Does testosterone therapy cause an increased risk of prostate cancer? | Peter Attia & Mohit Khera

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Watch the full episode: • 260 ‒ Men’s Sexual Hea...
This clip is from episode #260 of The Drive - Men's sexual health: Why it matters, what can go wrong, and how to fix it | Mohit Khera, M.D., M.B.A., M.P.H.
In this episode, Peter is joined by Mohit Khera, M.D., M.B.A., M.P.H., a world-renowned urologist with expertise in sexual medicine and testosterone therapy
In this clip, we discuss:
Why do people associate TRT with an increased risk of prostate cancer?
Testosterone may be protective against prostate cancer
Animal studies related to testosterone therapy and cancer
--------
About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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[@nefster9777]

Very good information!! I went to my Dr at the age of 42, I was working out 4-5 times a week and eating really good. I was tired all the time and went to my Dr of 17 year. I asked him to test my levels, he said if you leveled are low what are we going to do. I said what about TRT, he said that will give you cancer and He would not prescribe it to me. This is in 2007, I asked him again to test me and my test levels came back at 199. He wouldn’t do anything and back then there were not any TRT clinics except in Florida. I did a bunch of reading and research, I finally found a clinic that put me on TRT. To this day I have been on TRT, my range is level at 750, I have been higher and lower, both have there issues. My PSA has never been higher then .8. At 56 yo I am in a much better place and healthier than ever.

[@davidetre]

Thank you for your testimony. In my case… I have been training for more than 20 years, health conscious, and never took steroids or testosterone; nevertheless few years ago I had testicular cancer. Now fortunately I’m good, but because of what happened, doctors put me on TRT. They told me that if done under control, it’s completely safe.

[@charlestoddsullivanforpres6628]

Large observational study with a VA cohort back in 2010 saw massive problems following suppression of T levels upon Dx of prostate cancer. Within six months men were diabetic, occult CVD, depression etc.

[@almor6340]

This message is for Peter. Can you please do a segment where you explain this podcast to us mere mortals? The info here is fascinating but there were too many terms that I have no idea when they meant. Thanks,

[@charlestoddsullivanforpres6628]

Talking about the hypogonadal range - back around 2014 or so there was a paper in NEJM where men that had prostate cancer had worse outcomes as T got lower. This prostate cancer stuff is both fascinating and terrifying at the same time. It really needs a major emphasis in research, far beyond what is taking place right now. It wasn't long ago that I looked at PubMed and found more studies being devoted to PCOS in women (which is related to testosterone) than testosterone issues in men.

[@raymondfarrell6585]

I learned by having a prostatectomy that testosterone was the only fuel feeding prostate cancer growth. Being a bodybuilder and taking testosterone boosters for years, I thought it was the reason I had cancer, but my doctor said it's strictly genetic.

[@RealziesCuts]

The most important, natural testosterone booster: Avoid alcohol 💫 294 days no alcohol 🏆

[@lucid685]

What are your T numbers pre and post 295 days free from alcohol?

[@DesertVetRider]

Started TRT in 2021 and was diagnosed with prostate cancer two years later. Just had surgery 2 months ago. Did TRT cause it? I highly doubt it, but now I am freaked out to use TRT ever again.

[@kennethhudson4769]

How are you doing today?

[@DesertVetRider]

@kennethhudson4769 I am doing doing better. I pray the cancer is gone. Had some early blood work done, and it is looking promising. However, I won't know officially until next month. Thank you for asking.

[@kennethhudson4769]

@semperfi9313 I'm glad you're doing better. I had the surgery in February. I'm better than I was, but I still have a long way to go. I asked my doctor about starting a TRT regiment. I will find out next week if my levels are low. Would you suggest it?

[@tejanosbestcom1531]

What was your Gleason score at diagnosis

[@ИгорьИжщенков]

From as far back as the 1950s the autopsies of millions of middle aged and older men who died of all causes discovered that countless numbers of them harbored small cancerous tumors in their prostates that they never knew about and the amount of cancer increased with age. It’s estimated that 40% of men over fifty have small cancer lesions in their prostate, and by 70 years of age it’s 60 percent, and for most it’s an indolent cancer that would never have harmed them.

[@charlestoddsullivanforpres6628]

I believe there was a study in the 1950s that bathed prostate cells in a medium that was loaded with DHT and this also contributed to the stigma and scare for many years.

[@philipsmith6152]

Excellent interview, Luuuv hearing Hannah talk about his experiences, but wish I could hear the background questions !!

[@nole9512]

@8:00 I am surprised to see Peter recommend surgery for Gleason 3+3 and 3+4. Most MDs would put the former on active surveillance, and sometimes 3+4 goes on AS too. I would be curious as to why he would use surgery so quick when the potential side effects (incontinence and impotence) are devastating to most men.

[@hubriswonk]

He is a surgeon.......

[@naegleriafowleri2230]

Active surveillance means a chance of metastasis and dying dumbass

[@ordinaryretrogamer6944]

Good point ​@@hubriswonk

[@ricknowak4582]

It only proves to me that it's all about money! I have a Gleason 7 with a low volume four in there in my surgeon is acting like it's a matter of life and death! He's trying to make me panic! And I asked him ...."Dr it's 3 + 4 = 7 with a 5% Volume four!!!!!!". WTF!!?? "What are you nuts?!". And I am no doctor! But I do a lot of research on the internet and I believe I know MORE. than the doctor

[@hunterfrizzelle1946]

Mine was 3+4…. PSA 7.2….. I elected for surgery asap…. Good thing I did. My MRI showed a tumor .7cm…… 3 weeks later when I had surgery the pathology report showed the cancer consumed 31% of my prostate and was pushing out of the sides. Had I waited a few weeks later I’d be a dead man. 63% if men w prostate cancer have slow growing tumors. I was on the 37% side that had aggressive cancer.

[@optimalhealthmedicine1486]

Out-Freaking-standing interview!!! We have been doing BiPolar Androgen Therapy for 22 years with tremendous success and invaluable quality of life!! Great Job Gentlemen!! “PS: their “high dose” is 400mg Cypionate IM once every 28 days!! What the heck!! 🤣🤣. Who is running these studies. Cypionate true 1/2 life is just a little over 5 days!!!

[@charlestoddsullivanforpres6628]

Why aren't men receiving new treatments in line with the latest research? Because that's how it goes in American medicine. We have too few doctors, who work too many hours. It's not possible for them to keep up with the literature. Back in the 1990s, when PubMed had millions fewer entries, Altman and another guy looked at how many articles an Internist had to read every day in order to keep up with the field - it was 19. Doctors don't have time to read 19 abstracts per day, let alone digest 19 manuscripts. It's commonly found that it takes well over a decade for the latest research findings to go from bench to bedside. This is a problem.

[@ricknowak4582]

That's why I question this prostate cancer therapy. They're always coming out with new clinical trials. New hormone treatment medications!! What? The other ones don't work? After all these years and they still don't have a cure for prostate cancer? They're always coming out with new therapies. I am very angry!

[@mechanic6682]

2:54 This video is a year old. Please provide a link to the results of the study.

[@JOHNWAYNE1920]

Is the higher doses of test causing estrogen spikes which slows the cancer?

[@PappaMustafa]

Well this was good to hear. I been on trt for years

[@MasterofPlay7]

​@ayo9057yes I'm skeptical

[@bgoodorhell4u]

@ayo9057it’s safer than your drinking water and you have to pay for that too .

[@eddiegardner8232]

TRT is as safe as having the same testosterone level naturally, which if your testosterone is fairly high, is safer both in terms of not getting PC and not getting a higher grade of PC if you do get PC. PC cells grow best in Low-T testosterone concentrations. That is the "high danger zone". Better to be in the low danger zone of high-normal testosterone in terms of avoiding PC, and you will be healthier in other ways as well. Probably good to have lower range levels of estradiol as well.

[@irondirectprimarycare9440]

Peter. Myself and Dr. Ruddy would be glad to talk to you about the Prostate Community trial and the role of ivermectin and lactoferrin on prostatomegaly and cancer.

[@frankgyetuah-boadi601]

No one want to hear your crazy ivermectin covid nonsense

[@Max-cd8fm]

Excellent!!!! I’ll share this as a tool for “argument” for the T clinic we all go to…and I truly believe that me taking high dosages of Saw Palmetto daily is imperative

[@Dlindo8892]

Does the saw palmetto effect your libido negatively?

[@Max-cd8fm]

@@Dlindo8892 opposite ! If your prostate is healthy you feel better all around !

[@Carlos.Rivera]

How many Mili grams and what brand you use?

[@danieljrgensen133]

What is the name of that trial, he mentioned was expected to be published in june 2023?

[@natfat9064]

The Traverse trial

[@gocsa]

It was published June 16, title is "Cardiovascular Safety of Testosterone-Replacement Therapy".

[@goyo2897]

If someone has a Gleason 3+3 prostate cancer, they don't treatment let alone surgery. Same applies to some people with favorable Gleason 3+4, When treatment is required, focal therapy, rather than whole gland treatment like surgery, is the first stop on a decision tree. Sometimes men are candidates for that; sometimes not. Whether a man has surgery or radiation, androgen deprivation therapy may be prescribed if, and when, there is suspicion of spread. There are many different prostate cancer scenarios out there for men and every man has to educate themselves, get multiple opinions, and decide for themselves what is best for them. Each has their pros and cons.

[@armonnicholson]

Excellent video on a very important topic. Thank you for posting.

[@AnthonyShaw-ty9pi]

Isnt TRT a synthetic drug, made in a lab? Ive been on trt for 10 plus years. Im now 66. My prostrate is now 56 cc. An MRI i just recently had done, reveals 3 lesions, pi-rads 4/5, 4/5 & 5/5🤔 Possible prostate cancer. Im starting to question, TRT replacement now, and I'm in pretty good shape.

[@jasonstevenson547]

I have a question: I have been on TRT For 13 Years. My Test was 189 at 42 year old. My PSA was like 1.2- Over the years it has raised slowly. It Leveled out around 3.4- Recently when I increased my Test Cyp to 200 mg per week my PSA has gone up to 3.8 then 4.3 at 55 years old. Is this need for concern? Or Maybe this is BPH?

[@TjBrooks-zn2ol]

Anything over 4.0 at your age is a cause for concern. I was at 4.7 when diagnosed. Went from 2.69 to 4.7 in two years. Get checked!

[@crouss28]

Yes, similar happened to me, I now have prostate cancer. My provider did not follow up, I had to push a urology appointment. You may be fine but, take it seriously, catching as early as possible is key for the most treatment option.

[@paulpeele8387]

I was on TRT injections for many years. But when I developed PCa I found that Taking TRT very quickly doubled my PSA. Over a few years time I tried this return to TRT three times. Each time my PSA doubled. So even though I had greatly benefited from TRT, I decided it was too dangerous for me. Am I missing something? I can't understand what protocal you are saying allowed people to continue on TRT??

[@indiglo1971]

You can boost naturally. I took my testosterone levels from 298 ng/dl to 545 ng/dl with no shots, creams, or prescription medication whatsoever.

[@paulk9985]

What did you do to achieve this? I have stage 1 prostate cancer. I had been on and off testosterone replacement therapy for 10 years. I decided to stop it. Now I hover around 200 and am miserable... tired, flabby and low quality of life. The urologist mentioned some of the supplements like Ageless Male are safe. @@indiglo1971

[@bgoodorhell4u]

@@indiglo1971 how did you do that? If you were born in 1971 I was born in 1970 .. so we are almost the same age..let us in on your secret. Thanks

[@indiglo1971]

@bgoodorhell4u L-tyrosine, Boron, Tongkat Ali. All the lettered vitamins help A-E , b12, b6. Eggs, potatoes, berries. It helps to go organic and gluten free.

[@indiglo1971]

@@bgoodorhell4u Also....use bottled water instead of tap. Unfortunately, exogenous testosterone in general might lead to side effects like yours. Meaning, even more natural testosterone boosting can do this.

[@2bellamedica]

Any studies with progesterone and the ratio of hormones?

[@heypauly2002]

If I walk into my doctor's office complaining of low testosterone symptoms. And he doesn't do anything about it, how do I go about doctor shopping?

[@irondirectprimarycare9440]

We'd be glad to help if you're in our states that we serve

[@bgoodorhell4u]

@@irondirectprimarycare9440 what state is that ?

[@johnnybiggunz1141]

@@bgoodorhell4u look on line. Lots of clinics that will sell you TRT. The right way ofc, under doctors supervision.

[@indiglo1971]

I took my testosterone level from 298 ng/dl to 545 ng/dl with no prescription medication whatsoever.

[@charlestoddsullivanforpres6628]

They mention the Women's Health Initiative, started back around 1990 - largest study ever at the time, in terms of funding, IIRC. Complete disaster. Added confusion, not clarity.

[@VTVT1306]

Conclusion?

[@adrianb8620]

Is this protocol available in the UK? Anyone here doing it?

[@charlestoddsullivanforpres6628]

The Vigen paper in 2013 did enormous damage to TRT use. It's one of the worst statistical analyses ever. They used stabilized weights in a Kaplan Meier model, but there is an enormous amount of measurement error and what you have in their study is a change-state data generating mechanism and that is intractable, mathematically. Also, the data is very messy and the stabilized weight technique was shown in simulations to behave in a wildly erratic way. I worked for months to try and understand how they got the results they got. Even emailed Dr. Morgentaler who was among the first to raise the flag on that paper. Everything about the analysis is unsound.

[@IlIKRATOSIlI]

Excellent talk!

[@yvesparis7556]

Impressive info. Greatly done!!

[@offgridbuild]

What about testosterone replacement in men with BPH?

[@kubazaborowski7570]

dont listen idiots who told You that test or DHT will shrink your prostate. if U got BHP dont touch any steroid!

[@jameseason9949]

Well done! Thanks for sharing!

[@greasemonkeybd]

have low T about 305 so my doc gave me clomid 50mg 3 times a week starting about March 2023 had an increase to 550 at first blood test. PSA was still undetectable at last blood work in June 2023. The thing is I had my prostate removed in June 2017 and radiation 6 months after. had gleason 9 in my prostate.

[@locosphinx]

Peter, do you feel that there is no risk EVEN in people with quite a bit of family history of prostate cancer?

[@ordinaryretrogamer6944]

If you get metastatic PC and are on trt you are fucked

[@GregariousAntithesis]

My urine flow is reduced noticibly using TRT so obviously it has an impact on cardio vascular system snd im healthy 57 who exercises and eats whole food diet.

[@johnnykilo4967]

Been on TRT over a year now. I have the same issues. I find that zinc supplements along with Saw Palmetto somewhat alleviate this.

[@GregariousAntithesis]

@@johnnykilo4967 i have beem taking zinc in microdose daily in my electrolyte drink nothing helps me but i have noticed a decrease urine flow for some time now and this just compounds the issue. I think as we get older our prostate grows and becomes more vascular my PSA is normal but slow flow sucks. Plus i eat a whole food diet and exercise so some things are part of growing old and playing with yourself too much 🤣

[@johnnykilo4967]

@@GregariousAntithesis lol yea these are all facts. Maybe give the Saw Palmetto a try. When taking it I don’t have a need to whiz during the night.

[@jerseyjim9092]

Sounds like it's causing your prostate to enlarge. Makes sense since drugs that reduce testosterone are used to shrink an enlarged prostate.

[@naegleriafowleri2230]

Lmao has nothing to do with cardiovascular and everything to do with your prostate being bigger

[@mixalis6168]

More of an issue, trying to find someone who knows what they are talking about, TRT in Australia, is so bad @@

[@DurinRhohan]

what effect on men after heart bypass

[@optimalhealthmedicine1486]

Tremendous benefits!! The very first injection, the heart muscle and healing are dramatically improved! It only gets better after that. Testosterone has been shown over and over that it does NOT cause blood clots!

[@SixFive8]

​@optimalhealthmedicine1486 Hi, do you have any info on studies that it does not create clots? I'm really interested since I did have a dvt and pulmonary embolism a year ago.

[@ufind6048]

I wish they had addressed reports of increased cardio risk when on it.

[@SixFive8]

@@ufind6048 I believe they did...

[@charlestoddsullivanforpres6628]

If TRT or exogenous T was a cancer risk, epidemiological studies would show sky high rates in bodybuilders, power lifters, strongmen etc.

[@Carlos.Rivera]

And WWE as well

[@psychictampon]

"We have no idea why the results of the transformer trial arent being used to treat people!" You literally just said that standard care is $8k while t is $100... seems pretty clear to me lol.

[@adammadtin8451]

What about testosterone and melanoma risk Peter? Do you have any information on that? Ps I'm reading OUTLIVE and loving it. Will be recommending it.

[@paulfraley]

Started TRT..4 months later got prostate cancer....

[@eddiegardner8232]

Prostate cancer is very slow in growth. If you were diagnosed with prostate cancer, you had it well before you went on TRT; it just hadn't been detected. This is not unlikely, because screening for prostate cancer is VERY poorly done in this country. The only thing generally used is PSA testing or the infamous "finger wave" in your back door. Even if you do get regular PSA tests, they set the threshold for further investigation (with MRI or biopsy) so high that PC can be well underway before it is properly checked for and diagnosed. If you got TRT, it is because you were in what we now know is the "danger zone" of testosterone level, approximately 20 to 250 ng/dl of Total-T, so getting PC, and maybe even higher Gleason grade PC was more likely. Sorry that you have PC. Be sure to go to a center of cancer treatment excellence (Mayo, Cleveland Clinic, Sloan-Kettering, UCSF, etc) to get it correctly diagnosed and a good treatment plan, not an average local facility that doesn't specialize in treating PC. Good luck!

[@hankaul6256]

😢

[@riceexperiment]

Who funded those studies?

[@holisticallyme556]

Clearly not pharmaceutical firms

[@gregweever5895]

I’m a huge fan of Peter Attia love hearing this

[@davidedsall9362]

the testosterone therapy treatment was not pushes because the big parma suppresses that Let's see $100 sales vs $8000 sales what you you pick for you business ther reis no patient support group.

[@brucejensen3081]

Eunuchs seem to live 15 years longer than blokes with nuts. Having your testicles removed seems to have a positive impact on prostate. Testosterone seems to have all these positive effects. Is there something i am mising, is there something thats not Testosterone in the testicles that is really having adverse effects. Like if your nuts are useless and you go onto trt, it would seem removing your nuts as well would lead to a much longer life. But the question still is, what from the testicles is so harmful, and can this be blocked with nutrients, anti nutrients, meds

[@charlestoddsullivanforpres6628]

Eunuchs are living longer than women?

[@irondirectprimarycare9440]

I have a series on testosterone literature reviews on my KZbin channel for those who are interested in reading the literature with me.

[@ricknowak4582]

Wooden interrupt this gentleman so much. Let him complete his thought before you start button in! Ha!

[@dsloan9561]

“I get waaaay too PHOSPHORYLATED!!”

[@alphabeta8403]

3:00 Testosterone may be protective against prostate cancer Facilitators: No alcohol No nicotine No p0rn Low carb (

[@danyalraza4388]

half of your facilitators aren't real bro. But good for you

[@zeiddaas8038]

What is IF/2MAD ?

[@frederickrich7393]

You might not live forever but it will fucking feel like it.!!!

[@SixFive8]

What's your thoughts on the use of medically prescribed TRT therapy for someone who meets most factors for its use but had a dvt and pulmonary embolism over a year ago? Is that factor that would not be prescribed TRT therapy? Thank you for your educational videos.

[@JT0007]

Where does everyone buy their TRT? 🫡🇺🇸

[@paulk9985]

Your primary care doctor, urologist, or endocrinologist, by prescription. I think some of the supplements like Nugenix or Ageless Male may help. Not sure how safe they are, as they may not approved by the FDA.

[@goyo2897]

I think those supplements are safe but they just don't work when it comes to raising testosterone in an appreciable way @@paulk9985