TRT vs. Prostate Cancer

Happy Wednesday!

Every week, I get at least 1-2 messages like the one I received below:

I see this all the time.

Men chasing energy, drive, and vitality with testosterone therapy get spooked by PSA blips, hit the brakes, feel lousy again, and repeat the cycle.

Today I want to cover:

1. What the latest 2025 evidence says about testosterone and prostate cancer risk

2. Why the old “testosterone causes prostate cancer” myth refuses to die

3. How low T and hormonal volatility likely do more harm than physiologic replacement, and

4. My practical approach to BPH/high PSA

Let’s dive in!

Emerging Data

A new 2025 BJU International systematic review looked specifically at men with localized prostate cancer who received TRT and found no oncologic signal that TRT worsens outcomes (recurrence/progression) across observational data sets.

Translation?

Carefully selected men didn’t do worse on physiologic testosterone replacement. 

If anything, they had a higher quality of life with no progression of their already existing cancer.

The “Testosterone Causes Prostate Cancer” Myth

In the 1940s, Huggins & Hodges showed that metastatic prostate cancer regresses with androgen deprivation.

The prevailing “wisdom” suggested that if zero T shrinks tumors, then higher T must feed them.

For decades, this became dogma, even though later prospective data failed to show that eugonadal men with higher T get more prostate cancer.

Prostate tissue is exquisitely androgen-sensitive at very low T, but once androgen receptors are saturated, additional testosterone doesn’t drive more growth.

That’s why castration helps metastatic disease, yet returning a hypogonadal man to optimized T doesn’t appear to initiate or accelerate cancer, which has been confirmed by modern outcomes and echoed by regulators updating labels in 2025. 

What We Know Now

The TRAVERSE study (NEJM 2023) looked at over 5,000 men with low testosterone and heart risk.

It found that testosterone replacement therapy (TRT) was just as safe as placebo for major heart problems, with no increase in prostate issues.

The 2025 systematic review in BJU International focused on men with localized prostate cancer on TRT, showing no worsening of cancer outcomes in observational studies.  

Finally, the 2025 guidelines clarified what to monitor during TRT, so doctors don’t need to stop therapy just because PSA levels change slightly.

Most early PSA increases are small and level off, but large or persistent jumps still require a standard urology exam.

Is Low T Actually The Problem?

When men sit in chronically low testosterone states, the prostate is on the steep, hyper-responsive part of the androgen curve.

Small endogenous fluctuations can feel like big signals.

When we adjust testosterone levels to be in the normal middle range, we reach a point called the plateau, which is a key part of the saturation model.

This means that beyond this point, increasing testosterone doesn't significantly increase its effects on the prostate.

That’s one reason hypogonadal men often present with worse disease biology, while physiologic restoration doesn’t increase incidence or recurrence.

Maintaining consistent hormone therapy is much better than experiencing ups and downs.

On the other hand, if you have yo-yoing or fluctuating levels, your testosterone might drop too low or spike too high temporarily, which can cause problems.  

Stable, optimized testosterone levels over time are healthier than low, fluctuating levels that can cause symptoms or health issues. 

Where Peptides Fit In

For BPH, daily tadalafil (5 mg) improves urinary flow and sexual function.

Regarding peptides, here’s what I’ve seen work anecdotally as an adjunctive 8–12-week peptide protocol:

• KPV — 1 mg per day. Powerful anti-inflammatory signaling to calm local prostate irritation.

• Prostamax — 2 mg per day. A prostate-specific bioregulator that may normalize tissue architecture and PSA expression.

• Vesilute — 2 mg per day. Targets the bladder and urinary tract for smoother flow and reduced residual volume.

• Thymosin Alpha-1 (TA1) — 1 mg per day. Immune-modulating and protective against chronic inflammation that can drive PSA volatility.

When combined with lifestyle optimization, they can help stabilize the prostate environment while you fine-tune your TRT.

Final Thoughts

If there’s one message I want you to take away, it’s that men can improve their prostate health by optimizing their testosterone levels.

For decades, the medical establishment taught that testosterone was “fuel” for prostate cancer.

But the data are finally catching up to what men who’ve lived this know intuitively.

When testosterone is chronically low, everything starts to break down.

The prostate becomes more reactive to small hormonal fluctuations, inflammation worsens, and cellular integrity declines.

Men with low testosterone experience worse prostate outcomes, higher rates of aggressive disease, and poorer overall health.

On the other hand, optimized testosterone supports prostate balance, immune resilience, and metabolic function.

I hope more men will hear this message and demand that their healthcare providers review the data.

Together, we can challenge the long-standing beliefs that have impacted the quality of life for millions of men and work toward a better understanding of prostate health.

So don’t fear testosterone!

Your prostate will thank you for it.

Best,

Hunter Williams

Further reading

1. BJU International (2025): Oncological safety of TRT in men with localised prostate cancer: systematic review. https://pubmed.ncbi.nlm.nih.gov/40747831/ 

2. NEJM (2023): TRAVERSE RCT — cardiovascular safety of TRT. https://www.nejm.org/doi/full/10.1056/NEJMoa2215025 

3. European Urology Oncology (2024): Active surveillance outcomes with TRT (no increased conversion to treatment). https://www.sciencedirect.com/science/article/pii/S2666168324002143 

Disclaimer: I’m not a doctor. This email reflects my opinions and interpretation of the literature for educational and entertainment purposes only. It’s not diagnosis, treatment, or medical advice. Work with a qualified clinician before changing any therapy.