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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!



(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.


  1. Robert on 12/15/2016 at 7:35 am

    My name is Robert.I started taking cypionate injections a year ago.At that time my psa was a .3 after 3 months it was a .6 and now after 6 months is a .7 is this normal?

    • Augie Galindo on 12/16/2016 at 4:23 pm


      It certainly can be, but there are many factors to consider. You may want to proceed with a visit to your PCP for a prostate exam, and perhaps a referral to a urologist.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  2. Jaime on 06/30/2017 at 12:20 pm

    Is a Testosterone level of 0.2 ng/mL too low and if so does it need treatment?

    • Augie Galindo on 07/03/2017 at 4:24 pm


      It is low, but your calculated free testosterone and the presence or absence of symptoms is what matters most in determining your candidacy for therapy.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  3. […] At the six-month point, there is increased bone density, as well as a rise in the prostate-specific antigen (PSA) levels which are typically very low in those with low T. […]

  4. Andrew on 07/17/2018 at 3:50 am

    My current PSA level is 0.1 I have been told by urologists (for over three decades) my ED & incontinence are self inflicted.

    In 2017 aged 48 I was diagnosed with the congenital condition klinefelters syndrome by a locum doctor (I live in the UK). I had other red flag KS signs and understand now why 6 million people worldwide are never diagnosed with KS.

    In 2017 my TRT badly injected by a nurse has caused spinal clarification & spinal epidural lipomatosis
    My ED has improved with viagra 100mg & now switched to Testogel (as cannot trust doctors/nurses).

    My PSA level was never tested yet over a dozen urologists (from various hospitals) were keen with the DRE, urodynamic tests & ultrasounds.

    Why do urologists not consider klinefelters syndrome as a cause of ED and incontinence?

    • Andrew,

      Unfortunately, this can happen because of infrequent exposure to KS, and/or individual unfamiliarity. I agree that it should be part of the differential diagnosis.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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