¹Section of Urologic Oncology, University of Colorado Health Sciences Center, Aurora, CO, USA

Correspondence: Dr A Barqawi, Section of Urologic Oncology, University of Colorado Health Science Center, 1665 N. Ursula Street, P.O. Box 6510, Mail Stop F-710, Aurora, CO, USA. E-mail: al.barqawi@uchsc.edu

Received 11 April 2005; Revised 29 September 2005; Accepted 30 September 2005; Published online 10 November 2005.

Abstract

Substantial evidence supports the value of testosterone replacement therapy (TRT) in improving quality of life in men with proven aging male syndrome (AMS). Benefits of TRT include improved bone mineral density, reduced fracture risk, increased muscle mass, and improved mood, sense of well being, and libido, among others. There is currently a heated debate about the theoretical association between TRT and the initiation, progression, and aggressiveness of prostate cancer; however, this link has not been uniformly studied, and any results have been contradictory and nonconclusive. Although no clear evidence links TRT to prostate cancer, the possibility of increasing the risk of a clinical manifestation of a latent pre-existing malignancy can influence the decision about TRT use. Current recommendations are to exclude prostate cancer before initiating TRT in men over age 40 and to closely monitor men in the first year of testosterone replacement, followed by observation in subsequent years.