Can Testosterone Therapy Raise PSA Levels? What the Latest Research Reveals

Introduction: Understanding the Link Between Testosterone and PSA

Testosterone is one of the most important hormones in the male body. It helps control many key functions such as muscle growth, bone strength, energy levels, mood, and sexual health. As men age, testosterone levels naturally decline, often beginning in the 30s and continuing slowly over time. For some men, this drop leads to symptoms like fatigue, loss of libido, depression, weight gain, or trouble concentrating. When low testosterone causes such problems, doctors may suggest testosterone replacement therapy, or TRT, to restore hormone balance and improve quality of life.

At the same time, doctors often monitor another marker in men’s health — a blood protein called prostate-specific antigen (PSA). PSA is made by cells in the prostate gland, a small organ below the bladder that helps produce semen. In healthy men, PSA levels stay low. However, when the prostate becomes irritated, enlarged, or cancerous, PSA can rise. That’s why doctors use the PSA test as an early signal of possible prostate disease, including prostate cancer.

Because both testosterone and PSA are closely linked to the prostate, there has been long-standing concern that raising testosterone levels through therapy could also raise PSA or even stimulate hidden prostate cancer. This idea goes back many decades, when scientists first observed that prostate cancer often depended on male hormones to grow. Early research showed that blocking testosterone could slow advanced prostate cancer, which led to the belief that adding testosterone might “feed” cancer cells or increase prostate activity.

For this reason, men considering testosterone therapy are often asked a very common question: Can testosterone therapy raise PSA levels? And if it does, does that mean there is a greater risk of prostate cancer? These questions are not only important to patients but also to doctors who prescribe testosterone. The answers have a direct effect on how therapy is monitored, how often PSA should be tested, and whether small PSA changes should cause worry.

Over the past two decades, many studies have tried to clarify this relationship. While early medical opinion was cautious, newer research suggests that the connection between testosterone therapy and PSA is more complex — and perhaps less dangerous — than once believed. Most evidence shows that testosterone therapy can cause a small, temporary rise in PSA, especially in the first few months of treatment. However, this increase usually stabilizes and remains within safe limits. More importantly, large clinical trials and long-term studies have not found that testosterone therapy directly increases the risk of developing prostate cancer in men who are carefully screened and monitored.

Still, the topic continues to raise debate because PSA is such an important part of prostate health monitoring. A sudden increase in PSA levels can cause anxiety and often leads to more testing or even a prostate biopsy. Knowing whether testosterone therapy might naturally cause a small PSA rise — without it meaning something dangerous — is essential for both patients and healthcare providers.

In addition, doctors must remember that PSA levels can change for many reasons other than testosterone. For example, prostate infections, inflammation, recent sexual activity, or even certain medical procedures can cause a temporary PSA increase. Distinguishing these normal variations from worrisome changes requires experience and careful interpretation. That’s why professional medical groups, such as the American Urological Association and the Endocrine Society, have published clear guidelines on how to test PSA before starting testosterone therapy and how to track it during treatment.

This article explores what the latest research reveals about the connection between testosterone therapy and PSA levels. It will explain in simple terms what PSA is, why testosterone is prescribed, and what happens in the body when hormone levels change. It will review findings from major studies, summarize expert recommendations, and address the most common questions men ask when they are thinking about or already receiving testosterone therapy.

By the end of this article, readers will understand how testosterone therapy may influence PSA, what changes are normal, and when a PSA rise needs further attention. The goal is not to promote or discourage treatment, but to share clear, factual information based on current scientific evidence. Understanding these facts helps men and their doctors make informed decisions about hormone therapy while keeping prostate health under close and safe supervision.

In short, testosterone therapy and PSA testing are closely connected in modern men’s health care. One manages low hormone levels that can affect quality of life; the other protects against prostate problems that can threaten it. Knowing how they interact is the first step toward using testosterone safely and responsibly — which is exactly what the following sections will explain in detail.

What Is PSA and Why Does It Matter in Men’s Health?

Prostate health is a major part of men’s overall well-being, especially as they get older. One of the most common ways doctors check prostate health is through a simple blood test called the PSA test. PSA stands for Prostate-Specific Antigen, and it plays an important role in helping doctors look for early signs of prostate problems. Understanding what PSA is, how it works, and why it sometimes changes is key to understanding how testosterone therapy may affect it.

What Is PSA?

PSA is a protein made by the cells of the prostate gland, a small organ that sits below the bladder and in front of the rectum. The prostate’s main job is to make fluid that mixes with sperm to form semen. This fluid helps protect and move sperm during ejaculation.
A small amount of PSA naturally leaks from the prostate into the bloodstream. The PSA test measures how much of this protein is in your blood.

There are two main types of PSA in the blood:

1. Free PSA, which floats freely in the bloodstream.

2. Bound PSA, which attaches to other proteins.

Doctors often look at both the total PSA and the ratio of free to bound PSA. This helps them tell whether a high PSA might be caused by prostate cancer or by something less serious, like an infection or benign growth.

Why PSA Matters

PSA is important because it acts like an early warning sign for prostate problems. Higher-than-normal PSA levels may mean the prostate is irritated, enlarged, or possibly developing cancer. However, PSA is not a perfect test. It can rise for many reasons that have nothing to do with cancer.

Still, it’s one of the best tools doctors have for monitoring prostate health over time. By checking PSA levels regularly, doctors can see if something changes and decide whether further testing, such as imaging or a biopsy, is needed.

Normal PSA Levels and Age Differences

There isn’t one “normal” PSA level that fits everyone. PSA levels naturally increase with age, even in healthy men. This is because the prostate tends to grow slowly as men get older.
Here’s a general guide to what many doctors consider normal PSA levels:

• Men under 50: less than 2.5 ng/mL

• Men aged 50–59: less than 3.5 ng/mL

• Men aged 60–69: less than 4.5 ng/mL

• Men aged 70 and older: less than 6.5 ng/mL

It’s important to note that a number by itself doesn’t always tell the full story. For example, if a man’s PSA rises quickly from one year to the next, that may be more concerning than a single high number that stays stable. Doctors often look at PSA velocity—the rate of change over time—to get a clearer picture.

Factors That Can Affect PSA Levels

Many things besides prostate cancer can cause PSA levels to rise or fall. Understanding these helps avoid false alarms or unnecessary worry.

Benign Prostatic Hyperplasia (BPH):

This is a non-cancerous enlargement of the prostate that happens in many older men. As the prostate grows, it makes more PSA, even though it isn’t dangerous.

Prostatitis:

Inflammation or infection of the prostate can cause a sudden, sometimes large jump in PSA levels. This is often treated with antibiotics and anti-inflammatory medication.

Ejaculation:

Sexual activity within 24–48 hours before a PSA test can temporarily raise PSA. Doctors often recommend avoiding ejaculation before testing.

Urinary Procedures or Medical Exams:

Recent catheter use, cystoscopy (a camera inserted into the bladder), or even a vigorous prostate exam can cause a mild rise in PSA for a few days.

Exercise or Bicycle Riding:

Long bike rides can put pressure on the prostate and slightly raise PSA levels temporarily.

Medications:

Some medications, especially 5-alpha-reductase inhibitors (like finasteride or dutasteride used for prostate enlargement or hair loss), can lower PSA levels by up to 50%. Doctors need to know if a patient is taking these drugs to interpret the test correctly.

Testosterone Levels:

Since PSA production depends on male hormones, including testosterone, low hormone levels can reduce PSA. Increasing testosterone through therapy can, in some men, cause PSA to rise modestly—one of the main topics explored later in this article.

How PSA Is Measured and Interpreted

The PSA test is a simple blood draw, usually done in a doctor’s office or lab. Results are measured in nanograms per milliliter (ng/mL) of blood. The interpretation depends on:

• Absolute value: The total PSA level.

• PSA trend over time: Whether levels are steady, rising, or falling.

• Free-to-total PSA ratio: A lower ratio may suggest a higher risk of prostate cancer.

If PSA levels are higher than expected, the doctor may repeat the test to confirm. Sometimes, temporary causes such as infection or recent sexual activity explain the increase. Persistent elevation might lead to further tests such as a digital rectal exam (DRE), prostate MRI, or biopsy.

Why Understanding PSA Is Important Before Starting Testosterone Therapy

Before starting testosterone therapy, knowing your baseline PSA level is crucial. This helps doctors see whether future changes in PSA are due to the therapy or to a separate prostate issue. Monitoring PSA regularly during treatment ensures any concerning changes are caught early.

PSA testing isn’t just about detecting cancer—it’s also about understanding your body’s normal pattern and how it may respond to natural changes or medical treatments.

PSA is a key marker of prostate health. It’s a simple protein test that gives doctors insight into the prostate’s activity. While high PSA levels can raise concerns, they don’t always mean cancer. Age, prostate size, infections, medications, and even sexual activity can all influence PSA readings. For men considering or using testosterone therapy, understanding what PSA means—and how it changes—is an essential part of safe, informed care.

What Is Testosterone Therapy and Who Needs It?

Testosterone is a natural hormone that plays a key role in men’s health. It helps build muscle, supports bone strength, improves mood, and keeps sex drive normal. Testosterone levels usually reach their highest point during a man’s late teens and early twenties. After about age 30, levels often begin to drop slowly—by around 1% each year. For most men, this gradual decline is part of normal aging and does not need treatment. But when testosterone levels fall too low and cause noticeable symptoms, doctors may recommend testosterone replacement therapy (TRT).

Understanding Low Testosterone (Hypogonadism)

Low testosterone, or hypogonadism, happens when the body does not make enough of this hormone. There are two main types:

1. Primary hypogonadism: This occurs when the testicles cannot make enough testosterone, even though the brain sends the right signals. This can be caused by aging, genetic problems, injury, infection, or certain medical treatments like chemotherapy or radiation.

2. Secondary hypogonadism: In this type, the brain (specifically the pituitary gland or hypothalamus) does not send enough signals to the testicles to make testosterone. Causes can include obesity, stress, long-term use of opioids or steroids, or diseases affecting the brain.

Men with low testosterone may notice symptoms such as:

• Low energy and fatigue

• Loss of muscle mass and strength

• Reduced sex drive or erectile problems

• Depressed mood or irritability

• Difficulty concentrating

• Weight gain, especially around the belly

• Reduced beard or body hair growth

If a man has several of these symptoms, a doctor will usually check his testosterone levels with a blood test taken in the morning, when levels are highest. If the test confirms low levels, and no other cause explains the symptoms, TRT might be considered.

Forms of Testosterone Replacement Therapy

There are several ways to deliver testosterone into the body. Each method has its own advantages and drawbacks:

1. Injections:
   Testosterone can be injected into a muscle every 1 to 4 weeks, depending on the type of medication. Injections often give strong effects but can cause testosterone levels to swing up and down between doses.

2. Transdermal gels or creams:
   These are rubbed onto the skin daily (usually on the shoulders or upper arms). They provide steady hormone levels, but men must avoid skin contact with others until the area is dry to prevent transfer.

3. Skin patches:
   Patches stick to the skin and release testosterone slowly over 24 hours. They are convenient but may irritate the skin or fall off.

4. Pellets:
   Small pellets can be placed under the skin (often in the hip or buttock) during a short office procedure. They release testosterone over 3 to 6 months, offering long-term convenience but requiring minor surgery to insert and replace.

5. Oral or buccal forms:
   Some testosterone medications are placed on the gums or taken by mouth. They are less common because oral testosterone can affect the liver, though newer formulations are safer than older versions.

The best choice depends on a man’s age, health, lifestyle, and personal preference. Doctors and patients usually decide together based on what feels easiest and safest.

Goals and Benefits of Testosterone Therapy

The main goal of TRT is to restore testosterone to normal levels and relieve symptoms of deficiency. When used correctly, it can help:

• Improve mood and reduce feelings of depression or irritability

• Increase muscle mass and strength

• Reduce body fat

• Improve bone density and lower fracture risk

• Enhance energy and motivation

• Improve sexual function and libido

However, TRT is not meant to give men “extra” testosterone or enhance athletic performance. Taking too much testosterone can cause side effects such as acne, fluid retention, enlarged breasts, mood changes, or changes in cholesterol. It can also affect red blood cell counts and the prostate, which is why regular monitoring is essential.

Monitoring During Testosterone Therapy

Before starting TRT, doctors perform a complete medical evaluation, including:

• A physical exam

• Blood tests for testosterone, blood count, and PSA (prostate-specific antigen)

• Screening for prostate or heart problems

Once therapy begins, men are rechecked regularly—usually every 3 to 6 months at first, then yearly. Doctors monitor:

• Testosterone levels (to make sure they are within a healthy range)

• PSA levels (to watch for changes in prostate health)

• Hematocrit (the portion of red blood cells in the blood)

• Cholesterol and liver function

If PSA levels rise more than expected, or if other concerning symptoms appear, therapy may be paused or adjusted until the cause is understood.

Who Should Avoid Testosterone Therapy

Not everyone is a good candidate for TRT. It is usually not recommended for men who:

• Have untreated prostate or breast cancer

• Have high PSA levels that are not explained

• Have severe sleep apnea or uncontrolled heart disease

• Want to father children soon (because TRT can lower sperm production)

Men in these groups should discuss other options or be treated for underlying problems before considering testosterone therapy.

Testosterone therapy can greatly improve quality of life for men with true hormone deficiency, but it requires careful medical supervision. The therapy should be personalized, regularly monitored, and balanced with awareness of prostate health. Understanding how testosterone therapy works—and who truly needs it—helps men and their doctors make safe, informed decisions.

Why Is There Concern That Testosterone Therapy Could Raise PSA?

For many years, doctors and researchers have debated whether giving men testosterone therapy could raise their prostate-specific antigen (PSA) levels or even increase the risk of prostate cancer. To understand this concern, it is important to look at where the idea came from, how testosterone affects the prostate, and what we now know from scientific studies.

The Historical Link Between Testosterone and Prostate Cancer

The concern about testosterone and prostate health started in the 1940s. Two researchers, Dr. Charles Huggins and Dr. Clarence Hodges, made an important discovery: when men with advanced prostate cancer had their testosterone levels lowered—either by surgery or medication—their cancer slowed down. On the other hand, when they were given testosterone, the cancer started growing again. This led to the belief that testosterone “feeds” prostate cancer.

For decades, this idea strongly influenced medical thinking. Doctors avoided giving testosterone therapy to men who had any prostate problems, or even to those whose PSA was slightly higher than normal. Testosterone became seen as “fuel for the fire” when it came to prostate cancer.

However, later research showed that the situation was not that simple. The early studies were based on men who already had advanced cancer, not on healthy men or those with low testosterone. Over time, scientists began to question whether raising testosterone in men with normal prostates would actually trigger cancer or just cause small, harmless changes in PSA.

How Testosterone Affects the Prostate

To understand why testosterone therapy might influence PSA levels, we need to look at what testosterone does in the body. Testosterone is a male hormone, or androgen, that helps regulate sex drive, muscle mass, bone strength, and red blood cell production. It also affects the prostate, a small gland below the bladder that produces fluid for semen.

Inside the prostate, testosterone is converted into another hormone called dihydrotestosterone (DHT). DHT is even more powerful and plays a big role in prostate growth and function. When testosterone or DHT levels increase, prostate cells may become more active, producing more PSA.

This does not necessarily mean that the cells are turning cancerous. It simply means that they are working harder under the influence of higher androgen levels. Because PSA is a protein released by the prostate into the bloodstream, even a slight increase in prostate activity can lead to a mild rise in PSA levels.

This explains why men starting testosterone therapy sometimes see their PSA go up a little. In many cases, this increase is small—typically less than 0.5 to 1.0 nanograms per milliliter (ng/mL)—and stabilizes after a few months as the body adjusts. Still, doctors monitor PSA carefully, because a sharp or continued rise could signal a problem that needs further testing.

Distinguishing Between Temporary and Concerning PSA Increases

A key issue in clinical practice is telling the difference between a normal, temporary PSA increase and one that suggests something more serious. When a man begins testosterone therapy, doctors usually measure his PSA before treatment and again a few months later.

A small early increase may be expected as the prostate responds to new hormone levels. However, a significant or ongoing rise—especially an increase greater than 1.4 ng/mL within a year—can be a warning sign. In that case, doctors may stop therapy for a short time, repeat the test, or refer the patient to a urologist for a closer look.

It’s also important to note that PSA levels can fluctuate for many reasons not related to testosterone, such as recent ejaculation, prostate inflammation, urinary infection, or even bike riding. So, while testosterone may cause mild PSA changes, these must always be interpreted in the full clinical context.

The Modern Understanding: The “Saturation Model”

Recent research has led to a more balanced understanding of how testosterone interacts with the prostate. This is known as the “saturation model.” According to this theory, prostate cells need only a certain amount of testosterone to function at their maximum rate. Once the androgen receptors in the prostate are “saturated,” adding more testosterone does not make the cells grow or produce PSA faster.

In other words, in men with very low testosterone, restoring normal levels can increase PSA slightly because the prostate is responding to renewed hormone stimulation. But in men who already have normal levels, raising testosterone higher does not seem to further increase PSA or cancer risk.

This model helps explain why modern studies find that testosterone therapy often causes only mild, temporary PSA increases without leading to harmful changes in the prostate.

The concern that testosterone therapy could raise PSA levels comes from early findings linking testosterone to prostate cancer growth. Testosterone affects the prostate by increasing cell activity and PSA production, but this does not automatically mean cancer is developing. Most increases in PSA after testosterone therapy are small and temporary, reflecting the hormone’s natural influence on prostate function.

Doctors still monitor PSA closely, not because testosterone therapy is known to cause cancer, but because any unexpected or fast-rising PSA needs careful investigation. Understanding this balance—between natural hormone effects and true disease warning signs—helps patients and physicians use testosterone therapy safely while keeping prostate health in check.

What Does Current Research Say About Testosterone Therapy and PSA Levels?

Over the past 20 years, doctors and scientists have studied how testosterone replacement therapy (TRT) affects prostate health, especially prostate-specific antigen (PSA) levels. PSA is a protein made by the prostate gland. It is often used as a marker to help detect prostate problems, including cancer. Because testosterone can stimulate prostate tissue, many people have wondered if taking testosterone could cause PSA levels to rise or even lead to prostate cancer. Recent research has given us a clearer picture, and it is more reassuring than once thought.

Early Concerns and Shifting Perspectives

In the mid-20th century, medical experts believed that testosterone “fed” prostate cancer. This idea came from early studies showing that men with prostate cancer improved when their testosterone was reduced or blocked. For decades, this led doctors to avoid testosterone therapy in men who had or might have prostate disease. However, more recent research has shown that the relationship is not so simple.

Newer studies suggest that once a man’s testosterone level is in the normal range, adding more does not necessarily make prostate cells grow faster. In other words, the prostate may be sensitive to very low testosterone, but after a certain point, additional testosterone does not cause major stimulation. This is sometimes called the “saturation model.” According to this model, the prostate’s androgen receptors become fully activated at fairly low testosterone levels, and any increase above that threshold has little extra effect on PSA or prostate growth.

Findings from Major Clinical Trials

A number of large, high-quality studies have tested how testosterone therapy affects PSA levels in men with low testosterone. One of the most important is The Testosterone Trials, a group of seven coordinated studies funded by the U.S. National Institutes of Health. These studies involved older men with age-related low testosterone who were treated with testosterone gel or placebo for a year.

Results showed that PSA levels did increase slightly in the men who received testosterone therapy, but the change was small. On average, PSA rose by about 0.3 to 0.5 nanograms per milliliter (ng/mL) during the first year. A few men had larger increases, and these cases were checked with further testing. Importantly, the study did not find an increase in prostate cancer cases among men receiving testosterone.

Other large reviews, including meta-analyses that combine data from many trials, have found similar results. Across dozens of studies, testosterone therapy causes only modest rises in PSA—usually less than 1 ng/mL—and these changes tend to stabilize after several months. The majority of men on TRT never reach PSA levels that would be considered worrisome or abnormal.

A 2018 analysis published in the Journal of Urology reviewed data from over 30 controlled trials. It concluded that while testosterone therapy often causes a small early increase in PSA, it does not raise long-term PSA levels or the risk of developing prostate cancer. This finding has been supported by other research, including long-term observational studies following men for five to ten years.

Differences Between Short-Term and Long-Term Effects

Most studies show that the biggest change in PSA happens within the first 3 to 6 months after starting testosterone therapy. This rise is usually small and reflects the prostate adjusting to normal hormone levels again. After that period, PSA levels often level off and remain steady as long as testosterone is kept in the healthy range.

Long-term studies extending several years have shown no continued upward trend. In other words, testosterone therapy does not appear to cause an ongoing increase in PSA over time once levels have stabilized.

What About Men with Existing Prostate Conditions?

Doctors are more cautious in men who already have prostate problems such as benign prostatic hyperplasia (BPH) or a history of elevated PSA. Some studies have included these men under close supervision. The findings show that while minor PSA increases may still occur, they are usually within safe limits when the patient is carefully monitored.

In men who have been treated for prostate cancer and are now cancer-free, small studies suggest testosterone therapy can sometimes be used safely under close observation, but this remains an area of ongoing research and requires specialist guidance.

Expert and Guideline Conclusions

Leading medical organizations, including the American Urological Association (AUA) and the Endocrine Society, now recognize that testosterone therapy can be safely used in men without active prostate cancer when appropriate monitoring is done. Their guidelines recommend checking PSA levels before starting therapy and then repeating tests at 3 to 6 months, and again every 6 to 12 months thereafter. If PSA rises sharply—typically more than 1.0 ng/mL within a year—further evaluation is needed.

The latest research shows that testosterone therapy may cause a small and temporary rise in PSA, especially early in treatment. However, it does not appear to increase prostate cancer risk or cause ongoing PSA elevation when therapy is properly monitored. The key is careful screening and regular follow-up. For most men with low testosterone, these findings are reassuring and support that TRT, when prescribed appropriately, can be both effective and safe.

How Common Is a PSA Increase During Testosterone Therapy?

When men start testosterone therapy, one of the first things doctors watch is whether their PSA (prostate-specific antigen) levels go up. A rise in PSA can cause concern because higher levels can sometimes point to prostate problems, including cancer. However, not all PSA increases mean there is something dangerous happening. Many are mild, temporary, and part of the body’s normal adjustment to higher testosterone levels. Understanding how common these increases are—and what they mean—helps patients and doctors make informed choices.

How Often PSA Levels Rise on Testosterone Therapy

Several studies have measured how often PSA increases in men receiving testosterone therapy. Across these studies, between 10% and 30% of men experience a small rise in PSA during the first few months of treatment. The size of the increase usually depends on the person’s age, baseline PSA level, and how long they have been on therapy.

For example, in the Testosterone Trials—a large set of U.S. government-funded studies on older men—PSA levels rose slightly during the first year of treatment. On average, PSA increased by about 0.3 to 0.5 ng/mL after 12 months of testosterone therapy. This is considered a modest rise, well within what doctors expect from normal prostate stimulation by testosterone.

In most men, PSA levels stabilize after the first few months. This means that the body adjusts, and PSA stops rising once testosterone reaches a steady level in the blood. Only a small number of men have PSA changes that continue or become large enough to need further medical investigation.

Why PSA Levels May Rise Early in Therapy

The prostate gland is very sensitive to hormones—especially testosterone. Testosterone helps regulate how prostate cells grow and function. When men receive testosterone therapy, the prostate may briefly become more active. This increased activity can cause the gland to release more PSA into the bloodstream.

This early PSA rise usually does not mean there is a disease process occurring. It is a normal biological response to the sudden change in hormone levels. In most cases, the rise is mild and stabilizes within three to six months.

However, because PSA is also a marker for prostate cancer, doctors take every increase seriously until they confirm it is not related to cancer. That is why regular PSA testing is built into all responsible testosterone therapy programs.

Distinguishing Normal vs. Concerning PSA Changes

Doctors look at both the amount of PSA increase and the speed of the change.

• A small rise, such as 0.3 to 0.5 ng/mL within the first year, is generally expected and not alarming.

• A larger increase, such as more than 1.0 ng/mL within 6 to 12 months, is considered unusual and worth checking more closely.

It is also important to compare new PSA results with older ones. A gradual, steady trend over several years may reflect normal aging or benign prostatic enlargement (BPH). But a sudden spike—especially if it happens over a few months—might need further evaluation, including repeating the test or referring to a urologist for additional screening.

When an Increase Becomes a Red Flag

If PSA rises quickly or reaches a much higher number than before treatment, doctors may recommend:

• Repeating the PSA test in 6–8 weeks to confirm the change (since infections or lab errors can cause false elevations).

• Examining the prostate with a digital rectal exam (DRE).

• Referring to a specialist (urologist) for imaging or, in rare cases, a biopsy.

Research shows that true PSA “red flags” happen in only 2–5% of men on testosterone therapy. Most of these cases turn out to be benign, meaning the prostate tissue is healthy even though PSA temporarily increased.

Timing of PSA Changes

The timing of PSA changes gives useful clues about what is happening.

• First 3–6 months: Small, temporary rises are most common during this period as hormone levels stabilize.

• After 6–12 months: PSA usually returns to baseline or remains steady.

• After 1 year or more: Significant new increases are less likely to be from therapy alone and may signal another condition such as BPH, infection, or (rarely) cancer.

This pattern helps doctors decide whether a PSA change is normal or requires more testing. It is also why guidelines recommend checking PSA before starting testosterone therapy, at 3–6 months after starting, and then at least once a year afterward.

How Age and Baseline PSA Affect the Risk

Older men and those who already have higher PSA levels before treatment are more likely to experience an increase. For example, a man whose baseline PSA is 3.5 ng/mL may see a small bump to around 4.0 ng/mL after therapy begins. For a younger man with a baseline of 0.8 ng/mL, the rise might only be 0.1 or 0.2 ng/mL.

Doctors interpret these results based on relative change, not just the absolute number. A 20% rise may be normal for some men but concerning for others depending on their health history, age, and prostate size.

Most men experience minor PSA changes when they start testosterone therapy, especially in the first few months. These increases are typically small, temporary, and not linked to prostate cancer. Only a small fraction of patients show PSA patterns that require closer examination.

The most important step is consistent monitoring—getting baseline PSA levels before treatment, rechecking within 3–6 months, and continuing yearly screenings. With careful observation, testosterone therapy can be managed safely, giving men the benefits of hormone balance without ignoring prostate health.

Does Testosterone Therapy Increase the Risk of Prostate Cancer?

For many years, doctors and patients have worried that testosterone therapy might cause prostate cancer or make it grow faster. This concern began with early studies done many decades ago. However, research from the past 20 years has changed how scientists understand the relationship between testosterone and the prostate. Today, the evidence shows that testosterone therapy does not appear to cause new prostate cancer, though careful monitoring remains important.

Where the Concern Began: The Androgen Hypothesis

The fear that testosterone causes prostate cancer comes from research done in the 1940s. Scientists found that removing testosterone (by surgery or medication) could slow the growth of advanced prostate cancer. From this, doctors assumed the opposite must also be true — that adding testosterone might “feed” prostate cancer cells and make them grow faster. This idea became known as the “androgen hypothesis.”

For decades, this belief led doctors to avoid testosterone therapy in men who had a history of prostate cancer or even mild elevations in PSA. Testosterone was treated like “fuel for the fire.” However, newer studies have shown that this old idea is too simple and not completely accurate.

How Testosterone Affects the Prostate

Testosterone does play a role in normal prostate development and function. It helps maintain the size and activity of the prostate gland. But the relationship between testosterone and prostate cancer risk is not linear.
Research shows that once the body has a normal amount of testosterone, adding more does not necessarily make the prostate grow more or create cancer cells. This is called the “saturation model.” It means that prostate tissue needs only a small amount of testosterone to function. Once that level is reached, extra testosterone does not cause additional stimulation or harm.

In other words, low testosterone may shrink the prostate, but bringing levels back to normal does not seem to “overstimulate” it.

What Studies Have Found

Over the last two decades, many clinical studies and reviews have looked at whether testosterone therapy raises the risk of prostate cancer. Most of these studies do not show an increased risk.

• Randomized Controlled Trials (RCTs):
  Trials like The Testosterone Trials and others involving thousands of men found no higher rate of prostate cancer in men receiving testosterone therapy compared to those receiving placebo.

• Observational and Long-Term Studies:
  Men who used testosterone therapy for several years did not show higher rates of prostate cancer compared to men who did not use it. Some studies even found that men with low testosterone might be more likely to develop aggressive prostate cancer, although this link is still being studied.

• Meta-Analyses:
  When scientists combined data from many studies, they found no strong evidence that testosterone replacement therapy (TRT) increases prostate cancer risk. Some reviews included more than 20 trials and thousands of patients, with follow-up times ranging from one to ten years. The overall conclusion was that TRT does not cause prostate cancer.

Men With a History of Prostate Cancer

For men who already had prostate cancer in the past, testosterone therapy used to be considered unsafe. But newer research suggests that, in carefully selected men, TRT may be possible under close medical supervision.
For example:

• Men who had surgery or radiation for low-risk prostate cancer and remained cancer-free for several years sometimes use TRT without showing recurrence.

• Studies tracking these men found no significant increase in PSA levels or cancer return.

Still, this group requires special care. Doctors usually check PSA levels more often and may stop treatment if there are any concerning changes.

Possible Reasons for the False Link

Why did early doctors think testosterone caused cancer if it doesn’t? There are a few explanations:

1. Older studies involved men who already had prostate cancer before treatment started.

2. Screening tools like PSA tests were not widely used in the past, so early cancers were often missed.

3. When testosterone levels increase, PSA can rise slightly — which may have been mistaken as a sign of cancer.

4. Fear of prostate cancer led to a long-standing bias against testosterone therapy.

Modern research has corrected many of these misunderstandings.

What Major Guidelines Say

Today, leading medical organizations agree that testosterone therapy is not proven to cause prostate cancer, but men on TRT should be monitored regularly.

• The American Urological Association (AUA) states that current evidence does not show that TRT increases prostate cancer risk, but doctors should test PSA before and during therapy.

• The Endocrine Society also recommends PSA testing at baseline, again at 3–12 months, and then yearly.

• European and Canadian guidelines echo similar advice: TRT can be safe for most men when their prostate health is closely followed.

Based on current scientific evidence, testosterone therapy does not cause prostate cancer. It may cause a small, temporary rise in PSA, but this does not mean cancer is present. The risk of developing prostate cancer while on TRT appears to be similar to that of men not taking testosterone.

However, every man’s situation is unique. Regular PSA testing and prostate exams are still necessary to catch any potential issues early. For men considering testosterone therapy, the key is careful screening, informed discussion, and consistent follow-up with a qualified healthcare provider.

What Do Experts Recommend for PSA Monitoring During Testosterone Therapy?

When a man begins testosterone replacement therapy (TRT), one of the most important safety steps is regular monitoring of prostate-specific antigen (PSA) levels. PSA testing helps doctors make sure the prostate is responding normally and not showing early signs of disease.
Although small changes in PSA can be normal after starting testosterone, large or steady increases can signal something more serious, such as prostate inflammation or, in rare cases, cancer. For this reason, experts strongly recommend structured and consistent PSA monitoring before and during therapy.

Baseline PSA Testing Before Treatment

Before starting TRT, a doctor will perform a baseline PSA test. This first reading provides a reference point to compare with future results.

• Who should be tested: Most guidelines recommend a PSA test for all men over age 40 before starting testosterone therapy, especially if they have risk factors like a family history of prostate cancer or African ancestry.

• Why this step matters: If PSA is already elevated before treatment, it may point to an existing prostate issue that needs to be investigated before starting therapy. Treating low testosterone without first addressing a prostate condition could delay a correct diagnosis.

• Typical actions: If the PSA is above the normal range (commonly around 4.0 ng/mL, though this varies with age), the doctor may order repeat testing, a prostate exam, or refer the patient to a urologist.

Monitoring Frequency After Starting Therapy

After testosterone therapy begins, regular PSA testing helps track changes over time.

• Initial follow-up: Most experts, including the Endocrine Society and American Urological Association (AUA), recommend repeating PSA and a prostate exam at about 3 to 6 months after starting therapy.

• Ongoing follow-up: If the early results are stable, testing can be done every 6 to 12 months thereafter. For men who have higher risk factors, their doctor might prefer shorter intervals—such as every 3 to 6 months continuously.

• Why frequent checks matter: Early detection of a PSA rise allows doctors to adjust treatment, investigate possible causes, or refer for further testing before problems become serious.

How Much of a PSA Rise Is Concerning

A small increase in PSA after beginning TRT is fairly common and usually harmless. Testosterone can mildly stimulate prostate activity, leading to a slight boost in PSA production.
However, certain changes are considered clinically significant and should not be ignored:

• An increase of more than 1.0 ng/mL within the first 3 to 6 months, or

• A steady upward trend over time (for example, PSA doubling in less than three years).

These patterns might prompt the doctor to stop testosterone therapy temporarily and refer the patient for more tests, such as a prostate ultrasound or biopsy.
Still, it is important to remember that PSA can rise for reasons unrelated to cancer—like prostate enlargement (BPH), infection, or even recent sexual activity. Doctors interpret results in context rather than relying on a single number.

Steps if PSA Levels Rise During Testosterone Therapy

If PSA goes up unexpectedly, the response is step-by-step and careful:

1. Repeat the test. PSA can fluctuate from day to day, so doctors often recheck it in several weeks to confirm the result.

2. Review for other causes. The physician may ask about urinary symptoms, infection, or recent ejaculation—all of which can raise PSA temporarily.

3. Physical examination. A digital rectal exam (DRE) helps the doctor feel for any abnormal areas in the prostate.

4. Referral if needed. If PSA remains high or continues to rise, a urologist may order imaging or a biopsy to rule out cancer.

In many cases, PSA levels return to normal once an infection or inflammation resolves, and testosterone therapy can safely continue.

Individualized Monitoring Based on Risk

PSA monitoring should always be personalized. Not all men need the same testing schedule.

• Low-risk men (younger, no family history, normal baseline PSA) may only need annual testing once stable.

• Higher-risk men (older, strong family history, or previous elevated PSA) benefit from more frequent testing, every 3 to 6 months.

• Men who have had prostate cancer treated and are on testosterone therapy under specialist care require a completely different, more intensive schedule set by their urologist.

The Role of Communication and Record Keeping

Good communication between the patient, primary doctor, and urologist is essential.
Patients should:

• Keep copies of all PSA test results to track changes over time.

• Report new urinary symptoms such as difficulty urinating, blood in the urine, or pelvic pain.

• Never skip recommended follow-up appointments.

Doctors, in turn, should explain test results clearly and discuss the next steps if values change. A transparent plan helps reduce anxiety and improves safety.

Can Other Conditions or Medications Influence PSA While on Testosterone Therapy?

When a man is taking testosterone therapy, his PSA (Prostate-Specific Antigen) levels are usually checked regularly to make sure his prostate stays healthy. However, it is important to remember that testosterone is not the only factor that can affect PSA results. Many other medical conditions, medications, and even lifestyle factors can cause PSA levels to rise or fall. Understanding these can help both patients and doctors interpret test results more accurately.

Benign Prostatic Hyperplasia (BPH)

One of the most common reasons for a higher PSA level in men—especially those over 50—is benign prostatic hyperplasia, or BPH. This condition means the prostate gland has grown larger than normal, but not because of cancer. As the prostate enlarges, it produces more PSA. This can cause a mild to moderate increase in PSA levels, even when there is no cancer present.

Men who are on testosterone therapy and who already have BPH might see a small rise in PSA soon after starting treatment. This does not necessarily mean anything dangerous is happening. The increase might be related to the larger prostate tissue reacting to hormone levels.

Doctors often look at how fast PSA is rising and whether there are symptoms such as trouble urinating, a weak stream, or the need to urinate often at night. If PSA changes slowly and the patient’s symptoms fit with BPH, doctors usually monitor the situation rather than immediately performing a biopsy.

Prostatitis (Prostate Inflammation or Infection)

Another common cause of temporary PSA elevation is prostatitis, which means inflammation or infection of the prostate gland. This can happen because of bacteria (acute bacterial prostatitis) or sometimes for unknown reasons (chronic prostatitis).

When the prostate is inflamed, its cells release more PSA into the bloodstream. This can make PSA levels shoot up suddenly—sometimes doubling or tripling in a short time.

If a man on testosterone therapy has a sudden rise in PSA and also experiences pain in the lower back, pelvis, or groin, or has burning when urinating, the doctor might suspect prostatitis. A short course of antibiotics may be prescribed if infection is likely. Once the infection or inflammation improves, PSA levels often return to normal within a few weeks.

Urinary Tract Infections (UTIs) and Catheter Use

A urinary tract infection can also raise PSA levels, even if the prostate itself is not directly infected. Infections in the bladder or urinary system can irritate the prostate and cause inflammation that increases PSA.

Similarly, men who have had a urinary catheter inserted (a thin tube used to help pass urine) may have a temporary rise in PSA. The physical irritation to the prostate from the catheter can make the gland release more PSA.

Doctors usually recommend waiting several weeks after a urinary infection or catheter removal before retesting PSA to avoid a false alarm.

Effects of Medications

Some drugs can change PSA readings, either raising or lowering them. This is especially important for men on testosterone therapy, since doctors use PSA to monitor prostate health closely.

• 5-alpha-reductase inhibitors (such as finasteride or dutasteride):
  These medicines are used to treat BPH and male hair loss. They lower PSA levels by about 50% after several months of use. So, if a man takes these drugs, his PSA results need to be adjusted to interpret them correctly. For example, a PSA of 2.0 ng/mL might actually represent a true value of about 4.0 ng/mL in someone taking finasteride.

• Nonsteroidal anti-inflammatory drugs (NSAIDs):
  Common pain relievers like ibuprofen may slightly lower PSA levels in some men. This effect is usually small but can make PSA appear lower than expected.

• Statins (cholesterol-lowering drugs):
  Some studies suggest that statins may modestly reduce PSA levels. The reason may be related to their anti-inflammatory properties.

• Herbal supplements:
  Supplements such as saw palmetto, often used for prostate health, may also lower PSA levels slightly, although results vary widely between individuals.

Because these medications can affect PSA results, it is vital for patients to tell their doctor about all prescriptions and supplements they use before each blood test.

Lifestyle and Temporary Factors

In addition to medical conditions and medications, several temporary lifestyle factors can affect PSA levels:

• Recent ejaculation: Ejaculating within 24–48 hours before a PSA test can cause a small temporary rise in PSA.

• Vigorous exercise: Activities such as cycling or horseback riding can put pressure on the prostate and raise PSA temporarily.

• Recent medical procedures: A prostate exam, cystoscopy, or prostate biopsy can raise PSA for several weeks.

To get the most accurate results, men should avoid ejaculation, intense physical activity, and medical procedures involving the prostate for a few days before a PSA test. Doctors may recommend repeating the test later if an unexpected spike occurs.

Interpreting PSA Changes in Context

Because so many factors can influence PSA levels, doctors do not rely on a single PSA result to make decisions. Instead, they look at the pattern of PSA change over time—also known as PSA velocity.

A slow, steady rise over several years might point to normal aging or mild prostate growth. A sudden sharp rise could indicate infection, inflammation, or, in rare cases, cancer.

In men receiving testosterone therapy, it’s crucial to interpret PSA results in context. A small increase may be part of a normal biological response to testosterone, especially in the first few months of treatment. However, any large or rapid increase should always be evaluated carefully with repeat testing or imaging, if needed.

Many different factors—not just testosterone therapy—can influence PSA levels. Conditions such as BPH, prostatitis, and urinary infections; certain medications like finasteride or statins; and even lifestyle factors can cause PSA levels to rise or fall.

Understanding these influences helps prevent unnecessary worry or testing. The best approach is ongoing communication between patient and doctor, consistent monitoring, and interpretation of PSA trends over time rather than focusing on one single test result.

What Should Patients Discuss With Their Doctor Before and During Testosterone Therapy?

Starting testosterone therapy (TRT) is an important medical decision. While the treatment can help improve mood, energy, and physical health in men with low testosterone, it also requires careful monitoring—especially when it comes to prostate health. Talking openly with your doctor before and during therapy is one of the best ways to stay safe and get the most benefit. This section explains what topics patients should discuss, what questions to ask, and how to work with healthcare providers to keep PSA levels and prostate health on track.

Discuss Your Health History and Risk Factors

Before starting testosterone therapy, your doctor will ask about your overall health. It’s important to give honest, complete answers. Tell your doctor if you have ever had:

• Prostate problems such as benign prostatic hyperplasia (BPH) or prostatitis

• A family history of prostate cancer (especially if a father, brother, or uncle had it)

• Past abnormal PSA results

• Urinary symptoms such as frequent urination, weak stream, or pain

These details help your doctor assess whether testosterone therapy is safe for you. Men with a history of prostate cancer, for example, usually need special evaluation or close supervision before starting TRT. The doctor may also perform a digital rectal exam (DRE) and order baseline PSA testing to check for any signs of prostate issues before therapy begins.

Ask About PSA Testing and Monitoring Plans

PSA testing is a key part of safe testosterone therapy. The doctor will usually check your PSA before you start treatment, then again a few months after beginning TRT, and regularly after that—often every 6 to 12 months.

You should discuss:

• How often PSA will be tested

• What counts as a “normal” PSA level for your age

• What size of increase is considered concerning

For most men, a small rise in PSA (for example, less than 0.3–0.5 ng/mL in the first year) is common and not usually dangerous. However, a rapid or large jump in PSA, or a value above the normal range for your age, may need more testing.

Your doctor may repeat the PSA test to confirm the result. If PSA continues to rise, they might refer you to a urologist for further evaluation. This can include imaging tests or a prostate biopsy to rule out serious conditions such as prostate cancer.

Review Other Health Conditions and Medications

Many things can affect PSA besides testosterone. Talk to your doctor about:

• Enlarged prostate (BPH): This common condition can raise PSA on its own.

• Prostatitis or infection: Inflammation or infection of the prostate can temporarily increase PSA.

• Medications: Some drugs, such as finasteride or dutasteride, can lower PSA readings. Others, like certain supplements, might affect hormone levels.

• Recent activities: Ejaculation, bicycle riding, or even a recent prostate exam can cause temporary PSA changes.

Sharing these details helps your doctor interpret your PSA results correctly and avoid unnecessary worry or testing.

Understand the Role of the Urologist and Endocrinologist

Sometimes, testosterone therapy is prescribed by an endocrinologist, who specializes in hormones, while prostate health is monitored by a urologist, who focuses on the urinary tract and prostate.

You should make sure both specialists communicate with each other, especially if your PSA levels rise or if you develop urinary symptoms. Keeping your medical care coordinated helps ensure that all aspects of your health—hormonal, prostate, and general—are managed safely.

If you are seeing more than one doctor, bring copies of your PSA test results and treatment notes to each visit. You can also ask your clinic to share these electronically between providers.

Learn What to Do if PSA Levels Go Up

If your PSA rises during testosterone therapy, don’t panic. A mild increase is often temporary. Your doctor will likely:

1. Repeat the PSA test in a few weeks to confirm the change.

2. Ask about any new symptoms like difficulty urinating, pelvic discomfort, or blood in urine.

3. Rule out temporary causes such as infection or recent ejaculation.

4. Refer you for urology evaluation if the PSA remains elevated or continues to rise.

Remember, a higher PSA does not always mean cancer. It simply signals that more investigation is needed.

Talk About Lifestyle and Prostate Health

Healthy habits can support both testosterone therapy and prostate wellness. During your appointments, discuss:

• Diet: Eating more vegetables, fruits, and omega-3 fats may help reduce inflammation.

• Exercise: Regular physical activity supports hormone balance and cardiovascular health.

• Sleep and stress management: Poor sleep and chronic stress can lower testosterone and worsen prostate symptoms.

• Avoiding smoking and limiting alcohol: These can impact hormone and prostate health.

Your doctor can provide personalized guidance on lifestyle changes to complement testosterone therapy.

Keep Track of Your Own Results

Ask your doctor for copies of your lab results, including PSA, testosterone levels, and hematocrit (red blood cell count). Keeping a simple record or spreadsheet helps you notice trends over time.

If you see a steady increase in PSA, even within the normal range, bring it up at your next visit. Early discussion can prevent more serious problems later.

Good communication is the foundation of safe testosterone therapy. Patients who ask questions, share complete information, and follow up regularly with their doctors are more likely to have good outcomes. Remember, testosterone therapy can be effective and safe when used under careful medical supervision. Regular PSA monitoring and open conversations with your healthcare team help ensure that any changes are detected early and managed properly.

By staying informed and proactive, you can enjoy the benefits of testosterone therapy while protecting your prostate health for the long term.

Conclusion: What the Latest Evidence Reveals About Testosterone and PSA

Research over the last two decades has brought much-needed clarity to the question of whether testosterone therapy raises PSA levels and whether this change signals a greater risk for prostate cancer. The simple answer is that testosterone therapy can cause a small and temporary rise in PSA levels for some men, especially during the first few months of treatment. However, this rise is usually mild and stabilizes over time. Importantly, current medical evidence shows that testosterone therapy does not appear to increase the long-term risk of prostate cancer when it is used under proper medical supervision.

When a man starts testosterone therapy, his body’s hormone balance changes. Testosterone affects many tissues, including the prostate. The prostate has receptors that respond to testosterone, and a small increase in activity can lead to slightly higher PSA production. Studies show that most men have only a minor PSA change—usually less than 0.3 to 0.5 ng/mL—during the first year of therapy. In many cases, this is not a sign of disease but rather a normal biological response as hormone levels return to a healthy range. After the body adjusts, PSA levels often remain steady.

Doctors now understand that a small rise in PSA does not automatically mean prostate cancer is present or developing. In the past, there was great fear that testosterone could “feed” prostate cancer. This concern came from older studies in the 1940s that showed lowering testosterone slowed cancer growth in men who already had advanced prostate cancer. For decades, this led doctors to believe that raising testosterone might cause new cancers to grow. But newer and larger studies have shown that the relationship is more complex. Normalizing testosterone in men with low levels does not seem to increase the risk of cancer starting in the first place. Modern research has not found higher rates of prostate cancer among men treated with testosterone compared with those who are not.

What experts do agree on is the importance of monitoring PSA during testosterone therapy. Before treatment begins, every man should have a baseline PSA test and a prostate exam. This helps doctors know what is normal for that individual. After starting therapy, the PSA should be checked again after 3 to 6 months, then once a year if the levels remain stable. If PSA increases more than 1.0 ng/mL within a year or rises steadily over time, further testing may be needed. This might include repeating the PSA test, doing a digital rectal exam, or referring the patient to a urologist for additional evaluation. These steps help make sure that any serious condition is caught early.

Another key point is that PSA can change for many reasons other than testosterone. Infections, inflammation of the prostate (prostatitis), recent ejaculation, or even riding a bicycle can cause temporary rises in PSA. Age and the size of the prostate also matter. That is why a single elevated PSA test should not cause panic. Doctors look at trends over time and use other tests to understand what is happening. When monitored properly, testosterone therapy can continue safely for many years without major issues.

Clinical guidelines from respected medical groups like the American Urological Association (AUA) and the Endocrine Society now emphasize balanced, evidence-based management. They support testosterone therapy for men with confirmed low testosterone and symptoms that affect quality of life, as long as regular monitoring is performed. These organizations also agree that testosterone replacement is not linked to a significant rise in prostate cancer risk. Still, they recommend caution in men who already have known prostate cancer or who are at very high risk due to strong family history.

The future of research on testosterone and PSA is promising. Scientists are studying how genetics, lifestyle, and inflammation influence prostate health and how to identify which men might experience PSA changes more than others. There is growing interest in new biomarkers that might be more accurate than PSA for predicting prostate risk. This could make monitoring easier and reduce unnecessary biopsies or anxiety about normal PSA variations.

In summary, testosterone therapy can raise PSA levels slightly, especially early in treatment, but this is usually a mild and temporary effect. The latest research strongly suggests that this change does not mean a man is developing prostate cancer. When therapy is prescribed carefully and PSA levels are checked regularly, testosterone replacement can be both effective and safe. Men should always work closely with their healthcare providers to understand their results, report any new symptoms, and maintain consistent follow-up appointments.

The key message is reassurance: testosterone therapy, when medically indicated and properly managed, does not increase prostate cancer risk. Monitoring PSA is a valuable tool—not to discourage treatment, but to keep it safe. Modern medicine continues to refine how best to use testosterone therapy, ensuring that men can enjoy its benefits while protecting their long-term prostate health.