Testosterone Therapy & Prostate Cancer: Killing a 1940s Myth Once and For All

For decades, men have been told a lazy story:

"Testosterone feeds prostate cancer, so if your PSA is high or you've ever had prostate issues, you can't touch TRT."

That story has been used to deny men testosterone, destroy quality of life, push castration and estrogen therapy, and scare guys (and their families) into living the last 20–30 years of life half-alive.

Here's the problem:
Modern data does not support that story. At all.

Today, we have:

  • Major specialty guidelines,
  • Large randomized clinical trials,
  • Systematic reviews, and
  • Mainstream institutions like the Mayo Clinic

all converging on the same point:

There is no evidence that properly prescribed testosterone therapy causes prostate cancer. American Urological Association+1

Let's walk through how we got here, why the "testosterone causes prostate cancer" idea is scientifically bankrupt, and what that means for you if you're considering TRT with TotalHRT.

Where the Fear Came From: A 1940s Experiment in Men Who Already Had Metastatic Cancer

The entire "testosterone = prostate cancer" myth traces back to a tiny set of patients in the 1940s.

In 1941, Huggins and Hodges looked at men with metastatic prostate cancer and measured an old marker (serum phosphatase) before and after castration, estrogen, or testosterone injections. They saw that: AACR Journals+1

  • Castration or estrogen could temporarily lower the marker.
  • Giving androgens to these men (who already had widely spread cancer) sometimes made the marker go up.

From that, they concluded that androgens "stimulate" prostate cancer.

Key problems:

  • These were very sick men with advanced disease, not healthy men with normal prostates.
  • Sample sizes were tiny by today's standards.
  • They measured crude surrogate markers, not modern PSA or actual incidence of cancer.
  • They looked at treatment of existing metastatic cancer, not whether testosterone causes cancer in the first place.

Yet, medicine built an entire dogma on that limited, 80-year-old observation:

"High testosterone is dangerous. Low testosterone is protective. Therefore, raising testosterone must cause prostate cancer."

That leap was never actually proven. It just got repeated... and repeated... and repeated.

What Modern Guidelines Actually Say: AUA Calls Out the Lack of Evidence

Fast-forward to the modern era.

The American Urological Association (AUA) convened a multi-disciplinary panel, reviewed the evidence, and issued a guideline on testosterone deficiency and TRT. In their prostate cancer section, they state very clearly that clinicians should inform patients there is no evidence linking testosterone therapy to the development of prostate cancer (their Statement 17, Strong Recommendation, Grade B). American Urological Association+1

Translation into plain English:

AUA is telling urologists: "You do not have evidence that TRT causes prostate cancer. Stop acting like you do."

Other modern expert reviews echo the same thing:

  • A 2025 detailed practice review on TRT notes no compelling evidence that testosterone therapy increases the risk of developing or progressing prostate cancer and explicitly recommends telling patients there is no evidence of increased risk, even in the context of older FDA warnings.World Journal of Men's Health
  • Reviews in major journals emphasize that the totality of data fails to show increased prostate cancer incidence with TRT and call the old fears "misconceptions."OUP Academic+1

So when a clinician still tells a symptomatic, hypogonadal man that "TRT causes prostate cancer," they are not aligned with current urology guidelines.

If you want a mainstream, patient-facing explanation, here it is:

The Mayo Clinic's guidance on "Testosterone therapy and prostate cancer" explains that:

  • Historically, doctors believed higher testosterone could fuel prostate cancer.
  • But newer data does not support a link between TRT and prostate cancer development.
  • This has led to a re-evaluation of the old dogma and more nuanced, evidence-based decision-making.Mayo Clinic

When places like the Mayo Clinic are updating their language, it's a clear sign the science has moved on — even if some clinicians haven't.

Large Modern Trials: TRT Does Not Increase Prostate Cancer Risk

We now have big, modern studies that directly look at prostate safety on TRT.

JAMA Network Open 2023: Prostate Safety Trial

In 2023, Bhasin and colleagues published a randomized clinical trial in JAMA Network Open looking at men with hypogonadism on testosterone vs placebo, carefully screened to exclude high-risk prostate cases. Their findings:PMC+1

  • The incidence of prostate cancer (any or high-grade) was low.
  • No significant difference in prostate cancer events between TRT and placebo.
  • Other prostate events (like biopsies) were also similar.

This is the kind of trial design critics said they "needed" to feel comfortable. It's here. And it doesn't show what the old myth predicts.

Systematic Reviews & Meta-Analyses

Multiple systematic reviews and meta-analyses have looked at TRT and prostate cancer risk:

  • A 2021 review reported no higher rate of biochemical recurrence in men who received TRT after definitive treatment for non-metastatic prostate cancer, compared with those who didn't.PMC
  • Meta-analyses summarized by Loeb and colleagues note no increased incidence of prostate cancer in hypogonadal men on TRT vs those not treated.ASCO Publications+1
  • A 2025 systematic review of testosterone therapy in men with localized prostate cancer found no signal of worse oncologic outcomes with physiologic TRT dosing.BJUI+1

When you zoom out, the pattern is crystal clear:

Across multiple studies, TRT does not increase the risk of getting prostate cancer or make properly managed prostate cancer worse.

Logic Check: Who Actually Gets Prostate Cancer?

Here's the common-sense part that never matched the old fear narrative:

  • Young men have high testosterone and almost never get prostate cancer.
  • Older men often have low testosterone and are the ones who do get prostate cancer.

Epidemiologic and mechanistic data now suggest that low testosterone is associated with worse outcomes, not protection:

  • Reviews of endogenous testosterone and health outcomes show that lower testosterone correlates with higher rates of metabolic disease, cardiovascular events, and mortality — and does not protect against prostate cancer.PMC+1
  • A 2025 endocrine review summarizing TRAVERSE and other trials reiterates that properly monitored TRT does not drive new prostate cancer but may improve overall health risk profiles in men with documented hypogonadism.OUP Academic+1

The old "more testosterone = more prostate cancer" idea simply doesn't fit how the real world actually behaves.

What About Men Who Already Had Prostate Cancer or High-Risk Lesions?

The question that makes even progressive clinicians nervous:

"If I had prostate cancer or a concerning biopsy in the past, is TRT automatically off the table forever?"

Modern data says: Not necessarily.

  • A 2025 study in World Journal of Men's Health showed that men with high-grade prostatic intraepithelial neoplasia (PIN) who received TRT for a year did not experience increased prostate cancer risk compared with those who did not. The authors concluded that PIN alone is not a contraindication to TRT.World Journal of Men's Health+1
  • Systematic reviews of men who underwent definitive treatment (surgery or radiation) for localized prostate cancer and then later received TRT show low recurrence rates, often similar to or lower than in comparable men who remained hypogonadal.PMC+1

Is this an automatic green light? No.** These are nuanced, case-by-case decisions requiring:

  • Clear pathology and staging history,
  • Stable PSA trends,
  • Coordination with a knowledgeable urologist and TRT-literate clinician.

But the idea that "any history of prostate issues = lifetime ban on TRT" is simply not supported by modern evidence.

Beyond the Prostate: Evidence-Based Benefits of Testosterone Optimization

Once you stop clinging to the prostate myth, you can actually look at what TRT does for men with real testosterone deficiency.

A small sample of what the literature shows:

1. Metabolic & Diabetes Benefits

  • In men with type 2 diabetes or metabolic syndrome, TRT has been shown to improve insulin resistance, lipids, waist circumference, and other cardiometabolic risk factors.PMC+1
  • The T4DM trial and related work show that, on top of lifestyle intervention, testosterone treatment can reduce progression to type 2 diabetes in men with prediabetes and low T.OUP Academic+1
  • Recent coverage in The Cardiology Advisor highlighted that testosterone therapy was associated with mitigation of kidney injury markers in men with diabetes and hypogonadism — tying testosterone status to kidney health, not just energy and libido.The Cardiology Advisor+1

2. Cardiovascular Safety (and Possibly Benefit)

  • The TRAVERSE trial (NEJM 2023) followed over 5,000 men with hypogonadism and high cardiovascular risk. Testosterone therapy was non-inferior to placebo for major adverse cardiovascular events — in other words, no increase in heart attack, stroke, or CV death when TRT is used appropriately.PubMed+1
  • A 2024 review concluded that TRT does not worsen cardiovascular outcomes and may reduce mortality when men are treated and monitored correctly.PMC+1

3. Mood, Energy, Sexual Function, and Body Composition

  • Hypogonadal men treated with TRT report improvements in mood, energy, libido, and erectile function, often documented in standardized quality-of-life scores.Endocrinology Advisor+1
  • Long-term TRT is consistently associated with increased lean mass, decreased fat mass, and improved strength when combined with resistance training and proper nutrition.PMC+1

In short: refilling a deficient hormone back into a physiologic range tends to make human beings function better. Shocking.

How TotalHRT Approaches Testosterone Therapy (So You're Not a Lab Rat)

At TotalHRT, our entire model is built around data, not dogma.

Here's how we think TRT should be done:

Thorough evaluation, not a "Low T" drive-thru.

  • Full hormone panel (total and free testosterone, SHBG, estradiol, etc.)
  • Baseline PSA and prostate risk assessment in men over 40 or those with risk factors, exactly as AUA recommends.NYU Langone Health+1
  • Cardiometabolic markers (lipids, glucose/insulin/A1c, kidney and liver function).

Individualized dosing to physiologic levels.

  • Not "bodybuilder blasts," not under-dosing.
  • Aim is to restore healthy, youthful ranges, not push you into supraphysiologic territory.

Continuous monitoring.

  • Regular follow-up labs (including PSA as indicated) and symptom tracking.
  • If anything looks off, we adjust — we don't bury our heads in the sand.

Integrated care, not siloed thinking.

  • We coordinate with prescribing doctors, urologists, and other specialists rather than pretending TRT exists in a vacuum.
  • We stack TRT intelligently with nutrition, training, lifestyle, and (when appropriate) peptides to get compounding benefits, not isolated band-aids.

The point isn't "TRT is magic and risk-free."

The point is:

When you treat documented hypogonadism properly, the data overwhelmingly supports safety and real, measurable benefits — including for men who have been scared away for years.

Bottom Line: Stop Letting Outdated Dogma Steal Decades of Quality Life

If you're a man over 35–40 who:

  • Has classic low-T symptoms (fatigue, low drive, belly fat, brain fog, depression),
  • Has labs confirming low testosterone, and
  • Has been told "you can never use TRT because of your prostate,"

you deserve a second opinion grounded in 2020s medicine, not 1940s dogma.

Modern guidelines from the AUA, patient-facing education from the Mayo Clinic, and large randomized trials like TRAVERSE and the JAMA prostate safety study all converge on the same message:

Properly prescribed testosterone replacement therapy has no proven link to causing prostate cancer — and it may significantly improve your metabolic, cardiovascular, kidney, and overall health when you actually need it.The Cardiology Advisor+4American Urological Association+4Mayo Clinic+4

If you're tired of feeling half-alive because someone is still operating off a single, ancient experiment in men who were already dying of metastatic disease, it's time to upgrade your information and your care.

Ready to See What Optimized Testosterone Could Do For You?

Step 1: Get a comprehensive lab panel and symptom review.

Step 2: Sit down with a clinician who actually understands the modern data on TRT and prostate health.

Step 3: Build a testosterone optimization plan that is tailored, monitored, and integrated with your nutrition, training, and overall longevity strategy.

That's exactly what we do at TotalHRT by WellEvate.

You don't have to keep sacrificing your energy, strength, libido, mood, and long-term health because someone is afraid of a myth that should have died 20 years ago.

Important Disclaimer

This article is for education and advocacy only. It is not medical advice and does not diagnose, treat, cure, or prevent any disease. Testosterone and any other medications should only be used under the supervision of a licensed medical professional, with appropriate lab testing and follow-up. Never start, stop, or change any prescription based solely on information from the internet — including this article.

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