Testosterone deficiency syndrome (
TDS) can be linked to premature mortality and to a number of co-morbidities (such as sexual disorders, diabetes,
metabolic syndrome, ...).
Testosterone deficiency occurs mainly in ageing men, at a time when prostate disease (benign or malign) start to emerge. New
testosterone preparations via different route of administration appeared during the last decade allowing optimized treatment to these patients. One potential complication of this treatment is the increased risk of prostate and
breast cancer. Consequently, the guidelines from the agencies and the institutions, the recommendations of the scientific expert committees and the attitude of the clinicians to who, when and how to treat hypogonadal patients, is very conservative, not to say, highly restrictive. To date, as documented in many reviews on the subject, nothing has been found to support the evidence that restoring
testosterone levels within normal range increases the incidence of
prostate cancer. In our experience, during a long-term clinical study including 200 hypogonadal patients receiving a patch of
testosterone, 50 patients ended 5 years of treatment and no
prostate cancer have been reported. In fact, the incidence of
prostate cancer in primary or secondary
testosterone treated hypogonadal men is lower than the incidence observed in the untreated eugonadal population. However, even if the number of patients treated in well-conducted clinical trials for whom
cancer of the prostate has been reported is insignificant (a very few), the observed population is still too small to raise definite conclusions. Low
testosterone levels have been reported in patients undergoing radical
prostatectomy and the outcomes are of worse diagnostic in this population; at a later stage,
testosterone deficiency can be induced by anti hormonal manipulation of patient with a
prostate cancer, leading to the symptoms of
hypogonadism. The question is to know whether it is justified, in case of profound symptoms, to supplement those patients with
testosterone. Some attempts have been made and the results are encouraging: so it is time to re-examine our position and to question about the definite recommendation that patients with
prostate cancer should never receive
testosterone supplementation
therapy; this is already the situation when intermittent
androgen blockade is initiated if the
biological response is satisfactory. Furthermore, it has been advocated that, under a rigorous surveillance, patients cured of
prostate cancer can be treated with
testosterone supplementation with beneficial results.