Abraham Morgentaler, MD, FACS, presented “Testosterone Therapy in Men with Biochemical Recurrence and Metastatic Prostate Cancer” for the Grand Rounds in Urology audience in September 2021.

How to cite: Morgentaler, Abraham. Testosterone Therapy in Men with Biochemical Recurrence and Metastatic Prostate Cancer.” September 2021. Accessed Jul 2024. https://grandroundsinurology.com/testosterone-therapy-in-men-with-biochemical-recurrence-and-metastatic-prostate-cancer/

Testosterone Therapy in Men with Biochemical Recurrence and Metastatic Prostate Cancer

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, summarizes results from a recent study on testosterone (T) therapy for patients with biochemical recurrence and metastatic prostate cancer. He provides some background, explaining that physicians have been taught that raising testosterone in a man with prostate cancer is like “pouring gasoline on a fire,” even though approximately 20 years of evidence suggests that T therapy is safe after radical prostatectomy, after radiation therapy, in patients with prostatic intraepithelial neoplasia, and in patients on active surveillance. Dr. Morgentaler notes that his and his colleagues’ research indicates that T therapy is also safe for patients with advanced disease. He then goes over the makeup and design of the observational study, which featured 22 symptomatic men of a median age of 70.5. The median duration of T therapy was 12 months, and all patients reported symptomatic benefit from the treatment. The overall mortality was 13.6% with only one prostate cancer-specific death, and morbidity was fairly low, with no cases of pulmonary embolism, spinal cord compression or pathological fractures, and no observed rapid or precipitous progression of disease. Dr. Morgentaler highlights one 94-year-old patient’s experience, describing how this man wanted to be on testosterone because androgen deprivation made him too tired to do the things he enjoyed. After 6 weeks of T therapy, this patient’s brain was clearer, his appetite had improved, and he was exercising daily, and even though he died at age 95 after 11 months of therapy, Dr. Morgentaler emphasizes the importance of T therapy’s benefit to his quality of life in his final months. He concludes that there are men who prioritize quality of life over duration, that data contradict the idea that T therapy is dangerous for patients with prostate cancer, and that T therapy might in fact be a reasonable option for selected men with metastatic disease who refuse androgen deprivation.

For more on testosterone therapy from Dr. Morgentaler, watch his Review Trilogy of the 3rd Annual Androgen Society Meeting.


Abraham Morgentaler, MD, graduated from Harvard College in 1978 and Harvard Medical School in 1982. Dr. Morgentaler completed his residency in 1988 through the Harvard Program in Urology, and then joined the faculty of Beth Israel Deaconess Medical Center and Harvard Medical School. He is currently an Associate Clinical Professor of Surgery (Urology) at Harvard Medical School. In 1999, Dr. Morgentaler founded Men's Health Boston, the first center in the US to focus on sexual, reproductive, and hormonal health for men. Dr. Morgentaler was the recipient of the New Investigator Award in 1994 granted by the American Foundation of Urological Disease. Dr. Morgentaler is an international authority on men’s health and a pioneer in the treatment of testosterone deficiency in men. Dr. Morgentaler’s research is credited with reversing the decades-old belief that testosterone therapy is risky for prostate cancer. Dr. Morgentaler has published over 120 scientific articles on testosterone, prostate cancer, male sexual dysfunction, and male infertility. His work has appeared in The New England Journal of Medicine, The Lancet, The Journal of the American Medical Association, Cancer, and The American Journal of Medicine. He is the author of the book Why Men Fake It: The Totally Unexpected Truth About Men and Sex, which has been widely hailed as a groundbreaking exploration of male sexuality. Dr. Morgentaler’s other books include Testosterone For Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health, and The Viagra Myth: The Surprising Impact on Love and Relationships.