I have been a proponent of testosterone replacement therapy in men
with documented low levels of testosterone. Men with low testosterone
present with lethargy, malaise, decrease in libido, erectile
dysfunction, falling asleep after meals and loss of muscle mass. The
diagnosis is easily made with a blood test, the serum testosterone
level, and is easily treated with injections of testosterone or the
application of testosterone gels to the skin. The medical textbooks in the 1990’s state that the treatment is
contraindicated in men with difficulty with urination, untreated
obstructive sleep apnea, high blood counts, and in men with prostate
cancer.
But now there are a few doctors who question the advice of avoiding
testosterone in men who have been successfully treated for prostate
cancer. For decades the prevailing treatment for men with prostate
cancer that spread beyond the prostate gland was to decrease the
testosterone produced by the testicles. This was accomplished by
removing the testicles or orchiectomy, or medically castrating the men
with drugs that produced castrate levels of testosterone in the blood.
Dr. Abraham Morgentaller, a urologist a Beth Israel Deaconess
Hospital in Boston, began treating men with prostate cancer, who had
symptoms of low testosterone and confirmed by the blood testosterone
test, with supplemental testosterone. This was certainly against the
previous advice of other urologists.
What is the evidence to support this new approach to testosterone
deficiency in men with prostate cancer? Dr. Morgantaler published a
report that men who developed prostate cancer had a statistically
lower testosterone level than men who were free of prostate cancer.
He also started treatment of a select group of men with prostate
cancer with testosterone and followed them closely with PSA tests and
found that there was no increase in the PSA test but marked
improvement in the men’s libido, energy level, and over all quality of
life.
So what is a man to do? Talk to your doctor. If your doctor agrees
that there may be a roll for testosterone in men with prostate cancer,
you can receive therapy with testosterone replacement. In my practice
I select men who have zero, or near zero, PSA tests for at least one
year after treatment for prostate cancer. They receive testosterone
replacement under close scrutiny and must agree to getting a PSA test
every month. If the PSA rises, then they must agree to discontinue
the testosterone replacement therapy.
