None of us on HRT like to think about it, but testosterone therapy can have side effects. One of them that can occur in some men is an increase in PSA, the most commmon marker that urologists and other physicians use to monitor prostate health, including prostate cancer. Look at what this poster in the Peak Testosterone Forum reported:
“I have just got my bloods back after being on TRT for 10 months:
- Total Testosterone 899.14 ng/dl
- Estradiol (E2) 23.98 pg/ml
- SHBG 14.70 nmol/L
- DHEA-S 215.50 ug/dl
- S-PSA 2.57 ng/mL
So they seem good – SHBG is getting better, DHEA is down a lot but that is probably because I haven’t been able to get hold of DHEA tablets for ages and I’m not sure this is necessary. The one thing that concerned me is that PSA is up – do I need to address this? Prior results were 1.28 in 2012 and 0.97 in July 2014.” 
Before I go on, let me mention that many men and a few urologists now think that PSA is absolutely worthless and do not like to use it. Or, if they do use, they only use it with very rapid jumps and very high values. Of course, you’ll have to discuss with your doctor his or her stance, but I feel that you should not ignore a rising PSA, for several important reasons that I will discuss below. One of the practical reasons that you may no have thought about: an increase PSA could take you immediately off of testosterone therapy. Most doctors, if they see a big enough jump, will require urological clearance before they will allow you to continue testosterone therapy..
And some of you may even know that this is exactly what happened to me about two years ago. My PSA had consistently been 1.4 or less on testosterone cyiponate but then suddenly jumped to 6.3! I won’t go into the whole story, because I have covered what happened in considerable detail here: High PSA But No Cancer. But suffice it to say, I was taken off of testosterone immediately, and one month later my T levels had dropped to 111 ng/dl. Fortunately, they found it was not prostate cancer as far as they could tell and let me back on TRT.
Personally, I am glad that they did not ignore it, and the reason is that there are almost always three reasons that one’s PSA would jump:
–Increased inflammation, i.e. likely some kind of prostatitis
–An enlarged prostate
In my opinion, none of these should be ignored and can potentially affect your long term health. This is how my urologist – I did have some input – handled the situation in chronological order:
1. Test for Bacterial Prostatitis. Most prostatitis is non-bacterial, but it is a relatively inexpensive and simple test, so most doctors will do this pretty early in the troubleshooting game. In my case, this came back negative, and so my urologist went on with the following:
2. 12-Sample Prostate Biopsy. This procedure is quite “invasive,” but it is an outpatient procedure and generally not painful. Prostate biopsies are controversial now, and many in the medical community think they are overused. Nevertheless, I found it comforting that they found no cancer in any of the samples and a couple with inflammation. This pointed strongly to inflammation being the core issue causing my elevated PSA. I am not sure how I still feel about biopsies, because some experts are concerned about “needle tracking,” which is the idea that a biopsy needle often punctures a prostate cancer nodule and spreads it. In other words, biopsies could potentially be dangerous.  Some urologists are using MRI’s now.
3. 4kScore. I later did a 4kScore, something I discuss on my page My 4kScore Test for Prostate Cancer. One could argue that this blood test should really be done first, because it has a pretty high accuracy rate at predicting whether or not you have the aggressive form of prostate cancer. (It does not tell you if you have the “non-aggressive, standard” form of PSA.) This is very important, because it is the aggressive form that can (almost always) kill you: it can easily metasticize and, as you know, this gets incredibly serious and life threatening very quickly.
Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..
What if you have the non-aggressive form of prostate cancer? This is actually very common. Studies have shown that roughly half of all middle-aged men have (at a minimum) small nodules of this in kind of prostate cancer. Generally, urologists are not nearly as concerned about this form of cancer, because it is usually very slow-growing, literally taking multiple decades to grow. Furthermore, the story of one man shows that it probably can be regressed with supplements – discuss with your doctor of course – and is something I document here: A Prostate Cancer Cure?
4. Supplement and Diet Strategy. In my case, my 4kScore showed that I almost for sure did not have the aggressive form of prostate cancer and, as I mentioned, my biopsy strongly indicated that inflammation was the root cause of my problem. Because of this, I implemented a “protocol” that, according to the research, should combat inflammation. My current protocol makes use of turmeric extract and flaxseed, for example, both of which have done well in the studies. I can say, that my latest PSA read was 1.75, which was nearly back to my old levels of 1.4. I have many pages here: Summary Page for Prostate Issues. You may want to read my pages on How to Lower Your PSA Naturally for example.
By the way, inflammation is a root cause for both prostate cancer and the non-baterial prostatits. In my opinion, this makes fighting inflammation a no-brainer preventative strategy. There are many ways to do this and mine is just one.
5. Measure Your Estradiol. BPH (enlarged prostate) can increase your PSA. (My prostate was quite small and so that was definitely not my issue.) But I mention this, because both BPH and prostate cancer can be fueled by high estradiol values. For this reason pulling your estradiol (with the Best Estradiol Test for Men may be prudent. See my pages on High Estradiol and BPH / Prostate Cancer for additional details.
CAUTION: Of course, please discuss everything with your physician: he or she gets paid to stay up with the latest research and, hopefully, has considerable expertise from his or her practice. They also know your medical history. My story above is simply illustrative to give you some core ideas to discuss with your doctor.