Testosterone replacement is considered safe for people who are at low risk for a recurrence and who have had adequate therapy and are considered to be in remission.
Testosterone Laboratory Blood Testing
Blood tests are a factor that is used to determine whether testosterone replacement is needed. If you are having your testosterone level checked with a home test or at a laboratory as ordered by your doctor, your results might not be clear-cut.
Issues that affect blood levels of testosterone:
Testosterone blood levels are higher in the morning and lower in the evening. A test drawn at 4 pm that was “low” may simply be outside the normal range due to the time of day the blood was taken. There are two types of testosterone tests: total testosterone and free testosterone. Most routine tests only measure total testosterone. However, free testosterone is a much more accurate measure of the physiologic activity of testosterone.
Making a decision about your need for testosterone therapy is not based solely on the level of testosterone in your blood. It is equally important to consider your symptoms and whether they are indicative of low testosterone levels.
Testosterone Therapy and Prostate Cancer
Testosterone therapy may increase the risk of prostate cancer recurrence for some people.
Some factors that are particularly associated with a high risk of recurrence:
Extraprostatic extension (spread of cancer outside the prostate) Positive margins Positive nodes Gleason scores of 8 or more on biopsy Invasion of the seminal vesicles
There are some situations when testosterone therapy would not be harmful and may be beneficial for people who have had prostate cancer.
Men who have low-grade or benign tumors Men who have completed therapy with surgery or radiation and appear to be cured can use testosterone therapy after an appropriate waiting period between two and five years. The risk of cancer recurrence at this point is generally quite low. When a man with known prostate cancer has a low testosterone level and severe physical infirmity or very advanced muscle loss that is associated with notable weakness.
Why the Confusion?
The confusion about using testosterone therapy in men with known prostate cancer arises because prostate cancer is not a single illness.
There are:
Low, intermediate, and high-grade formsLocalized disease and metastatic cancerHormonally sensitive types and types that are insensitive to hormone treatment
A single protocol would not be universally appropriate for every type of prostate cancer.
Testosterone Therapy Administration and Risks
Testosterone therapy comes in different formulations, including short or long-acting injections, creams, gels, and transdermal patches. Additionally, there is an approved oral treatment option.
There is variability in the way that men will respond to testosterone therapy. For some people, the impact of testosterone replacement is prompt and dramatic. In other men, even after an adequate trial period of six months, a noticeable benefit may be lacking.
The only way to know for sure whether you will benefit from testosterone is to give it an adequate trial period.
Testosterone replacement can increase the risk of blood clots. Long-term testosterone replacement therapy is associated with an increased risk of cardiovascular problems, including heart attacks and strokes, particularly in older males.
