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Testosterone & Cancer Link
  Testosterone Therapy in Men with Androgen
Deficiency Syndromes: An Endocrine Society Clinical
Practice Guideline - pdf attached

Download the pdf here

There are theoretical concerns that testosterone treatment of older men could increase clinical prostate cancer; however, available evidence is not convincing.....the prevalence of occult prostate cancer increases with age (100), and it is not known whether increasing the serum testosterone levels into the range observed in young normal men will increase the incidence of clinical prostate cancer
cardiovascular disease risk and testosterone treatment in older subjects require a longer, large-scale, adequately powered study (23). The authors also reviewed the issue of prostate cancer. The data at present do not support the concept that testosterone is a risk factor (24) for development of prostate cancer, but Cunningham and Toma correctly argue that inadequate data are available to determine whether long-term testosterone treatment will increase the risk of either benign or malignant prostate disease.
testosterone treatment in men of all age groups should be used judiciously. More data are needed to determine which patients will benefit from treatment and for which symptoms. Long-term studies are necessary to determine whether treatment with testosterone in young, middle-aged, or older men will enhance, decrease, or have no effect on cardiovascular and prostate disorders.

Testosterone Treatment of Older Men-Why Are Controversies Created? Editorial - (02/18/11)
Why Is Androgen Replacement in Males Controversial? - CLINICAL REVIEW- pdf attached - (02/18/11)
High Blood Testosterone Levels Associated With Increased Prostate Cancer Risk
ScienceDaily (May 10, 2004) — Men over 50 years of age with high blood levels of testosterone have an increased risk of prostate cancer, according to a study by researchers at Johns Hopkins and the National Institute on Aging. The finding throws some doubt on the safety of testosterone replacement therapy, the investigators say.
The researchers measured several forms of testosterone in almost 3,000 blood samples collected over a 40-year period from 759 men in the Baltimore Longitudinal Study on Aging, of whom 111 were diagnosed with prostate cancer. One form of testosterone, called free testosterone, which is biologically active and can actually be used by the prostate, was found to be associated with increased prostate cancer risk, according to J. Kellogg Parsons, M.D., instructor of urology at the Brady Urological Institute at Johns Hopkins and lead researcher of the study.
"Since testosterone replacement therapy increases the amount of free testosterone in the blood, older men considering or receiving testosterone replacement should be counseled as to the association until data from long-term clinical trials becomes available," says Parsons.
The association between free testosterone and prostate cancer risk in older men was not affected by height, weight, percent of body fat, or muscle mass. Total testosterone levels and dehydroepiandrosterone sulfate (DHEAS), another androgenic hormone, were also unrelated to prostate cancer risk, while the protein that binds testosterone in blood, called sex hormone-binding globulin (SHBG), was associated with a slightly decreased risk for prostate cancer.
Higher serum free testosterone is associated with an increased risk of prostate cancer: results from the Baltimore longitudinal study on aging. J. Kellogg Parsons, H. Ballentine Carter, Patricia Landis, E. James Wright, Elizabeth Platz, E. Jeffrey Metter.
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Johns Hopkins Medical Institutions.
Testosterone, prostate cancer, and balding: Is there a link?
We can thank the Greeks for the name doctors apply to male hormones. Androgen comes from the words meaning “man-maker,” and it’s a well-chosen term. Testosterone is the most potent androgen, and it does make the man. It’s responsible for the deep voice, increased muscle mass, and strong bones that characterize the gender, and it also stimulates the production of red blood cells by the bone marrow. In addition, testosterone has crucial, if incompletely understood, effects on male behavior. It contributes to aggression, and it’s essential for the libido or sex drive, as well as for normal erections and sexual performance. Testosterone stimulates the growth of the genitals at puberty, and it is one of the factors required for sperm production throughout adult life. Finally, testosterone also acts on the liver. Normal amounts are harmless, but high doses can cause liver disease and boost the production of LDL (“bad”) cholesterol while lowering the amount of HDL (“good”) cholesterol.
Although testosterone acts directly on many tissues, some of its least desirable effects do not occur until it is converted into another androgen, dihydrotestosterone (DHT). DHT acts on the skin, sometimes producing acne, and on the hair follicles, putting hair on the chest but often taking it off the scalp. Male-pattern baldness (androgenic alopecia) is one thing, prostate disease quite another — but DHT also stimulates the growth of prostate cells, producing normal growth in adolescence but contributing to benign prostatic hyperplasia (BPH) in many older men.
Scientists have taken advantage of the link between male pattern baldness and BPH to develop a single medication for both conditions. Finasteride blocks the conversion of testosterone to DHT; when taken in a 5-mg dose (Proscar), it helps some men with BPH, and in a 1-mg dose (Propecia), it helps some men with androgenic alopecia. A newer drug, dutasteride (Avodart), has a similar effect on BPH but is not yet approved for baldness.
Is there another dark side to the DHT connection? Since DHT drives both hair loss and the growth of prostate cells, do men with androgenic alopecia have an increased risk of prostate cancer? Perhaps, according to scientists in Australia. They evaluated 1,446 men who were diagnosed with moderate to high-grade prostate cancer before age 70 and compared them with 1,390 men of the same age who were free of the disease. Even in the era of molecular biology, the research tool was simplicity itself. The researchers looked at each man’s scalp, then used sophisticated statistical methods to see if there was a link between hair loss and prostate cancer. They found that men with bald spots at the top of their heads (vertex baldness) were one and a half times more likely to have prostate cancer than those without bald spots. The association was particularly strong for men who were diagnosed with high-grade prostate cancer at 60–69 years of age. In contrast, there was no link between a receding hairline (frontal baldness) and cancer.


Although it may seem far-fetched, there are precedents for an association between vertex baldness and disease in men. Harvard’s Physicians’ Health Study found that men with bald spots were more likely to develop coronary artery disease than men with full heads of hair. Mild vertex baldness was linked to a 23% increase, moderate baldness to a 32% rise, and severe baldness to a 36% increase in risk. As in the Australian study of prostate cancer, frontal baldness was not associated with risk.
Although testosterone and DHT are the leading suspects, doctors don’t know what accounts for the apparent associations between vertex baldness and prostate cancer and heart disease. Although explanations are on the thin side, there is no reason to think that hair loss itself is harmful to the prostate or heart — though it may take a toll on some men’s self-image. But, more research is needed to explore the connection between hair loss and disease in men.
October 2004 Update
Prognosis: Testosterone and Prostate Cancer
NY Times
Published: April 25, 2011
Doctors have long held that men with prostate cancer should not be given testosterone because the hormone might fuel tumor growth. But a small study adds to evidence that the fear may be overblown, at least in patients without evidence of recurrent or metastatic disease.
Researchers studied 13 men with scores of 6 or 7 on the 10-point Gleason scale, indicating mildly to moderately aggressive prostate cancer. They all initially chose watchful waiting rather than treatment for their cancers. All the men had low testosterone.
The men received testosterone therapy for an average of two and a half years, and had periodic prostate biopsies. None of their cancers progressed or spread to other organs. One subject whose score had increased to 7 from 6 had his prostate removed, but the final pathological exam found no aggressive disease.
The authors acknowledge that the study, published in the April issue The Journal of Urology, was small and retrospective. Still, it is the first to use biopsies to monitor the effects of testosterone in men with untreated, localized prostate cancer.
The lead author, Dr. Abraham Morgentaler, an associate clinical professor of surgery at Harvard, said that the findings of this and other recent studies suggest that the risks of testosterone therapy may have been exaggerated.
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