Testosterone and the prostate: The evidence so far

It has traditionally been accepted that testosterone substitution in men with testosterone deficiency syndrome has the potential to harm the prostate. This theory originates from 1941 and is based on data presented for only two patients, one of whom had already been castrated. A review of the current peer-reviewed medical literature, however, has proved inconclusive. Whilst there is clear evidence that a reduction in serum testosterone to castration concentrations is able to reduce levels of prostate-specific antigen and delay the progression of established prostate cancer, it is difficult to prove the converse. Recent studies have shown that testosterone replacement has little effect on prostate tissue androgen levels and cellular function, whilst in men with prostate cancer, low serum testosterone levels were reported to be associated with the presence of extraprostatic cancer. Nevertheless, it is clear that the two classical contraindications for the administration of testosterone, that is, suspected or histologically proven prostate cancer and symptomatic benign prostatic hyperplasia, must be carefully respected. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.