TRT, DHT and prostate cancer

[MikeXL]

Generally, Doctors who advocate TRT seem to subscribe to the theory of Androgen Receptor (AR) suturation. Under this theory, the ARs in the prostate are fully saturated at total testosterone levels of 150. And thus, a testosterone level 1,200 is no more likely to cause malignant or benign prostate growth than is a testosterone level of 200.

Testosterone and DHT bind to the same AR. So, one would think that if the AR is saturated such that increased T levels aren't a concern for prostate cancer (PC) then increased DHT levels wouldn't be a concern for PC either. However, the same doctors who believe in the saturation theory, still seem concerned with elevated DHT causing or worsening prostate issues. Why is this?

hoping dr Crisler or Saya or McClain could shed light. Nelson

 

[MikeXL]

I posted this the face book page, and Dr Saya gave a great answer that I will post here.

"The saturation theory is just that...a theory. Thus, even if we subscribe to it and believe it has merit, there is no guarantee that it holds true as a 100% physiologic fact. Throw into the equation that prostate cancers can have mutations of the androgen receptor (consequently perhaps altering the receptor behavior/dynamics vs "normal" androgen receptors) and you can see that there are no certainties. Regarding the testosterone vs DHT question pertaining to "saturation theory", I would personally say the stakes are simply higher when talking about DHT. With DHT being a MUCH more potent androgen than testosterone, it is akin to wagering your house vs wagering your sofa on one's confidence of the universal applicability of the saturation theory."