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DEAR DR. ROACH: I'll be 70 in August, and in 2012, I had prostate cancer. My prostate was removed. My PSA level was low but rose fast, so I guess it was an aggressive form of cancer. After the removal, they still found evidence of cancer, and I underwent 35 radiation treatments that were also completed in 2012.
Afterward, I had two Lupron shots to keep my testosterone low. I guess it's been very low ever since. Beginning in 2017, I have been on GLP-1 agents for diabetes, and I'm now on Mounjaro. These meds have been great; I've lost 50 pounds, and all my numbers are perfect. Without testosterone, though, I've lost a lot of muscle.
I'd like to begin some testosterone therapy and weight work in order to start to regain as much muscle as I can. Weights alone don't seem to do much. The cancer doctor says that I'm crazy to want to start testosterone. What do you think?
-- D.R.
ANSWER: This remains a controversial subject. On the face of it, your cancer doctor has a point. Your prostate cancer was stopped by preventing your body from making testosterone. It worked, and now you're alive. Men with high-risk prostate cancer in particular have an increased risk that testosterone (your own or prescribed) could stimulate dormant cancer cells. Your cancer specialist has the relevant information about the pathology of your cancer, and if they're recommending against it, I won't urge you to do so.
Men with lower-risk prostate cancer (Gleason 6, or 3+3) who don't have any evidence of the disease (a PSA score of 0) have only a very small risk of recurrent prostate cancer when they're being treated with testosterone replacement therapy. Studies found recurrence rates to be between 0% and 7% in up to five years of follow-ups.
In my own practice, I discuss the risks and benefits with my patients, and if they're interested, I have them discuss it with their expert -- usually a urologist but sometimes a medical oncologist.
I understand why you're interested in testosterone to build muscle and perhaps increase your energy and vigor; however, you don't want to do this at the cost of a recurrence of life-threatening cancer.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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