Elevated PSA and Testosterone

Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.


Understanding the complex relationship between hormones, prostate health and men's overall health is crucial. 

The link between testosterone and elevated prostate-specific antigen (PSA) levels has been a topic of great interest in the medical world. 

Does this relationship have a hormonal basis? This article delves into the fascinating world hormones in order to solve the mystery of elevated PSA and testosterone. 

We examine the latest research, expert opinions, clinical studies and recent clinical trials to give you a complete understanding of this fascinating connection. 

We will explore important questions such as:

  • Can elevated PSA levels be impacted by testosterone levels? 
  • What are the potential implications for prostate health if testosterone levels increase? 
  • What can men do, most importantly to support prostate health and maintain hormonal balance? 

We will explore the complex interplay of hormones and the links between testosterone and elevated PSA. 

You will be able to better understand this relationship and what you can do to maintain optimal prostate health. 

What's testosterone?

Testosterone is an essential hormone in male sexual development, libido and aggression.

Additionally, testosterone causes many changes during puberty such as facial hair growth, Adam's apple formation and deepening voice tones; muscle development; as well as increased penis size and testes size.

Athletes and bodybuilders sometimes use illegal steroids that increase testosterone levels for rapid gains in strength and mass; its increasing presence may contribute to depression anxiety or suicidal thoughts as well.

Females convert testosterone to estrogen, which has numerous impacts on her reproductive and urinary systems, mood, cognitive function and fat storage.

It may cause clitoral growth as well as changes to breast texture and size as well as pubic hair growth and pubic hair thickness; and contributes to creating a more mature curved figure.

It is this hormone which gives trans men their characteristic voice change (even though not all men experience the full deepening of pitch).

Doctors can prescribe testosterone injections or patches, injected subdermally or applied topically daily, to boost testosterone levels and help strengthen muscles, protect bones, increase sex drive and treat erectile dysfunction.

Treatment may come in the form of injections under the skin or gels and patches applied topically daily - it's important that they know about any medical history as certain health conditions could interact negatively with testosterone therapy and reduce its efficacy.

Prostate-Specific Antigen explained

The prostate gland, located below the bladder in male reproductive systems, produces prostate-specific antigen (PSA).

In the diagnosis of prostate cancer, PSA, PSA velocity and PSA density, as well as free PSA, have been used for many years to determine whether or not a prostate biopsy is necessary.

Although PSA is not an ideal marker, it is still widely used to diagnose and treat prostate cancer.

A PSA test measures how much PSA there is in your blood; although this cannot provide definitive answers as to the source of rising PSA levels; instead it may indicate potential issues within the prostate itself, including cancerous growths or cysts.

PSA testing is one of the best ways to detect prostate cancer early, when treatment options are most viable.

There are various kinds of PSA tests, with blood testing typically being the most commonly administered option; digital rectal exams (DRE) often follow this and involve inserting gloved fingers into the rectum to look for signs of prostate.

Another way to test for PSA in your body would be a urine analysis test which measures its levels in your system.

But there can be risks involved with PSA tests; one major downside could be unnecessary treatment that leads to serious side effects or could even exacerbate cancer progression.

Scientists disagree about what constitutes an acceptable PSA level; however, in the past a PSA level of 4.0 ng/mL or higher usually resulted in further testing, including biopsy - in which doctors take samples from your prostate to examine further.

Some doctors recommend biopsies if your total PSA level falls below 10.

Additionally, these scientists may also order a test known as percent-free PSA which compares bound to unbound forms in circulation.

Higher percentages indicate noncancerous conditions while lower numbers suggest cancerous conditions.

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Understanding the link between elevated PSA levels and testosterone 

Many studies show both a positive and a negative correlation between serum prostatic specific antibody levels and testosterone levels.

There have been reports of sensitivity and specificity problems with the use of PSA, as it is not tissue-specific nor cancer-specific.

The growth and development of the prostate gland is largely influenced by testosterone. The PSA produced by the prostatic epithelium may be regulated androgenically.

The development of prostate cancer is linked to serum testosterone and the disease is controlled by androgen withdrawal.

There are conflicting findings in studies on the association between serum PSA levels and serum testosterone.

Few studies have shown a positive correlation with low levels of serum testosterone in hypogonadal males (saturation theory).

However, no significant correlation has been found between serum PSA levels and serum testosterone among healthy males. 

Testosterone replacement therapy and PSA

In repsect of TRT, the patient must be involved in both the decision to treat as well as the plans for monitoring the treatment.

Testosterone treatment often leads to an increase in serum prostate-specific antigen, which may then lead to urological referrals, prostate biopsy and the detection of prostate cancer.

Whilst, the level of detection of prostate cancer may be increased by testosterone treatment, even though there is no conclusive evidence that it causes prostate cancer.

The overtreatment of indolent, subclinical prostate cancers, particularly in men older than 65, has and continues to be of major concern.

Because of the limited data from clinical trials about the PSA response of older men to testosterone treatment, the Endocrine society Guidelines suggested thresholds for urological referal based on the distribution of PSA increase in the finasteride arm of a trial of men with benign prostate hyperplasia as well as the absolute PSA levels that urologists recommended.

Causes of prostate cancer

Doctors are aware that prostate cancer starts when cells develop DNA changes. 

The DNA of a cell contains instructions for the cell. The changes instruct the cells to multiply and grow more quickly than normal.

Although it's unclear what causes prostate cancer exactly, a number factors can increase the risk.

  • Age - as we age, the risk increases. Most cases are diagnosed among men older than 50.
  • Black men are more likely to develop prostate cancer than Asian men
  • Family history - having an older brother or father with prostate cancer increases your chances of getting it. Research also suggests that having a female relative with breast cancer can increase your prostate cancer risk.
  • Recent research suggests that obesity may have a link with prostate cancer. A balanced diet and regular physical activity may reduce your risk of prostate cancer.
  • Research is being conducted to determine the link between diet and prostate carcinoma. There is evidence that eating a high-calcium diet is associated with an increased risk for prostate cancer.

    Research findings on the correlation between PSA and testosterone

    Researchers in the 1940s discovered that prostate cancer stopped spreading when testosterone levels dropped in men.

    Researchers also discovered that testosterone given to prostate cancer patients made the cancer worse.

    The researchers concluded that testosterone is a factor in prostate cancer.

    Some evidence shows that hormone therapy for prostate cancer reduces testosterone levels.

    Many doctors believe that testosterone is the cause of prostate cancer. As such,they will not prescribe testosterone to men with a prostate cancer history. 

    Recent research has contradicted the relationship between testosterone and cancer. Other studies contradict this, finding that men with lower testosterone levels are at a greater risk for prostate cancer. 

    The review published in 2015 by the Journal Medicine also found that testosterone replacement therapy does not increase PSA.

    PSA, or prostate-specific antigen (PSA), is elevated in men who have prostate cancer.

    In a meta-analysis from 2016, researchers found that there was no correlation between testosterone levels and prostate cancer risk.

    A study review found that testosterone treatment does not increase prostate cancer risk or severity in men already diagnosed with the disease.

    The available evidence indicates that testosterone therapy could be safe for certain men who are low in testosterone and have completed successful prostate cancer treatments. They may also not face a high risk of a recurrence.

    This case shows that a rise in PSA doesn't necessarily mean there is prostate cancer.

    This study shows that testosterone therapy for men with hypogonadism does not raise PSA in the blood, except when given intravenously. And even then, it's a minimal increase.

    The data of the studies included were insufficient to assess the prostate cancer risk with testosterone therapy. However, evidence from the literature suggests that testosterone therapy does not affect prostate cancer risk.

    TRT is not known to cause prostate cancer, despite the fact that it has been well-established that TRT can affect the hormones in the prostate.

    There is controversy about whether testosterone replacement therapy should be given to men in middle age for clinical symptoms of andropause regardless of the level of serum testosterone. 

    TRT can cause fluid retention, gynecomastia and polycythemia. It may also worsen existing prostate cancer. Patients on TRT must be closely monitored, including digital rectal exam and PSA testing. 


    TRT may not provide any clinical benefits in men with eugonadal status and can even expose the patient to unwanted risks or side effects from exogenous androgens.

    PSA levels in males receiving androgen treatment are likely to change.

    Patients on finasteride experience a 2.2-fold decrease in PSA serum levels when compared with normal-age-matched men.

    The prostate volume is lower for hypogonadal males, similar to serum PSA.

    These volumes can be normalized to match controls of the same age with TRT.

    Patients with BPH symptoms can have rapid progression due to the obstructive symptoms.

    Patients on TRT can expect to see changes in PSA, but it is important that they are closely monitored. 

    It is recommended that all clinicians conduct a digital rectal exam and PSA baseline before beginning TRT. The PSA level should also be monitored 6-12 weeks following the initiation of TRT.

    As long as a patient is on TRT and undergoing a digital rectal exam, the PSA will be checked semi-annually.

    If the PSA is greater than 0.75ng/mL/y regardless of baseline PSA or there are nodules on digital rectal exam while taking TRT, a biopsy should be performed.

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