bottom Line: Today, most urologists throughout the world, myself included, are comfortable using testosterone in men without the fear of causing prostate cancer, and in the US a majority will now offer testosterone treatment to some men previously treated for prostate cancer.  This revolutionary change in medical beliefs and practice resulted directly from the work of Dr. Morgentaler, who became a David against Goliath and was relentless in his pursuit of scientific truth and making it possible for some men who have prostate cancer with documented hypogoandism to receive hormone replacement therapy.