Can Testosterone Replacement Therapy Cause Enlarged Prostate?

Posted: August 9, 2021

Testosterone replacement therapy is a common treatment for men with low T. Many people wonder if there’s a connection between testosterone and an enlarged prostate. This is a common misconception. However, many researchers have concluded there’s little to no evidence that men using testosterone have higher risks for an enlarged prostate. If you think you have a testosterone deficiency, it’s important to discuss the particulars of your case with one of our treatment providers, including any potential risks. However, research suggests an enlarged prostate isn’t a major concern for those who start a testosterone therapy regimen. 

Testosterone replacement therapy can help improve symptoms of low T. Research suggests it doesn’t increase the risk for enlarged prostate.

What is an Enlarged Prostate?

Before we get into whether testosterone therapy (TRT) can affect your risk for an enlarged prostate, it’s important to talk about what an enlarged prostate is, some symptoms, and some other basic information. You likely know what your prostate is, but as a quick recap: the prostate is a muscular gland that surrounds your urethra. It makes most of the fluid found in your semen and the muscle helps propel semen forward during sexual climax. 

Over time, this gland can become bigger and may cause some symptoms. This is an enlarged prostate. Also known as benign prostatic hyperplasia (BPH), this is where the prostate produces more and more cells and swells up, putting pressure on the urethra. The extra pressure on the urethra can then lead to lower urinary tract symptoms (LUTS). BPH is not prostate cancer and doesn’t increase your risk for prostate cancer. However, symptoms of an enlarged prostate can negatively affect your quality of life. 

Enlarged prostate is a common condition. It affects an estimated 50% of men over 50 years old. The risk for an enlarged prostate increases with age, as the prostate tends to grow as you get older. 

Symptoms of BPH/LUTS

So, what are the symptoms of BPH? We mentioned that BPH can cause you to develop LUTS. When the prostate puts pressure on the urethra, you might experience several different symptoms, such as:

• Frequent urination
• Urgency
• Weak urine stream
• Straining to urinate
• Urine stream intermittency
• Nocturia (waking up at night to urinate)

An enlarged prostate can affect urination and your urinary tract. Therefore, it can also increase the risk for things like painful urination, urinary tract infections, and even urinary tract blockages where you’re unable to urinate.

Can Testosterone Replacement Therapy Increase the Risk for Enlarged Prostate?

So, now let’s talk about whether testosterone replacement therapy can affect your risk factors for an enlarged prostate. It’s a common misconception that testosterone can cause or worsen BPH. There are a few reasons for this misconception. 

First, many believe rising testosterone levels during puberty cause prostate growth. When you’re born, your prostate gland is quite small and remains that way until puberty. At this point, the gland grows quite quickly. Then, growth slows down for a couple of decades.

Another reason some believe that testosterone affects prostate enlargement is because of a study from the 1940s by a man named Charles Huggins. In his studies, he looked at the effect of castration in relation to prostate cancer. He found a relationship between prostate cancer growth and testosterone. 

However, there are a few important things to note. First, while testosterone can cause the prostate to grow during puberty, enlarged prostate in young men with peak testosterone levels is pretty rare. Instead, the risks for BPH go up with age. Age is also a risk factor for low testosterone.

In addition, the Huggins studies are quite old and looked at prostate cancer, not normal prostate tissue, which is what causes an enlarged prostate. Therefore, these studies may not be particularly helpful when it comes to looking at BPH.

Several modern studies have found that testosterone doesn’t cause or worsen an enlarged prostate and, in some cases, may even help reduce symptoms. 

Studies Show Prostate Size and Enlarged Prostate Symptoms Aren’t Associated with Testosterone Replacement Therapy

There have been many studies to research whether testosterone replacement therapy affects the risk for BPH. Many have also shown there’s no change in enlarged prostate after beginning testosterone. 

One 2015 study out of the University of Illinois looked at data from 1995 to 2015 to see if TRT might cause or worsen BPH or LUTS. The study looked at men with low testosterone and mild LUTS. Those taking TRT noticed either no change in their symptoms or even a slight improvement. This includes LUTS as well as their International Prostate Symptom Scores (IPSS). The researchers also found no significant increase in prostate size after beginning testosterone therapy.

Some Men May Notice Symptom Improvement with Testosterone Replacement Therapy

In other studies, some men have even noticed their enlarged prostate symptoms get better after beginning testosterone. One study looked at patients with metabolic syndrome, LUTS, and low testosterone levels. The researchers found that the men’s LUTS symptoms improved after starting testosterone. They theorized that testosterone replacement therapy may have helped reduce some of the risks for inflammation that are common in those with metabolic syndrome, which, in turn, helped reduce prostate inflammation and symptoms of an enlarged prostate. Therefore, some men may even benefit from testosterone if they have both low T levels and symptoms of enlarged prostate, though research is still ongoing.

Why Testosterone Replacement Therapy May Not Affect Enlarged Prostate

Researchers are still studying the link between testosterone and the prostate. However, there are a few reasons why TRT may have no effect on prostate size or enlarged prostate symptoms. While it’s true that the prostate increases in size during puberty, serum testosterone in your blood as you get older may not have much influence on your prostate. Several researchers believe that blood testosterone has little effect on the prostate, only the testosterone inside the prostate, which doesn’t seem to change easily with testosterone administration. 

Also, for those who noticed improvements, there may be an explanation for that as well. It’s not entirely clear what causes an enlarged prostate. However, some believe low nitric oxide levels in the body may be partially to blame. Nitric oxide may help with the process of relaxing smooth muscles. How does this relate to testosterone? Many believe testosterone affects nitric oxide production in your body. 

So, while research continues for testosterone and enlarged prostate, there may be several explanations to why testosterone replacement therapy later in life does not seem to cause or worsen enlarged prostate. 

If you’re experiencing symptoms of low testosterone, our treatment providers may be able to help. Our team can help find underlying causes of your symptoms and work with you to create customized treatment plans to help you feel great again. 

Address Your Whole Health at Low T Center

Getting quality health care is easy with our team at Low T Center. We’re dedicated to making men’s health care convenient, accessible, and affordable. Our providers take a holistic approach to men’s health. We are here to help you identify potential causes of your symptoms. We also help find treatment solutions to help you feel your best. Make an appointment today to take the first step toward better health and get a comprehensive health assessment!

Related Posts

Disclaimer: This article is made available for general, entertainment and educational purposes only. The opinions expressed herein do not necessarily reflect those of Low T Center. You should always seek the advice of a licensed healthcare professional.