EAU - EANM - ESTRO -ESUR - ISUP - SIOG Guidelines on Prostate Cancer (2025)

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* Hypogonadal men receiving testosterone supplements do not have an increased risk of developing PCa [84]. A pooled analysis showed that men with very low concentrations of free testosterone (lowest 10%) have a below average risk (OR: 0.77) of PCa [85].




3.2 Aetiology and risk factors for prostate cancer

A wide variety of endogenous and exogenous/environmental factors have been discussed as being associated with the risk of developing PCa, or as being aetiologically important for the progression from latent to clinical PCa [14]. As previously discussed, there is likely a racial factor involved, but Asians who immigrated to the USA have approximately half the risk of PCa when compared to their US born Asian-descendant counterparts, implying a role for environmental and/or dietary factors [15]. These guidelines divide the risk factors into hereditary, such as ethnicity, family history and known genetic mutations, in which direct heritance of the risk factor is more obvious and direct, and non-hereditary, such as dietary and medical factors as well as metabolic syndrome and obesity, in which there may well be hereditary components, but they are more indirect.




3.2.2.3.2 Testosterone

Hypogonadal men receiving testosterone supplements do not have an increased risk of developing PCa [84]. A pooled analysis showed that men with very low concentrations of free testosterone (lowest 10%) have a below average risk (OR: 0.77) of PCa [85]. Furthermore, although the evidence is limited, men who are managed expectantly for PCa, or who received radical curative therapy, do not have worse outcomes when receiving testosterone supplementation, despite a theoretical higher risk of progression after correction of the hypogonadal situation [86].








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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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