This rise is typically due to the stimulation of prostate tissue by the increased levels of testosterone. This does not mean that TRT is unsafe, but rather that your doctor is taking precautions to ensure your prostate health is not at risk. Quitting smoking can lower your risk of developing prostate cancer and help keep your PSA levels stable. While TRT itself doesn’t necessarily cause prostate cancer, it can sometimes lead to a rise in PSA levels, which may signal an issue with the prostate. Studies have shown that TRT does not appear to increase the risk of developing prostate cancer in men who do not already have it. Testosterone Replacement Therapy, commonly known as TRT, is a treatment used to help men with low testosterone levels. Additionally, there is a higher incidence of prostate cancer among men with low testosterone. For example, if a man is found to have high levels of PSA in his blood, a prostate biopsy may be recommended to determine if prostate cancer is present. Still, they recommend caution in men who already have known prostate cancer or who are at very high risk due to strong family history. They support testosterone therapy for men with confirmed low testosterone and symptoms that affect quality of life, as long as regular monitoring is performed. What experts do agree on is the importance of monitoring PSA during testosterone therapy. Modern research has not found higher rates of prostate cancer among men treated with testosterone compared with those who are not. However, a rise in PSA does not always indicate prostate cancer—it could simply reflect increased prostate stimulation due to higher testosterone levels. Similarly, in human patients with primary hypogonadism, testosterone replacement allows the development of normal prostatic growth and BPH.5 It is also well-known that in men with diseases of the prostate (such as prostate cancer or BPH), castration or androgen deprivation treatments leads to decrease prostate size and improvement in urinary function in some patients.6 In the context of TRT, monitoring PSA levels is crucial because testosterone therapy can potentially increase PSA levels, which might signal prostate complications. Another large review of studies concluded that TRT does not cause prostate cancer but emphasized the importance of monitoring PSA levels in men undergoing treatment. By staying informed and proactive, you can enjoy the benefits of testosterone therapy while protecting your prostate health for the long term. When a man is taking testosterone therapy, his PSA (Prostate-Specific Antigen) levels are usually checked regularly to make sure his prostate stays healthy. Based on current scientific evidence, testosterone therapy does not cause prostate cancer. Today, leading medical organizations agree that testosterone therapy is not proven to cause prostate cancer, but men on TRT should be monitored regularly. For men who already had prostate cancer in the past, testosterone therapy used to be considered unsafe. From this, doctors assumed the opposite must also be true — that adding testosterone might "feed" prostate cancer cells and make them grow faster. With careful observation, testosterone therapy can be managed safely, giving men the benefits of hormone balance without ignoring prostate health. While there have been reports of metastatic prostate cancer in older men who are on testosterone therapy, these are mostly anecdotal. In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development. As such, prostate cancer incidence in men on testosterone therapy is similar to men not on testosterone therapy.18,19 Similarly, in a 3-year prospective trial, the incidence of prostate cancer was similar among men receiving TRT and controls. It has been over 60 years since Hodges and Huggins described a relationship between serum testosterone levels and prostate cancer progression. The long-standing belief was that increasing testosterone levels would stimulate prostate cancer growth or cause recurrence. Low testosterone can lead to a variety of symptoms, including fatigue, decreased libido, erectile dysfunction, loss of muscle mass, and cognitive decline. Insurers typically require symptoms plus two low morning testosterone results and periodic labs. Testing should be done in the morning (before 10 a.m.) when levels peak, and repeated on a separate day. When you confirm the diagnosis, match the formulation to your life, and monitor smartly, you can expect meaningful gains in energy, sexual health, and body composition, without trading away safety. Ask about lab bundles and telehealth follow‑ups to save time and cost. Center meals on protein (1.0–1.2 g/kg/day for most), fiber, colorful produce, and healthy fats. Current guidelines on the frequency of PSA monitoring and role of pre-treatment transrectal ultrasound guided prostate biopsy are lacking. For men with untreated prostate cancer on active surveillance, TRT remains controversial. TRT does not appear to increase cancer recurrence in hypogonadal men following radical prostatectomy. In one study, 12 months after TRT, only one patient out of 20 men with previous PIN developed overt prostate cancer. Morgentaler et al. proposed a saturation theory where prostate growth becomes insensitive to changes at normal androgen levels due to saturation of the androgen-receptor; however, there is exponential growth at castrate levels. When your testosterone levels are optimized, the improvements can extend across multiple aspects of your physical and mental well-being.
