Male Hormones
By Michael Lasalandra
Manny Hamelburg was diagnosed with prostate cancer in 1987 at the age of 47. He received radiation treatment and thought he was out of the woods until the cancer returned five years later. It had spread to his bones. The only treatment left at that point was for Hamelburg to receive what are known as hormone treatments -- injections of a drug that stops the production of testosterone, the male hormone. The accepted wisdom on prostate cancer has been that testosterone drives the growth of prostate cancer much as estrogen fuels breast cancers.
The drug, Lupron, worked in that Hamelburg’s level of PSA (prostate-specific-antigen, a blood marker for prostate cancer) dropped sharply, indicating his cancer was being controlled. But the treatment did not come without side effects. ``There was a complete loss of libido,’’ says Hamelburg, of Weymouth, who is now 67. ``My muscle mass was down. So was my mental acuity. And I was suffering hot flashes.’’ After seven years on the hormone shots, Hamelburg decided to stop them and see what happened. ``My PSA didn’t go back up,’’ he says.
Off the injections, his testosterone level jumped a little, but ``not enough to turn the faucet back on,’’ he says. His symptoms remained. There is a fix available for men with low testosterone levels: testosterone supplementation. There are prescription gels or patches available that boost testosterone levels for aging men with flagging libidos. But these products have been controversial. The fear is that they may spur prostate cancer growth. As a result, testosterone supplementation has been generally frowned upon and absolutely verboten when it comes to men who have had prostate cancer.
But the thinking is changing, not only when it comes to healthy men with low testosterone levels, but also in regards to men, like Hamelburg, who have had prostate cancer. ``It turns out the story has been upside down,’’ says Dr. Abraham Morgentaler, urologist at Beth Israel Deaconess Medical Center, and co-author with Dr. Ernani Rhoden of Brazil of a review on the risks of testosterone therapy published in the New England Journal of Medicine in 2004. ``I’ve been heavily involved in this research. Study after study has failed to find any solid evidence that raising testosterone raises prostate cancer risk. We have been denying men a potentially helpful treatment based on a concept that lacks evidence.’’
Twenty percent of men over the age of 50 have low testosterone levels and may have symptoms similar to those Hamelburg was suffering, says Morgentaler, director of Men’s Health Boston, a urology practice, and associate clinical professor of surgery at Harvard Medical School. ``Low testosterone is under-recognized and under-treated,’’ he says. ``And part of it is that doctors have been very worried about the prostate cancer risk.’’
Hamelburg was thinking about trying testosterone supplementation after reading that more men who had been treated for prostate cancer were taking it. He asked Morgentaler about it and the urologist showed him a number of studies indicating it would be okay to do so. ``I can’t say I wasn’t worried at all, but I was willing to take the risk,’’ Hamelburg says. ``It offered me the opportunity to jump back into feeling like a man.’’ After eight months on testosterone, ``I have sexual feelings back,’’ he says. ``I’ve started to feel more manly. My muscle mass is fabulous. I’ve lost 50 pounds. I’m excited about things.’’ And his PSA levels have barely moved.
Morgentaler says three studies on men treated for prostate cancer with radiation who had taken testosterone for five years showed no cancer recurrences. His own study, published in 2006, reviewed the historical literature on the subject and found the original report that led to the belief that testosterone could cause prostate cancer to grow was based on questionable results from only one patient.
``More recent data have shown no apparent increase in prostate cancer rates in clinical trials of testosterone supplementation in normal men or men at increased risk of prostate cancer,’’ his study concluded. In fact, denying men testosterone supplementation may be doing more harm than good, Morgentaler says. ``Several recent studies -- but not all -- have shown that men with normal testosterone levels seem to live longer than men with low testosterone,’’ he says. ``And there is also evidence that a normal testosterone helps with blood sugar control and decreases several cardiovascular risk factors. Although we don’t yet have studies definitely proving the safety of normalizing testosterone in men with prostate cancer, I just don’t see the sense of withholding a treatment based on a theoretical concern that has no supporting evidence.’’
For men without a diagnosis of prostate cancer, testosterone therapy is a well-established treatment that can improve sexual desire and function, energy and sense of vitality, and bone density, he says. Morgentaler encourages men with these symptoms to ask their physician whether they might have low testosterone. The diagnosis can be made with a simple blood test.
(This article first appeared on www.thebostonchannel.com in January, 2008)
