An Old Concern, New Evidence
For decades, doctors worried that testosterone therapy might cause or fuel prostate cancer. This concern came from older research showing that lowering testosterone could slow advanced prostate cancer.
Since then, many studies have looked at this question more closely, and the picture has changed.
What Current Research Shows
Current evidence does not show that testosterone therapy causes prostate cancer in men with low testosterone. Studies—including large trials like TRAVERSE—have not found higher rates of prostate cancer in men on testosterone compared with placebo.
One explanation is the "saturation model": the prostate's response to testosterone appears to max out at relatively low levels. Raising testosterone from low to normal doesn't seem to keep stimulating prostate tissue.
In 2026, HHS requested updates to testosterone labeling that would limit the prostate cancer contraindication to metastatic prostate cancer, reflecting this updated evidence.
Why Monitoring Still Matters
Even though TRT doesn't appear to cause prostate cancer, prostate health is still monitored because:
- Prostate cancer is common as men age
- Testosterone may make an existing, undiagnosed cancer easier to detect—or could affect a cancer that's already present
- PSA can rise slightly when starting treatment
Monitoring typically includes:
- A PSA test before starting treatment (often for men over 40)
- Repeat PSA testing within the first year and periodically after
- Evaluation if PSA rises significantly
Who Should Be Cautious?
- Men with metastatic prostate cancer should not use testosterone
- Men with a history of prostate cancer should discuss treatment carefully with their urologist or oncologist
- Men with severe urinary symptoms from an enlarged prostate need close monitoring
Learn more about provider-guided testosterone therapy here: Heva Hormone Optimization
The Bottom Line
Testosterone therapy has not been shown to cause prostate cancer. With proper screening and regular PSA monitoring, TRT can be used safely by most men with low testosterone.