Testosterone, a steroid hormone found in mammals and other animals   that is a part of the androgen family of hormones.  The term ‘Androgen’ is derived from two Greek words-‘andros’ meaning ‘man’ and ‘gen’ meaning ‘to produce or give birth to’; so basically Androgen signifies male hormones, including both testosterone and androsterone.   Commonly known as a male sex hormone, testosterone is solely responsible for sperm motility, sexual desire, secondary characteristics (body hair, deepening voice etc.) in men.

It is mostly synthesized by the testes and few amounts are produced by the adrenal glands. The secretion of testosterone is controlled by 2  glands present in the brain- hypothalamus and pituitary through the endocrine hormone system. The hypothalamus directs the pituitary gland about the secretion parameters, pituitary relays the chemical messages via  the blood stream.  This production is at its peak when a male reaches puberty and starts declining at a rate of 1% after the age of 30.    Testosterone being a sex hormone is not strictly related to sexual functions and organs, it also plays a major role in balancing and maintaining few of the body’s major functions which includes-

  • Body mass.
  • Bone density.
  • Mood and cognitive functions.
  • Cardiovascular system.
  • Blood production and blood pressure. 
  • Fat distribution.   

Testosterone can also be found in the female body system, it is secreted by the ovaries and the adrenal glands and plays a significant role in sexual desire, treatment of breast cancers and irregular periods.  The level of testosterone in females is comparatively very low than in males, about 7-8 times lower on an average but when it comes to production/day it is 20 times lower than that of males.    Here we will discuss the benefit of testosterone on our prostate health.

Role of Testosterone on Prostate health

Prostate is an essential organ of the human reproductive system which secretes a fluid that maintains an optimal condition for sperms. It also helps in sexual functions. Prostate gland in older people often tends to get affected by various disorders, especially prostate cancer, which might be an effect of ageing. Testosterone, being a member of the androgen family regulates sexual functions and plays an influential role in prostate function.  The ageing process involves a gradual decrease in the testosterone level leading to various health related problems. Here in this article we will discuss testosterone’s contribution in maintaining a sound prostate health and explore the relation between prostate health and advancement in the field of Testosterone Replacement Therapy (TRT). 

The prospective use of endogenous testosterone preparations in testosterone replacement therapy (TRT) for older people and for male contraception, moreover its purpose as a potential supplement for people suffering from the testosterone deficiency syndrome (TDS), increases the use of testosterone supplement. However, a little information regarding the clinical effects of testosterone supplementation on prostate health is known.   Testosterone deficiency and Prostate health

The revelation of testosterone’s importance of bodily function has led Testosterone deficiency, testosterone replacement therapy (TRT) and Late-onset hypogonadism (LOH) to be the prominent subject of testosterone research. Association of aging, with increasing risk of prostate cancer, BPH (benign prostatic hyperplasia) and testosterone deficiency has led researchers to elucidate the their relation for safety administration of testosterone replacement therapy (TRT). A common hypothesis regarding Testosterone’s role in prostate cancer viewed testosterone supplementation to be an aggravating factor for the disease. It was assumed declined levels helps in mitigating the situation. Recent evidences reveal testosterone replacement therapy (TRT) only supplements the lost testosterone and restores the depleted testosterone levels and have no significant effect over prostate health, thus ruling out the previous beliefs, though caution is still taken during testosterone’s administration

Further studies helped in disproving the hypothesis that stated association of high level testosterone with the growth of prostate cancer and with improper prognosis. Recent developments have explored a completely different phenomenon, which stated that low levels of testosterone are allied to defective prognosis attributes in prostate cancer, such as an elevated Gleason score or increase in the amount of prostate-specific antigen.

To understand the correlation between low testosterone levels and the prognosis factors of prostate cancer a detailed study was organized, which ran over a span of 2 years and included 137 male volunteers. Observations were deduced after the thorough analysis of prostate biopsies, measured hormonal level and levels of prostate specific antigen. The results were-

  • Higher testosterone levels were associated with lower levels of prostate specific antigen and was not related to Gleason score.
  • The level of testosterone was inversely related to amount of tumor for biopsy.
  • Men having lower testosterone levels and prostate cancer faces a higher risk of poor prognosis and increased tumor burden before the onset of treatment.

This study solidified the notion that poor prognosis of prostate cancer shares some relation to pre-treatment of depleted testosterone levels

An association of Prostrate with testosterone started with a misconception but a study in the year 2002 which included 207 men having low testosterone levels,  to observe the changes in various parameters of the prostate gland- prostrate volume, prostrate antigen levels an even symptoms of urinary tract after administering the TRT dissolved any misconceptions. The results were surprisingly positive as all the parameters showed significant improvement after the therapy.  Another study with same numbers came with some interesting observations revealing that testosterone is indeed not responsible for changes in gene expression or any neoplastic growth in prostate tissue.   The claims on testosterone or TRT as carcinogens for prostate cancer were falsified by a study in New England Journal, which stated that no such evidence has been found which can prove that higher testosterone levels poses a greater risk of prostate cancers.However, testosterone being responsible for cell growth may pose a threat to patients suffering from prostate cancer.

Prostate safety becomes a predominant health concern along with aging. Older people who receive TRT (Testosterone replacement therapy) also face substantial risk and require cautious handling during the dosage, as little information is known regarding the effects of testosterone on prostate health. An experimental study was performed to study the effects of testosterone by analyzing the effects of TRT (Testosterone replacement therapy) on prostate tissue of older people with testosterone deficient conditions. A total of 44 men, aged between 44 to 78 years volunteered for this study where they underwent a randomized placebo controlled trial for over one year. The experimental analysis was directed to measure a 6 month change in the androgen levels of prostate tissue and affiliated changes in gene expression, histology, clinical features and bio-markers. Prostate biopsies revealed that even if TRT (Testosterone replacement therapy) is efficient in revitalizing the testosterone levels, it holds little effect over the androgen levels and cellular functions of prostate tissue.   

It is hypothesized that sex hormone replacement through androgen serum has the ability to influence the threat posed by prostate cancer. An integrated analysis was performed to estimate this threat dependency by interpreting the epidemiologic data. This data was collected from a huge pool of men having clinically diagnosed with prostate cancer, by “The Endogenous Hormones and Prostate Cancer Collaborative Group”. The risks were estimated by divisions and statistical analysis by grouping the data based on age, study. The observations were-

  • Any association between the risk regarding prostate cancer and testosterone serum concentration, free concentration of testosterone, dehydroepiandrosterone sulfate, dihydrotestosterone, estradiol, or levels of free estradiol.
  • The risk of prostate cancer shares an inverse relation with SHBG (sex hormone binding globulin).  

The association of testosterone with prostate health, specifically prostate cancer is still opaque. An organized study was performed to relate testosterone with prostate conditions by measuring the prostate volume, prostate specific antigen, serum levels and uroflow parameters. The study was performed by dividing the volunteers based on their age and period of testosterone treatment- 47 men with recently diagnosed hypogonadal conditions, 78 hypogonadal men with at least 6 months of effective testosterone replacement treatment and 75 healthy men. The outcome based on the detailed analysis of the samples revealed a positive correlation between prostate volume and age in normal and testosterone treated men, but there were other significant conclusions.

  • Notable changes were not observed in the prostate levels of hypogonadal men undergoing testosterone treatment,  the same results were observed for uroflow analysis and prostate specific antigen values.
  • Prostate volume was remarkably lower in hypogonadal men, who were not undergoing any treatment, when compared to other groups.

This study had a significant influence, as  it verified that testosterone influenced the growth of the prostate should not debar hypogonadal men from getting their testosterone supplemented by testosterone replacement therapy (TRT). 

Testosterone deficiency and Prostate health

Various studies have already been performed in the arena of testosterone research to exploit its contribution in human biological system. Being the most complex system in the animal kingdom, human biology poses several mysteries in its  keep. Testosterone is generally defined as sex stimulating hormone, but performs and maintain a regulatory role among some significant  bodily functions. Gradually, through these detailed studies the role of testosterone in  the regulation of prostate health is coming to light.

Few are known about the relation between prostate health and testosterone. Men having lower testosterone levels and prostate cancer faces a higher risk of poor prognosis and increased tumor burden before the onset of treatment.  

Controversies regarding the role of testosterone in facilitating the growth of prostate cancer started with the discovery of Huggins in 1966, in which he showed that prostate size varied with testosterone levels.  The prostate health is monitored by the levels of prostate specific antigen (PSA), and recent studies have revealed that testosterone replacement therapy (TRT)  does not have any effect on prostate cancer, but long term involvement still needs to be explored.

Summary

Prostate health begins to decline with age and so does testosterone levels. The controversy regarding the role of testosterone in prostate cancer and benign prostate hyperplasia still eludes the scientific community. The specifications regarding this  enigmatic relationship can only be unearthed with further scientific explorations.

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