Testosterone After Surgery or Radiation for Prostate Cancer
When it comes to testosterone, think of Goldilocks and the Three Bears: You don’t want too much, and you don’t want too little. There are health risks at either extreme. You want it to be just right, in the normal range.
“After radical prostatectomy, if you have an undetectable PSA and your testosterone is low, it’s okay to take some supplemental testosterone to restore it to normal range,” says Weill Cornell Medicine urologist Jim C. Hu, M.D., M.P.H. I recently interviewed him for the Prostate Cancer Foundation’s website, and Jim’s expert opinion also was featured in our book. What is the normal range? In our book, my co-author Edward “Ted” Schaeffer, M.D., Ph.D., Chair of Urology at Northwestern University, says it is between 300 and 800 ng/dL. (If you look on the internet, you can see the normal range as high as 1,000 to 1,200 ng/dL, but I trust and respect Ted Schaeffer’s advice.)
Restoring normal levels of testosterone has become a more common practice in recent years, Hu notes. “People used to worry that you’re pouring gas on a fire,” adding testosterone to prostate cancer – but if there is no prostate tissue, and the supplement only brings testosterone back to where it should be, it is safe. Look at it this way: It’s not like you’re re-introducing testosterone to your body, like bringing wolves back to some wilderness area where they had become extinct. You’ve already got testosterone; you’re just bringing it up to the normal level. “There is no evidence that restoring testosterone levels to the normal range makes you more likely to have a recurrence of prostate cancer if you have an undetectable PSA after surgery.”
At the American Urological Association’s 2024 meeting in San Antonio, Hu and colleagues presented results from a population-based study looking at data from SEER (the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program) and Medicare. “We found that men who got testosterone supplementation to the normal level after surgery were not at a higher risk of prostate cancer-specific mortality.” More recently, they looked at SEER and Medicare data for men with lower-risk prostate cancer on active surveillance who got testosterone replacement therapy. “These men were not at any increased risk from developing aggressive disease or dying of prostate cancer.”
“There are health risks from having testosterone below the range where it should be,” says Hu, “including a higher risk of heart attack, loss of muscle mass and bone density, a higher risk of cognitive impairment, and a higher risk of developing metabolic syndrome, which can lead to diabetes.”
Because of the benefits of having testosterone restored to the normal range, “in men diagnosed with low-risk prostate cancer who are on active surveillance, men with an undetectable PSA after surgery, or men with a low, stable PSA after a successful response to radiation therapy, testosterone supplementation is becoming a more accepted practice.”
For men who have undergone radiation therapy, Hu recommends waiting two years before considering testosterone supplementation, “to make sure the PSA has trended down in an appropriate way.” Note: If you choose to start testosterone supplementation (after radiation or surgery), it is vital that you do this in conjunction with a physician and continue to monitor your PSA closely, along with regular bloodwork to monitor liver function and blood counts.
In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.” As Patrick Walsh and I have said for years, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.
© Janet Farrar Worthington
Leave a Reply
Want to join the discussion?Feel free to contribute!