Does Testosterone Cause Prostate Cancer? The Evidence Reviewed

Of all the misconceptions surrounding testosterone replacement therapy, the fear of prostate cancer is perhaps the most persistent — and the most consequential. It has caused generations of men to suffer from testosterone deficiency unnecessarily, denied effective treatment by clinicians who were taught that testosterone “feeds” prostate cancer. The reality, as revealed by decades of research, is far more nuanced — and far more reassuring.

The Origins of the Fear: The Huggins and Hodges Hypothesis

The concern originated from a 1941 paper by Charles Huggins and Clarence Hodges, who demonstrated that surgical castration (and thus testosterone elimination) caused regression of metastatic prostate cancer — a finding that earned Huggins the 1966 Nobel Prize. The logical inverse — that giving testosterone would accelerate prostate cancer — became medical dogma, despite never being rigorously tested in the original research.

What the Modern Evidence Actually Shows

The “saturation model,” developed by Dr. Abraham Morgentaler at Harvard Medical School, provides a more accurate framework. Prostate cells contain a finite number of androgen receptors that can be fully saturated at relatively low testosterone concentrations. Above this saturation threshold, additional testosterone does not further stimulate prostate cell growth. This explains why men with low testosterone do not have less prostate cancer, and why raising testosterone from deficient to normal levels does not increase prostate cancer risk.

Multiple large epidemiological studies and meta-analyses have confirmed: low testosterone is actually associated with higher Gleason grade prostate cancers and more aggressive disease at diagnosis. TRT in men with carefully monitored, treated, and stable prostate cancer has been shown in multiple studies to be feasible without increasing recurrence risk. The largest prospective registries of TRT patients do not show elevated prostate cancer incidence compared to age-matched controls.

Appropriate Monitoring on TRT

None of this means TRT should be initiated without prostate monitoring. At Multigen Wellness, all male patients receive baseline PSA (prostate-specific antigen) testing and digital rectal examination prior to TRT, with PSA monitoring every 6–12 months thereafter. Men with a history of prostate cancer require a more individualized risk-benefit discussion with their oncologist. But for the vast majority of men with testosterone deficiency and no prostate pathology, fear of prostate cancer should not be a barrier to treatment. Call +1 (800) 259-0015 to discuss TRT safely and properly monitored.