Can Your PSA Be Too Low?
A recent article from RenalAndUrologyNews.com brings up an interesting fact about the relationship between Low T (testosterone deficiency) and your PSA (prostate specific antigen). While the awareness of prostate cancer and the importance of having your PSA checked has long since become general knowledge for most men, little if any attention has been paid to what a very low PSA level might indicate.
What Does a Low PSA Mean While on TRT?
The prostate specific antigen assay was initially developed as a tumor marker. For most men, a reading of less than 4.0 ng/mL is normal. That is, if your PSA is abnormally elevated, one of the first things to rule out would be the presence of prostate cancer. There are other things that more commonly cause elevated PSA levels such as infection, benign prostatic hyperplasia (BPH), and inflammation. Conversely, medication used to treat male pattern balding and/or non-cancerous growth of the prostate (BPH) can artificially lower your PSA reading.
Testosterone Replacement Therapy And BPH
Since prostatic enlargement is mediated by a metabolite of testosterone called DHT, it is common for prostate volume and PSA levels to increase when testosterone levels are normalized in hypogonadal men. More testosterone leads to more circulating DHT, higher DHT levels can increase the size of your prostate and your PSA. For this reason, it is extremely important that your urinary habits, prostate health and PSA be closely monitored if you are on treatment for Low T.
Interestingly, Mr. Charnow’s article points out that extremely low PSA readings may in fact be indicative of, or at least correlate with, Low T. So, while a very low PSA may put your mind at ease that you have reduced chances of having prostate cancer, be aware that it may very well be telling you that your testosterone is low.
Also reported upon by Jody Charnow, another study by Dr. Kevin McVary, of Southern Illinois University School of Medicine showed no significant increase in lower urinary tract symptoms (LUTS) in patients being treated with testosterone when compared to those not on TRT. Essentially, this means that the associated difficulty with urination that results from prostatic enlargement, is no more likely to occur in men being treated with testosterone.
PSA, Low T, and Prostate Cancer
Another article from the same source as well as this article written by Dr. Eliezer Ben-Joseph, both tout studies which disprove long-held notions that testosterone replacement increases your risk of prostate cancer. Studies done in the 60’s and 70’s with small cohorts that lacked the benefit of having patients whose prostate cancer was treated with the advanced methods we use today, are much to blame for these misconceptions.
Today, more and more men with a history of treated prostate cancer are now enjoying the benefits of testosterone replacement. Certainly, this should only occur in an environment that allows very close supervision, but as more data is collected, the positive effects of TRT become better defined and established.
Your PSA remains an important number. There is much debate about it’s usefulness as a screening tool in low risk men, but as for men who are being treated for Low T the recommendations from The Endocrine Society and other field experts still consider it the standard of therapy
If you have questions about how testosterone therapy may affect your prostate health please CONTACT US and we would be happy to discuss it with you!