Historically, prostate cancer – both active and treated - has been an absolute contraindication to testosterone therapy and – from a regulatory perspective – still is. The incidence of prostate cancer is higher in older men, in whom prostate cancer accounts for one in five new cancer diagnoses.
Thanks to improvement in early detection and treatment of prostate cancer, prostate cancer mortality has decreased 50% during the past two decades, and more men are living with a history of prostate cancer.
The aging of the male population and the increasing number of prostate cancer survivors have resulted in a significant increase in the number of men presenting with hypogonadism and treated prostate cancer. Therefore, it is important to consider the growing number of recent studies which have challenged the long-standing belief that prostate cancer is an absolute contraindication to testosterone therapy.[2-4]
Here I summarize the results of a notable study which investigated the effects of testosterone therapy in men with treated and untreated prostate cancer , and conclude with the latest recommendations on managing testosterone deficiency in men with history of prostate cancer.
One main reason testosterone replacement therapy (aka testosterone treatment) is surrounded by controversy is that testosterone can be abused, both in athletic populations and the general public. Scientific evidence is undisputed that testosterone y potently enhances physical performance and increases muscle growth.[1-3]
The ethical issue of fair play in sports, coupled with the well-known adverse health effects of supra-physiological doses of anabolic steroids [4-14], has given medically legit testosterone replacement therapy (aka TRT, testosterone therapy or testosterone treatment) a bad reputation and is depriving many suffering men with testosterone deficiency from receiving medically needed testosterone treatment.
In this article I will point out the salient differences between use testosterone replacement therapy – a.k.a. testosterone therapy or testosterone treatment - and abuse of anabolic steroids, and explain why testosterone treatment - which per definition is medically provided and supervised - has no parallel with abuse of anabolic steroids.
Fear of prostate cancer remains one of the major concerns with testosterone therapy among doctors, and reason to deny suffering hypogonadal men testosterone treatment.[1, 2]
This fear persists despite mounting research over the past decade that has clearly refuted the belief that testosterone therapy increased risk of prostate cancer among men in the general population.[3-5]
Aside prostate cancer, benign prostatic hyperplasia (BPH) with its associated lower urinary tract symptoms (LUTS) are also common concerns with testosterone therapy.
In this article I summarize and comment on the results of the Registry of Hypogonadism in Men (RHYME) study; a large, multi-national prospective registry of men with testosterone deficiency, which was designed and powered specifically to assess prostate cancer outcomes in hypogonadal men receiving testosterone therapy compared with untreated hypogonadal men or general population estimates.-
The science of aging is moving forward as scientists are elucidating the biology of aging. The ultimate goal is to develop treatments that delay aging, and in so doing, delay the development of aging-related diseases.
Aging is the greatest risk factor for the majority of chronic diseases that are driving morbidity and health costs , but the aging process can be delayed with lifestyle (exercise and nutrition), genetics, and pharmacologic approaches.[3-8]
The so called “geroscience hypothesis” (“gero” is short for gerontology, which is the scientific study of the process of aging and its consequences) holds that treatments that are targeting fundamental processes of aging may delay, prevent, alleviate, or reverse a wide range of diseases and conditions for which age is the primary non-modifiable risk factor. Interventions that target fundamental aging processes have the potential to transform human health and health care.
Excitement is now high because time has come for the first study to test the effect of metformin on aging-related outcomes in humans and see if it qualifies as an "anti-aging pill"...
If you are following the anti-aging news, you’ve heard about the supposed benefits of chronic calorie restriction for increasing longevity. These claims are based on research done in various species such as flies, worms and mice.
Here I will explain that chronic calorie restriction makes it impossible to implement and reap the health benefits of an active lifestyle with regular exercise, and causes severe health consequences for humans.
While animal studies can and do shed light on what’s going on at mechanistic level, we have to be very careful and resist the temptation to extrapolate results from animal experiments to humans.
Here I will make the case that chronic calorie restriction actually counteracts the prospects of a healthy vital long life.
A bidirectional relationship exists between excess body fat, and/or belly fat, and testosterone levels in men. That is, excess body (belly) fat decreases testosterone levels and may cause testosterone deficiency, and low testosterone levels increases body (belly) fat.[1-4] I covered this in-depth in a previous article “Testosterone and Fat Loss - the Evidence”.
In “Keep your waist to less than half your height” I introduced the waist-to-height ratio and explained that it is a better tool for predicting health outcomes and mortality than is waist circumference alone. I have also covered the association between a large waist (i.e. belly) and reduced testosterone levels in "Young Men, Waist, Testosterone and Erectile Function: Low-T is not only an old man's issue".
Here I will summarize research showing that the waist-to-height ratio can also be used as a screening tool for testosterone deficiency.
Most people, including traditional doctors, think that testosterone deficiency is an old man’s issue. This is very wrong! Actually, an excess amount of body fat can cause a man’s testosterone levels drop to as much as 10 years of aging.
Several studies have demonstrated that too much body fat is associated with reduced testosterone levels independent of aging.[2-4]
Low levels of testosterone (both total and free testosterone) are a consistent feature among young men below 40 years of age with metabolic syndrome, the hallmark of which is an enlarged belly.
Young men (20–39 years) with the lowest baseline total testosterone levels have the highest risk of developing cholesterol and blood fat abnormalities (dyslipidemia).  Compared to age-matched men with the highest baseline total testosterone levels of 663 ng/dL or higher, those with the lowest baseline total testosterone levels of 418 ng/dL or below had up to a twofold greater risk of developing an adverse lipid profile 5 years later, which in turn could contribute to future risk of cardiovascular disease.
Thus, testosterone deficiency clearly has health implications also for younger men. But how much does your belly actually impact your testosterone levels… and erectile function?
In a previous article “Watch Your Belly – not just to look good!” I summarized research showing that an expanded belly is a ticking health bomb and manifestation of deteriorating vitality, as well as reduced physical attractiveness.
Measuring your waist circumference is a good starting point to see where you stand (i.e. to get your baseline) and monitor your progress with exercise and healthier eating. And esthetically, your waist measure tells a lot.
Nevertheless, accumulating research shows that health outcomes are more strongly associated with the ratio of your waist to your height, i.e. the waist-to-height ratio. The waist-to-height ratio is simply the ratio of your waist circumference to your height (abbreviated WHtR). To stay (or become) healthy, as well as physically attractive, make sure your waist circumference is less than half your height.
In a previous article "Testosterone Deficiency and Treatment - the FACTS" I presented the conclusions from an International Expert Consensus Conference on Testosterone Deficiency and Its Treatment.
Here I summarize the key points, and link to a video summary by Dr. Abraham Morgentaler, an internationally renowned testosterone scientist and clinician.
Over the past two decades it has been established beyond any doubt that the amount of fat around the waist (aka abdominal fat and visceral fat) is at least as important, if not more important, than the total amount of body fat in predicting and /or causing complications that have been traditionally associated with overweight/obesity.
Abdominal obesity is a strong risk factor for cardiovascular disease independent of BMI (a proxy for obesity) [2, 3] and is thought to affect disease risk through increased insulin resistance.[4, 5] Actually, the common development of insulin resistance with aging is caused by growing bellies, rather than aging per se. Notably, normal-weight abdominal obesity is associated with higher mortality than generalized obesity (as defined by BMI).
An enlarged belly is an especially strong indicator of metabolic risk in men.[8, 9] People with large a waist circumference – i.e. those having a belly - have an increased risk of cardiovascular disease, diabetes and cancer, compared to those with smaller waist circumferences, regardless of BMI. [10-14] Your waist also impacts your longevity, which I covered in a previous article "Watch Your Waist - it may shorten your life!"
And your belly can interfere with your sex life...