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Preventing and treating low testosterone can improve men’s health, even in those with prostate cancer and symptomatic prostate enlargement

For 80-plus years, it has been urologic dogma that testosterone is detrimental to the well-being of men with prostate cancer and other diseases of the prostate.

Dr. Ananias C. Diokno, former chief medical officer and chair of Urology at Beaumont Hospital, Royal Oak, believes that - contrary to popular opinion - treatment with testosterone (T) can be used safely and effectively. He says not only does testosterone alleviate the many symptoms of late onset hypogonadism that results from a testosterone deficiency (low T), but it might also be beneficial for men with prostate enlargement or prostate cancer.

Eager to gain a better understanding of testosterone’s role in men’s health, Dr. Diokno reviewed scientific, peer-reviewed papers published over the last four decades. He subsequently sought to answer another question that has perplexed him for many years: Why are prostate cancer and benign prostatic hyperplasia (BPH) more common in older men when testosterone levels have significantly declined?

Based on his findings, he authored a paper titled “?” published in the Aug. 1 issue of International Urology & Nephrology. In addition to interesting clinical data, Dr. Diokno provides a summary of basic science and animal research that explains the importance of cellular testosterone and its relationship to prostate diseases. He offers 10 recommendations as a way forward.

“The evidence and recommendations challenge current beliefs and practices,” Dr. Diokno said. “Careful analysis of the many scientific papers underscores the importance of avoiding significant testosterone decline and supports the use of testosterone replacement therapy (TRT). This new approach can revolutionize the management of men’s health, positively impacting longevity and the quality of life.”

His conclusions:

• Using testosterone in men with symptoms and signs of low testosterone significantly improves their quality of life
• A lower, rather than higher, level of testosterone or a faster decline over time appears to be an initiating factor in the development of prostate cancer and BPH
• TRT is safe and effective in men with previous prostate cancer, low-grade prostate cancer or symptomatic BPH

Among his ten recommendations, Dr. Diokno suggests health care providers initiate the following:

• Annual monitoring with questionnaires for signs and symptoms of late onset testosterone deficiency including erectile dysfunction, depressed mood, decreased muscle mass and strength, increased weight, etc.
• Reassessment of the guidelines pertaining to the diagnosis and treatment of low T
• Measuring serum testosterone levels by age 30, then periodically to monitor the rate of decline
• Initiating TRT when symptoms develop, or a significant decline is established
• Continuing vigilance and close follow-up with health care provider
• Establishing funded research to determine the role of TRT in the prevention and treatment of prostate cancer and BPH

“Millions of men throughout the world suffer from the many symptoms of hypogonadism and diseases of the prostate. Improving the quality of life with longevity for those suffering from these maladies will be a significant contribution to humanity. Preventing these diseases would be even better,” Dr. Diokno said. “It is time to embrace this opportunity to improve men’s health.”