Testosterone drive and prostate cancer risk

Dear Dr G,

I understand you are dedicating the whole month of September to prostate cancer and sexual health.

I also would like to take this opportunity to discuss my dilemma with testosterone replacement therapy and prostate cancer.

I am a man in my mid-sixties and was diagnosed with Late Onset Hypogonadism, also commonly known as male menopause, ten years ago.

As my testosterone levels were so low, I was put on testosterone replacement therapy so that I could maintain my libido.

Sadly, over the last few months, I was diagnosed with prostate cancer, and the doctors suspected it is related to the testosterone drive.

My oncologists have suggested for me to stop testosterone replacement therapy.

In fact, the doctors even suggested I may need to go on medical castration to control the malignancy.

Clearly, I am horrified at how testosterone has landed me in a cancerous mess.

On the other hand, I am also fearful of how the testosterone deprivation will affect my sexual relationship with my wife in the future.

I hope to put Dr G on the spot for some clarification between testosterone drive and prostate cancer risks.

Firstly, can testosterone cause prostate cancer?

Will all men with higher levels of testosterone be at risk of prostate cancer?

On the other hand, will prostate cancer itself affect the levels of testosterone?

How can the treatment of prostate cancer alter my sex drive and erection?

And finally, will my sex life be completely doomed without my testosterone drive.

Yours truly,

Risky Rick

Prostate cancer is the most common solid tumor among men, and its relationship with testosterone has intrigued doctors and researchers for over 80 years. Testosterone, the main male sex hormone, drives male vitality, muscle mass, and, importantly, is responsible for sexual desire.

Because the prostate is a hormone-sensitive gland, both cancer and its treatments are closely tied to testosterone.

In the 1940s, researchers Charles Huggins and Clarence Hodges already discovered the curious link between testosterone and prostate cancer. The study revealed when men’s testosterone production dropped, their prostate cancer stopped growing.

The researchers also found that giving testosterone to men with prostate cancer made their cancer grow. The finding of this link was so significantly important that Charles Huggins was awarded the Nobel Prize in Physiology or Medicine in 1966. This discovery led to the long-standing belief that “testosterone fuels prostate cancer”.

Modern understanding and current evidence paint a more nuanced picture. In a Saturation model, once androgen receptors in prostate tissue are saturated at relatively low testosterone levels, additional testosterone does not significantly stimulate further cancer growth.

On the one hand, some studies suggest men with very low testosterone may present with more aggressive cancers, possibly because the disease adapts to thrive in a low-androgen environment. On the other hand, most men with normal testosterone never develop prostate cancer, indicating multiple genetic, environmental, and lifestyle factors play roles.

Although prostate cancer itself will not affect testosterone levels directly, treatments such as Androgen Deprivation Therapy (ADT), lowers testosterone to castration levels. Almost all men on ADT experience reduced or absent sexual desire, resulting in erections become rare or impossible. Patients also experience fatigue, mood swings, hot flashes, and loss of confidence further reduce sexual well-being.

Strategies to overcome libido loss have also been studied extensively. Medical interventions such as Phosphodiesterase-5 inhibitors can help with erections if nerves are intact. For men cured of prostate cancer and with low testosterone, carefully monitored testosterone replacement therapy (TRT) may restore libido, though this is still controversial and must be supervised by specialists.

Penile rehabilitation with the use of vacuum devices or injections after surgery helps preserve erectile tissue health.

Lifestyle measures such as regular exercise can boost testosterone naturally, improve mood, and enhance body image. On the other hand, a healthy diet that is rich in fruits, vegetables, lean protein can support vascular health and indirectly benefits erectile function and testosterone production.

Sleep and stress reduction also play vital roles as poor sleep and high stress lower testosterone and libido.

Psychological and relationship support can also be important for couples, as sex therapy and counseling can help couples adapt to changes in intimacy. Open communication and honest discussions with partners reduce frustration and maintain closeness.

Alternative intimacy approaches such as exploring non-penetrative sexual activity, sensual touch, and emotional intimacy can maintain connection when erections are difficult.

Australian-born academic and influential feminist Germaine Greer once warned: “Testosterone is a rare poison”.

When it comes to the poisonous effect of testosterone and prostate cancer, the relationship between testosterone and prostate cancer is complex and far from the simple “testosterone causes cancer” view of the past.

Treatments, particularly androgen deprivation therapy, can significantly reduce libido and sexual function, often impacting quality of life as much as the disease itself.

Men facing the threat of prostate cancer and challenges of testosterone deprivation treatments often put Dr G on the spot for his opinion on the utilisation of this “poison”.

His view is: “With medical therapies, lifestyle adjustments, and psychological support, many men can regain intimacy and sustain fulfilling relationships without risking cancer growth without reigniting the hormone.”