Are You on Active Surveillance but Have Low Testosterone? Here’s Good News
By Dr. Dan Sperling
Masculinity may mean different things to different guys, but the body’s chemistry behind it is virtually the same for every male. It all comes down to male hormones. These molecules, called hormones, are produced by specific organs or glands and released into the bloodstream. Think of hormones like messengers. They circulate in the body in order to “instruct” the development and function of physical male features. In addition, male hormones play a significant role in sex drive and overall energy.
The most familiar male hormone is testosterone, or T. When a man’s T level is within normal range, it helps maintain overall wellness and quality of life. However, as men age, T levels can begin to drop. Low T is no fun. Symptoms can include things like less interest in sex, erectile dysfunction (ED), fatigue, poor sleep, risk of heart problems, and loss of bone or muscle mass. Low T can even cause emotional problems like moodiness or depression.
Testosterone replacement therapy (TRT)
Thankfully, low T can be successfully treated—but it must first be accurately identified because other conditions can also cause similar symptoms. How can you know if low T is the problem? Well, a simple blood test provides your doctor with a correct diagnosis. If low T is indeed the problem, there is a great way to reverse the symptoms: Testosterone Replacement Therapy, or TRT. It is safe, and it works!
You may have heard that TRT is NOT safe if you have prostate cancer. This is not the case. Current research has established that TRT does not cause prostate cancer to begin, or to worsen low-risk disease. It is now widely accepted that prostate cancer patients who have gone through treatment, and who also have low T, can safely be prescribed TRT while being monitored for cancer recurrence.
TRT and Active Surveillance
What about patients who have been diagnosed with low-risk prostate cancer and are on Active Surveillance (AS)? The benefits of AS are increasingly being discussed with newly diagnosed patients as a way to avoid the side effect risks of whole gland treatment, for as long as possible. A July 2023 study was done to see if patients on AS who use TRT have a higher chance of getting worse cancer that needs treatment sooner. To find out, for five years the authors followed two groups of patients who were on AS. Twenty-four of the AS patients were receiving TRT, while seventy-two were not. The percent of those who came off AS to receive active treatment was the same in both groups. Therefore, the researchers wrote, “TRT was not associated with conversion to treatment in this matched analysis among patients with localized prostate cancer on AS.”i
This is good news for prostate cancer patients who are on AS and also have low testosterone. If and when they decide to move ahead with treatment, they can continue TRT as determined by their doctor.
Remember: if you have any symptoms of low testosterone, don’t try to diagnose yourself. Make an appointment to discuss your situation with your doctor and have a blood test. Even if you have been diagnosed with prostate cancer, your doctor can determine the right testosterone replacement therapy for you.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.
i Daza J, Ahmad A, Shabir U, Jing Z et al. Does testosterone replacement therapy increase the risk of conversion to treatment in patients with prostate cancer on active surveillance? Urol Oncol. 2023 Jul 7:S1078-1439(23)00215-6.
