For many men recovering from prostate cancer, life after treatment can bring unexpected challenges. Symptoms like low energy, fatigue, reduced sex drive, and difficulty building muscle can affect quality of life.
Sometimes, these symptoms are caused by low testosterone, a condition known as hypogonadism. Until recently, many prostate cancer survivors were told that testosterone replacement therapy (TRT) wasn’t an option because of concerns that it could fuel cancer growth.
Now, new research suggests that for a carefully selected group of prostate cancer survivors, short-term testosterone therapy may be both beneficial and safe. While the findings are encouraging, experts say the decision to use TRT should always be made after a thoughtful discussion with your healthcare team.
What is testosterone replacement therapy?
Testosterone is a hormone that plays an important role in many aspects of men’s health, including:
- Sexual desire (libido)
- Erectile function
- Muscle mass and strength
- Bone health
- Energy levels
- Mood
After certain medical conditions, like prostate cancer and related treatments, testosterone levels can decline.
Testosterone replacement therapy (TRT) is a treatment that restores testosterone levels using injections, gels, patches, or other formulations. The goal is to relieve symptoms and improve quality of life.
Historically, however, TRT has generally been avoided in men with a history of prostate cancer because testosterone was thought to stimulate the growth of any remaining cancer cells.
What did the new study find?
Researchers conducted a phase II clinical trial involving 136 men who had:
- Previously undergone surgery (radical prostatectomy) for low-grade, localized prostate cancer
- Maintained undetectable PSA levels for at least two years
- Experienced symptoms of low testosterone
- Had labs that confirmed low testosterone levels
Participants received either weekly testosterone injections or a placebo for 12 weeks without knowing which treatment they received.
Compared with the placebo group, men receiving testosterone therapy experienced:
- Increased sexual activity
- Improved sexual desire
- Better prostate cancer-specific sexual quality of life
- Improved mood, with fewer negative emotions
- Better body composition
- Improved stair-climbing power
- Higher aerobic fitness
Interestingly, erectile function itself did not improve significantly during the 12-week study, suggesting that testosterone may help some aspects of sexual health more than others.
What about the risk of cancer coming back?
This was one of the study’s most important findings.
Researchers closely monitored participants’ prostate-specific antigen (PSA) levels, which can help detect signs that prostate cancer has returned after treatment.
During the 12-week treatment period and the three months of follow-up afterward, no participants experienced a biochemical recurrence, meaning no PSA levels rose to the threshold that would suggest the cancer had returned.
While this is reassuring, it’s important to remember that the study followed patients for only a short period of time.
Why these results matter
For years, many prostate cancer survivors with low testosterone have had few treatment options because of uncertainty about TRT’s safety.
This study provides early evidence that carefully selected men with low-risk prostate cancer who have been successfully treated with surgery may be able to receive testosterone therapy without an immediate increase in recurrence risk.
It also highlights that treating low testosterone may improve more than sexual health. Increased energy, strength, physical performance, and emotional well-being can all play important roles in long-term survivorship.
Larger studies with longer follow-up are still needed to determine whether testosterone therapy remains safe over many years.
Should you consider testosterone therapy?
If you’re experiencing symptoms like fatigue, low libido, reduced muscle strength, or other signs of low testosterone after prostate cancer treatment, it’s worth bringing these concerns to your healthcare team.
Rather than assuming TRT is or isn’t appropriate, ask whether testing your testosterone levels makes sense and whether your individual cancer history affects your treatment options.
Together, you can discuss questions such as:
- Are my symptoms likely related to low testosterone?
- Should my testosterone levels be checked?
- Based on my cancer type and treatment history, am I a candidate for TRT?
- What are the potential benefits and risks for someone in my situation?
- How would my PSA and overall health be monitored if I started treatment?
Every prostate cancer survivor has a different risk profile. Researchers emphasize that this is not a green light for all prostate cancer survivors. Because long-term safety remains unknown, testosterone therapy should be considered on an individual basis with guidance from your urologist or oncology team.
If you’re experiencing symptoms of low testosterone after prostate cancer treatment, don’t hesitate to start the conversation. An informed discussion with your care team can help determine whether TRT is appropriate for your unique situation.
Remember that you can always reach out to an oncology nurse practitioner at Outcomes4Me to help you better understand your diagnosis.
