TRT and Prostate Cancer: Risks, Evidence & Safety (2026)

Medically reviewed by: Katelyn Schwartz, NP, Family Nurse Practitioner with Advanced Training in TRT, BHRT, and Menopause Care
Last reviewed: October 2026

The question often comes before any talk of energy or libido. A man sits down to go over his blood work, and his first worry is whether testosterone could give him the cancer his father had. It’s a fair question, and it deserves an answer built on current research into TRT and prostate cancer, not on 1940s assumptions. Below, you’ll see what the latest trials found, why PSA can drift up, and how a provider-led TRT program in Vancouver checks the prostate.

About 1 in 9 men in Canada will develop prostate cancer in their lifetime, according to the Canadian Cancer Society. It’s also the most common cancer in Canadian men. So the question often arrives alongside months of symptoms of low testosterone.

Does TRT Cause Prostate Cancer? The Short Answer

Current evidence does not show that TRT causes prostate cancer in men who are screened before starting. In TRAVERSE, a large placebo-controlled trial, high-grade prostate cancer was found in 0.19% of men on testosterone and 0.12% on placebo over about two years. That difference was not statistically significant. Testosterone is generally not started in men with active or suspected prostate cancer, and PSA is checked before and during treatment.

What the trials show: no significant rise in high-grade or overall prostate cancer in carefully selected men.
What they can’t show yet: effects over many years, or safety in men with active cancer.
What to expect on your labs: PSA often rises a little, and your provider tracks how fast.
Who needs extra care: men with a family history, Black men, older men, and anyone treated for prostate cancer.

Where the “Testosterone Feeds Cancer” Idea Came From

The worry about testosterone and prostate cancer has a real scientific origin. In the 1940s, researchers found that advanced prostate cancer depends on testosterone. Since then, lowering testosterone to castrate levels has been a first-line treatment for advanced disease. From there, a simple assumption took hold: if removing testosterone slows the cancer, adding it back must speed it up.

Yet that logic rested on men whose testosterone had been pushed close to zero. Moving a low level back to normal is a different situation.

Why More Testosterone Isn’t Always More Fuel

In 2009, Abraham Morgentaler and Abdulmaged Traish described what they called the saturation model in European Urology. Prostate cells respond to testosterone through androgen receptors, the docking sites the hormone binds to. At very low levels, prostate growth is highly sensitive to small changes in testosterone. But the receptors become fully occupied at levels well below the normal range. Once they’re full, more testosterone adds little further effect.

That would explain why castration has such a dramatic effect, while raising a low level to normal seems to change little. It’s a model rather than a proof, though population data largely fit it.

In 2018, Watts and colleagues pooled 20 prospective studies in European Urology, with more than 6,900 men who later developed prostate cancer. Men in the lowest tenth of free testosterone had a lower overall risk of diagnosis than everyone else. Their high-grade risk was slightly higher, though not significantly. The authors say biology or detection bias may explain the pattern.

What the Latest Research Shows on TRT and Prostate Cancer

TRAVERSE: A Large Placebo-Controlled Trial

Shalender Bhasin and colleagues published the prostate results of TRAVERSE in JAMA Network Open in 2023. The trial analyzed 5,204 men aged 45 to 80 with low testosterone, symptoms, and heart disease or a raised heart risk. Men with a PSA above 3.0 ng/mL or a high urinary symptom score could not join. Half used a testosterone gel and half a placebo gel, without knowing which.

The trial found high-grade prostate cancer in 5 of 2,596 men on testosterone (0.19%) and 3 of 2,602 on placebo (0.12%). That difference was not statistically significant. Still, with only eight high-grade cancers in total, the trial could not rule out a small increase. There were no significant differences in overall prostate cancer, urinary retention, prostate procedures or biopsies. PSA did rise more with testosterone, which matters for monitoring.

Their results don’t apply to men with known prostate cancer, higher PSA values, or unconfirmed low testosterone. Treatment lasted just under two years on average, and cancers can take many years to develop. So the trial supports medium-term safety in screened men, not lifelong safety.

Pooled Trials and Registry Data

A 2026 meta-analysis led by García-Becerra in the International Journal of Impotence Research combined 41 randomized trials with 11,161 men. Testosterone therapy was not linked to a significant increase in prostate cancer events. The authors call this support for short- to mid-term safety and say long-term data are still needed. It largely confirms the same trial data rather than adding a new test.

Loeb and colleagues studied Sweden’s national prostate cancer register for the Journal of Clinical Oncology in 2017. Men who had filled testosterone prescriptions had no higher overall risk of prostate cancer. They did have more favourable-risk cancers found in the first year, which the authors said suggests detection bias. Aggressive cancer was less common after a year of use. However, that was an observational finding the authors said “warrants further investigation”, so it isn’t proof of protection.

The Evidence at a Glance

Study	Design	Did it test TRT?	Main prostate finding	Main limit
TRAVERSE (JAMA Network Open, 2023)	Randomized, placebo-controlled, 5,204 men	Yes	High-grade cancer 0.19% on TRT vs 0.12% on placebo, not significant	About two years, screened men only
García-Becerra (Int J Impot Res, 2026)	Meta-analysis of 41 trials, 11,161 men	Yes	No significant rise in prostate cancer events	Short to mid-term trials only
Loeb (J Clin Oncol, 2017)	Swedish national registry	Yes, from prescription records	No rise overall, more favourable-risk cancer found early	Observational, detection bias likely
Watts (Eur Urol, 2018)	20 prospective studies, pooled	No, natural hormone levels	Lowest tenth of free testosterone had lower risk	Observational, detection bias possible

Why PSA Can Rise on TRT, and When It Matters

PSA, or prostate-specific antigen, is a protein made by the prostate. In TRAVERSE, PSA rose more in men on testosterone than in men on placebo. So some upward movement is expected, and guidelines set thresholds for when a rise needs a closer look.

What matters is the size and speed of the change. The Endocrine Society’s 2018 guideline recommends a urology consultation if any of these appears in the first 12 months:

a confirmed PSA rise of more than 1.4 ng/mL above your starting value;
a confirmed PSA above 4.0 ng/mL;
a prostate abnormality found on a digital rectal exam.

After the first year, monitoring follows standard prostate screening for your age and background. The Canadian Urological Association adds that a significant PSA rise should be investigated, not simply blamed on testosterone.

The Monitoring Schedule in Canadian Guidance

The 2021 CUA guideline on testosterone deficiency sets a clear schedule:

PSA blood test: before starting, at 3 months, at 6 months, then yearly.
Digital rectal exam: before starting, then once a year.
Symptoms and testosterone level: reviewed at the same visits.

Our guide to TRT blood tests explains each result. Between tests, mention a weaker stream, more trips to the bathroom at night, or new trouble passing urine. The Canadian product information for injectable testosterone advises checking PSA and the prostate if urination becomes harder or your habits change. Many come from benign enlargement, covered in our guide to TRT and an enlarged prostate.

Who Needs Extra Caution Before Starting TRT

Your personal and family history shape how carefully your provider checks the prostate first.

A Known or Suspected Prostate Cancer

The Canadian product information for testosterone lists known or suspected prostate or breast cancer as a reason not to use it. The Endocrine Society recommends against starting without a urology check first in three more cases. They are a palpable prostate nodule, a PSA above 4 ng/mL, or a PSA above 3 ng/mL with a high prostate cancer risk.

Family History, Ancestry, and Genes

A brother or father diagnosed with prostate cancer raises the stakes. The CUA’s 2022 screening update says men under 50 with an affected first-degree relative have roughly five times the risk of diagnosis. For men at increased risk, it suggests starting PSA screening at 45 rather than 50. The Endocrine Society gives Black men and men with a first-degree relative as examples of increased risk. For men aged 40 to 69 in that group, it suggests discussing the risk and offering monitoring options.

For men with an inherited gene change such as BRCA2, the CUA advises a testing plan built with a clinical geneticist.

Age and the Product Information

The Canadian product information takes a more cautious line than the recent trials. It says older men treated with androgens may be at increased risk of prostate enlargement and prostate cancer. It also says they, and others with known risk factors, should be checked for prostate cancer before starting. Both lead to one plan: screen first, then keep monitoring, along with the other TRT complications your provider watches for.

Can You Use TRT After Prostate Cancer Treatment?

The answer depends on the cancer and its treatment. The CUA guideline says some men with low testosterone symptoms can be considered for a medically supervised trial of testosterone. That includes men treated with surgery or radiation for localized cancer and men on active surveillance, provided there is no evidence of active disease. The CUA rates this evidence as low and the recommendation as weak, and it advises consulting a urologist.

The Endocrine Society’s 2018 guideline is stricter and recommends against testosterone in men with prostate cancer. The line is firmest for advanced disease. Men with metastatic or high-risk cancer who are likely to need hormone-lowering treatment should not be offered testosterone. A 2026 systematic review in Cureus found nine eligible studies, mostly retrospective. They suggest TRT does not appear to raise recurrence in low- to intermediate-risk disease, while data on high-risk disease remain limited. So the decision belongs with your urologist and cancer care team.

How Beyoung Health Approaches Prostate Safety

Concerns about TRT and prostate cancer are best answered with lab results, not reassurance alone. At Beyoung Health, you complete your blood work before your consultation. A licensed Nurse Practitioner reviews it with you, along with your prostate and family history, and you decide together whether TRT suits you. Follow-up labs then track how your levels change over time. Results vary with baseline levels, health and history.

Learn more about our testosterone replacement therapy approach, or see how care works for TRT in Vancouver and TRT in Toronto. When you’re ready, book a TRT consultation in Vancouver to talk it through.

TRT and Prostate Cancer: Common Questions

Q: Does TRT cause prostate cancer?

Current evidence does not show that it does, at least in men who are screened first. TRAVERSE found high-grade prostate cancer in 0.19% of men on testosterone and 0.12% on placebo, with no significant difference. The trial excluded men with a PSA above 3.0 ng/mL and lasted about two years, so PSA checks continue while you’re on treatment.

Q: Will my PSA go up on testosterone?

It may rise somewhat, since PSA rose more on testosterone than on placebo in TRAVERSE. In the first 12 months, the Endocrine Society advises a urology review for any of three findings. These are a confirmed rise of more than 1.4 ng/mL above baseline, a confirmed PSA above 4.0 ng/mL, or an abnormal prostate exam.

Q: Can I take TRT if my father had prostate cancer?

It may be possible, with closer checks first. A first-degree relative with prostate cancer puts you at increased risk. If your PSA is above 3 ng/mL, the Endocrine Society recommends a urology evaluation before starting.

Q: Can TRT speed up a cancer that’s already there?

The trials can’t fully rule that out. That’s why the Canadian product information lists known or suspected prostate cancer as a reason not to use it. It’s also why PSA and a prostate exam come before the first prescription. In the Swedish registry, the extra early cancers in year one suggested detection bias.

Q: Is TRT safe after prostate cancer treatment?

For some men, it may be an option. Canadian urology guidance says some men can be considered for a supervised trial with a urologist involved. That covers treated localized cancer or active surveillance, with no active disease. Men with metastatic or high-risk cancer who are likely to need hormone-lowering treatment should not be offered it.

Q: Does low testosterone protect against prostate cancer?

Not in a way you can use. In pooled data from 20 studies, men in the lowest tenth of free testosterone had fewer diagnoses overall. Their risk of high-grade disease was slightly higher, though not significantly. Detection bias may explain the pattern, so it isn’t a reason to stay low when labs show a real deficiency.

This content is for informational purposes only and does not constitute medical advice. Testosterone therapy requires a prescription and ongoing monitoring by a licensed provider. Speak with a qualified provider about your own situation before starting or changing any treatment.