What Precludes Beginning Testosterone Replacement?

Prostate Cancer is a real and serious concern for men of a certain age. When we encounter men who are in denial about or resistant to this reality, it causes grave concern.

What Precludes Beginning Testosterone Replacement?

• Current Untreated Prostate Cancer
• A young man who is currently making his own testosterone, without symptoms
• A man who wants to exceed normal levels for weightlifting
• A man with severe prostate enlargement that prevents urination.

Sadly there are times when a man wants to make an appointment to receive testosterone replacement, but is not a candidate for testosterone replacement, and I will not accommodate his wishes.  In no way is this because I wish him harm but because I want to do him NO HARM.   It is the duty of all physicians to only treat people who need treatment for their health, and to refuse to use medications or surgery even when the patient demands it, if it will harm him or her. As much as I value the independence of patients to make their own healthcare decisions, there are times when I cannot accommodate their wishes for their own good.  

This type of thing occurs often when I am treating patients with testosterone and estradiol, so much so that I evaluate both the lab results and the symptoms of a prospective patient before I make an appointment to come to see me.  No one wants to come to the doctor, waste time and money, and not receive the treatment they desire.  By only seeing those patients who need testosterone replacement and who can take it safely, I can limit the number of unhappy patients I see.  In certain cases I tell them that I wills see them to discuss other medical issues I have found, but I don’t plan on giving them testosterone.  

The husband of one of my long -term female pellet patients sent his blood work in and his history and symptoms.  I know this lovely man and was looking forward to treating him so I was surprised to find that he had a very high PSA, and by history had also had one the year before, but had refused a prostate biopsy from his treating urologist.  I asked him to get a second opinion of another urologist and have whatever evaluation he needed from this specialist, and then send the results to me and after that showed he did not have prostate cancer, then I would treat him. Let’s call this gentleman Dan.

He was adamant that he wants testosterone because he doesn’t feel well, yet he had many high risk factors for prostate cancer and he had an elevated PSAs for over a year.

His father had died of prostate cancer, and he was told over a year ago that he had a “hard spot” on his prostate but refused a biopsy then and now.  Sadly Dan was so distraught that he accept the fact that he needed a biopsy or MRI of the prostate for me to feel comfortable treating him with testosterone, and wanted treatment without the “proof” he was safe to take testosterone.

It is one thing to treat someone with testosterone who may have a high risk of developing prostate cancer, and quite another thing to treat a man who already has prostate cancer with testosterone.  In his book Testosterone Forever ,  

Dr. Morgantaler states that in some circumstances there may be a role for testosterone replacement after the cancer is treated.   However, in high risk individuals without cancer the replacement of testosterone may actually prevent the development of prostate cancer.  Dr. Morgantaler’s research details how prostate cancer is already established, then the cells have changed and testosterone can actually stimulate the growth of prostate cancer.  

High Risk for Prostate Cancer

• Family History
• Prostate Exam: Hard or Soft, Lumpy or Smooth?
• PSA: greater than 4.0 or not
• Age Less than or equal to 50 or or more than or equal to 70

Tools for Evaluation of Suspected Prostate Cancer

• PSA
• Physical exam of the prostate
• MRI
• Ultrasound of Prostate
• Prostate Bx—to determine if it is cancer and if it is aggressive cancer or not

My Advice:  You can’t ignore serious illness—You must get the work up and find out if you have a problem or not!  Cancer does not wait to grow just because you don’t know about it! If you don’t follow the steps then your doctor cannot decide if he or she is going to do harm with a particular treatment.  Why would you ignore such a warning sign?

Just think, if you were told that your house’s foundation was cracked and might fall down any minute, what would you do?  Assuming you have no experience in construction would you do nothing?  Sadly, I think some men might just ignore it until the house crashed around them, and that is why we see such advanced cancer, denial!

But for those of you with logical sense, it is very important to find the problem if there is one, and relieve the nagging worry in the back of your mind, which in itself can make you sick!  But more importantly it is imperative that you share this information with your family and get their vote on what you should do because just sometimes, we can’t think, if we are thinking about ourselves!

I told Dan that he MUST go to the Urologist and get an MRI or a biopsy and then follow his advice because he/she is the expert and you are not, so please hear what we have to say to you!  We are trying to prevent a disaster, and we don’t want your “house to fall down”!  If you can’t do it for yourself, then do it for your wife and kids!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.