Testosterone and prostate cancer

TRT Won’t Increase Your Risk of This Cancer, New Study Reveals

New research suggests that it doesn’t—but you should stay on top of one key biomarker.


or years some men have shied away from testosterone replacement therapy due to a possible link with prostate cancer. Now, a new study reveals TRT may not increase your risk after all.

Results from a double-blind randomized trial published in the Journal of the American Medical Association revealed that TRT likely doesn’t heighten the risk for prostate-related illnesses, including cancer, in those who aren’t already predisposed (1).

The news may provide comfort to those who could benefit from TRT, but were reluctant to try due to this possible link. The myth has long stopped aging men—who have cancer prevention at the top of mind—from seeking treatment for symptoms of low testosterone, says Jim Staheli, D.O.

About the Expert:

Dr. James Staheli, D.O., is the medical director for Broad Health and a family medicine doctor in Atlanta, Georgia. He specializes in hormone treatment for men.

What the Study Found

Researchers used data from the 2023 TRAVERSE study—the largest TRT study to date—to select around 4,000 TRT recipients who had low incidences of prostate conditions such as cancer, acute urinary retention, and an enlarged prostate. They excluded men with prostate-specific androgen (PSA) levels higher than 3.0 nanograms per milliliter (ng/mL) and a high score during a self-assessment of prostate symptoms, as both markers could be indicative of an increased risk for prostate conditions. 

After 21 months of testosterone treatment, researchers found that there was no significant difference in prostate cancer incidence between men who received TRT and the placebo group. 

The link between testosterone and prostate-specific antigen

The study authors wrote that these results “should not be applied to patients with known prostate cancer, those with higher PSA values, or men who do not have confirmed hypogonadism.” For context, hypogonadism occurs when the body’s sex glands can’t produce adequate levels of testosterone (2).

The relationship between testosterone and PSA is complicated. PSA is a protein produced by both cancerous and non-cancerous tissue in the prostate, according to Staheli. “It’s primarily used to screen for prostate cancer, but it’s not a definitive test.” 

Normal PSA labs range anywhere between 0.0-3.9 ng/mL (3). PSA levels greater than 4.0 ng/mL—or an increase of 1.0 ng/mL or more from a previous, healthy lab result—could indicate that you have, or are at risk for, prostate cancer.

While there is some evidence suggesting that higher testosterone levels may lead to an increase in PSA production (4), other research suggests that untreated low T is linked to more severe prostate cancer (5).

My PSA Levels Are High—Can I Still Take TRT?

It depends, says Staheli. While healthy people who take TRT aren’t at an increased risk for prostate cancer, men with PSA levels over 4 ng/ml or PSA over 3 ng/ml in people at high risk for prostate cancer won’t be able to start—or continue—TRT without further urological evaluation. For example, a urologist may prescribe an MRI, imaging, a biopsy and further tests. 

Also, it’s important to note that high PSA levels aren’t always linked to cancer, Staheli says. These conditions and activities can also raise your PSA levels:

  • Urinary tract infections
  • Inflamed prostate
  • Sexual activity
  • Vigorous exercise
  • Bicycling, motorcycling, and horseback riding
  • Fasting 
  • Taking certain medications or supplements


In other words, an initial test that shows high PSA levels doesn’t automatically disqualify you from getting TRT. Check in with your doctor to see if you’d be a good candidate.

Hone’s at-home testosterone assessment is the simplest way to uncover whether your levels are low. If you qualify for treatment, TRT can be sent right to your door.