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Your PSA Numbers and Testosterone Replacement Therapy — Will TRT Increase Your PSA Numbers or Cause Prostate Cancer?

PSA numbers (prostate-specific antigen) are not as precise an indicator of prostate cancer as we’d like to think they are, which makes the answer to this question complicated — in fact, it’s more like two questions:

PSA numbers — The chemical structure of prostate-specific antigen (PSA, gamma-seminoprotein) prostate cancer marker protein.

  1. Will TRT increase your PSA numbers?
  2. Will TRT cause prostate cancer?

Let’s start with the first question:

Will Testosterone Replacement Therapy for Low Testosterone Increase Your PSA Numbers?

The short answer is yes, but it’s not the danger you think it is.

According to this article: “…men receiving testosterone will have an associated increase of 0.30 ng/mL/y in serum PSA, with older men experiencing a greater increase of 0.43 ng/mL/y.”

However, the same article makes a very important qualification: “Hypogonadal men [men with low testosterone] have depressed PSA levels compared to normal age-matched men…”

So there’s this idea that your PSA level is directly tied to your risk of prostate cancer — if you have a high PSA, you must have prostate cancer (or you’re very likely to develop it). This is simply not how it works.

However, your levels are likely to be lower than they should be if you’re suffering from low testosterone.

Getting your testosterone levels back to normal (normal for your body) is likely doing the same for your PSAs — you’re just getting back to where you would be if you didn’t have low testosterone.

PSA Numbers Above 4.0 ng/mL Don’t Automatically Mean Prostate Cancer

Even if your PSA numbers go up, that doesn’t mean you’re going to automatically get prostate cancer.

We know now that prostate cancer has many more risk factors than your PSA levels — in fact, it’s not even clear that a baseline for prostate-specific antigens even exists.

It used to be that PSA numbers above a certain level (about 4.0 ng/mL) was considered abnormal, the idea being that an elevated level (PSA above 4.0 ng/mL) could indicate prostate cancer and was reason for recommending a biopsy of the prostate.

Today, we look at things a little differently.

In fact, depending on your age, the “baseline” may be much lower than 4.0, possibly closer to 3.0 or even 2.0.

However, I use that term “baseline” loosely — we simply don’t know if such a baseline even exists, and it seems to be the case that the level of your prostate-specific antigens is only one of many different risk factors for prostate cancer.

Furthermore, the speed with which change occurs matters. We monitor something called your PSA velocity, or rapidity of change over time, and this allows us to keep track of potentially abnormal changes that could “fly under the radar” by remaining below the upper limits of normal.

As for our second question…

Will Testosterone Replacement Therapy (TRT) Cause Prostate Cancer?

The answer is simple on this one — no, it won’t.

According to the same article cited above: “Although the hormonal responsiveness of prostate cancer is well established, it is generally accepted that TRT does not induce the development of prostate cancer.”

Testosterone replacement therapy is not going to cause you to develop prostate cancer. And even if your PSA numbers are a little high to begin with, it’s unlikely that TRT is going to worsen the situation.

However, we should still be careful and keep a close eye on your PSA numbers if you have other risk factors.

When you begin therapy, one of the first things we do is to assess all your critical indicators, find out your hormone levels, and then recommend an appropriate course of action.

It all starts with a testosterone blood test.

Learn more about the $25 Low T Test here.

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(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.

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