PSA during TRT in Older Men: Data from a Controlled Trial

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Prostate Specific Antigen Levels during Testosterone Treatment of Hypogonadal Older Men: Data from a Controlled Trial


Prostate specific antigen (PSA) changes during testosterone treatment of older hypogonadal men have not been rigorously evaluated. The Endocrine Society Guidelines recommendation of urological referral for a confirmed increase in PSA >1.4 ng/mL is not based on PSA changes in testosterone-treated men.

Double-blinded, placebo-controlled trial.

Twelve United States academic medical centers.

790 hypogonadal men ≥65 years with average testosterone levels ≤275 ng/dL. Men at high risk for prostate cancer were excluded.

Testosterone or placebo gel for 12 months.

Main outcomes
Percentile changes in PSA during testosterone treatment for 12 months.

Testosterone treatment that increased testosterone levels from 232 ±63 ng/dL to mid-normal was associated with a small but significantly greater increase (p<0.001) in PSA levels than placebo treatment. Serum PSA levels increased from 1.14±0.86 ng/mL (mean ±SD) at baseline by 0.47±1.1 ng/mL at 12 months in the testosterone group and from 1.25±0.86 ng/mL by 0.06±0.72 ng/mL in the placebo group. Five percent of men treated with testosterone had an increase ≥1.7 ng/mL and 2.5% of men had an increase of ≥3.4 ng/mL. A confirmed absolute PSA >4.0 ng/mL at 12 months was observed in 1.9% of men in the testosterone group and 0.3% in the placebo group. Four men were diagnosed with prostate cancer; two were Gleason 8.

When hypogonadal, older men with normal baseline PSA are treated with testosterone, 5% had an increase in PSA ≥1.7 ng/mL,
and 2.5% had an increase ≥3.4 ng/mL.

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Defy Medical TRT clinic doctor
When i first started TRT i...which was with a TRT mill, they had me on 400mg/wk to start and my PSA went from .9ng/mL to 6.8ng/mL. I was stupid and uninformed. It then dropped to 4.6 to about a 2.6 ave. I got off TRT for a while and it dropped to 2.1 in the short 2 months I stopped. When i started back up it went to 2.7 and has since settled at 2.5.

I've been on TRT since July of 2017. I'm 55 yo and with no underlying medical condition other than age related T decline that prompted my to start TRT.
Mine went from 0.93 a year before trt, to 0.77 three months into TRT, but then a sizable rise to 1.8 ten months after the 0.77 reading. Any cause for concern at the velocity?
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