: How can testosterone replacement trigger prostate cancer?
Sheldon Marks, MD: Cancer cells are exquisitely sensitive, and in fact stimulated to grow by testosterone. So before a man is put on testosterone therapy, it's essential that we know he does not have cancer,both by an exam and a blood test. And if a man is put on testosterone he needs to be monitored to make sure that a cancer doesn't develop, by monitoring the exam and the PSA blood test.
Interviewer: There are a lot of men out there who are saying, ooh, my testosterone is a little low, I need a little oomph. And there's a downside to that.
Sheldon Marks, MD: Absolutely. Well, the problem is that it's easy to treat. And men if they're depressed, if they're feeling a little fatigued, if their sex drive is down,any reason they go to the doctor and it's easy to say, aha, your testosterone is low, give them testosterone replacements where they draw a single level and say, "Look here's the problem",but it's not the right way to do it. The testosterone level fluctuates dramatically throughout the day,and so if you don't draw it at the right time you might be getting an artificially high or low level so it should be drawn primarily at mid to late morning.And then you have to understand what it is you're treating. Are you treating a symptom or are you treating a blood test result. So we want to treat the man, monitor the levels.It's important that the levels be appropriate, and it's important that we're sure we're treating the right thing.Just because his testosterone might be low there might be other more serious or dangerous causes of whatever's ailing him.
Interviewer: Like what?
Sheldon Marks, MD: Hormone imbalances as far as like diabetes, thyroid disorders, liver disorders. It could be side effects from medication;it may be side effects from social activities such as marijuana, tobacco or alcohol. All of these things can impact on a man as well as if he's stressed or fatigued,that doesn't necessarily mean there's something hormonally wrong. Maybe he's not getting enough sleep.Maybe he's stressed because of work and he just needs to learn better stress reduction techniques than try to look for something, a shot or a pill that will make things better.Today there are a lot of problems with men being diagnosed and treated with testosterone for problems that really aren't low testosterone.And we really need to be careful because too much testosterone for the wrong reasons can stimulate prostate cancer.