Does TRT Increase Cancer Risk? What Studies Say in 2025

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Is testosterone therapy just swapping one medical condition for another? 

For men who suffer from low energy, diminished muscle tone, and declining libido, Testosterone Replacement Therapy (TRT) appears to be a fix. And most of the time, it can be. Over the last couple of decades, TRT has become a credible method of restoring male hormonal homeostasis, cognitive engagement, and rebuilding self-worth. But there remains an issue that still creates hesitation- does TRT increase the risk of carcinoma, particularly prostate cancer? 

While it is a concern coming from a historical call, the scientific community in 2025 has a much better understanding of this relationship. This article will help dispel the myth, suggest new evidence, and show how TRT enters the picture in a safe and contemporary concept of male health- particularly under the guidelines of a competent medical practitioner.

Where the Cancer Concern Started: Historical Perspective

Decades ago, the notion that testosterone could cause cancer, particularly prostate cancer, was feared, and this notion continues to shape beliefs and attitudes today. 

Huggins and Hodges Study (1941)

This study was the most well-known study reporting that lowering testosterone produced tumour shrinkage in men with advanced prostate cancer. Consequently, the idea formed that testosterone was fuel for cancer cells. 

However, this was an observational study with men who were already diagnosed with aggressive, late-stage prostate cancer, not healthy men or men with low testosterone. Despite the study's limitations, it created decades of conservative thinking and misbeliefs.

What Recent Research Says: Studies from 2010 to 2025

Today, there is even greater evidence from over two decades of research that has shed light on the relationship between testosterone replacement therapy (TRT) and cancer. The progression of TRT research has clarified the issue, as well as brought relief.

Morgentaler et al., 2011 – The Foundational Follow-Up

This important study followed men with low testosterone who were receiving TRT. The study found no increased risk of prostate cancer. This study opened the door for wider acceptance of TRT as long as it was done with appropriate clinical management.

Wallis et al., 2016 – A Meta-Analysis in JAMA Oncology

This meta-analysis was based on data that included over 190,000 men and found no sufficient evidence that TRT leads to an elevated rate of prostate cancer. However, this study highlighted the necessity to continue screening, appropriate screening, and individualized treatment.

Haider et al., 2020 – A 10-Year Longitudinal Study

In this German-based long-term study of over 1,000 men on TRT, data showed that there is no increase in prostate cancer cases. Also, they had:

• Decreased obesity
• Better management of blood sugar and blood pressure
• Overall, higher levels of satisfaction and energy

Pastuszak et al., 2022 – TRT After Prostate Cancer Treatment

The field of research of TRT has emerged as a treatment for cases or potential cases of prostate cancer. This study ultimately found that it is entirely safe for men with previous cases of prostate cancer, monitored closely, and showed no increase in the recurrence rate of prostate cancer.

NCCN Guidelines Update (2024)

In an unprecedented moment, the National Comprehensive Cancer Network (NCCN) recognized that if men are carefully followed with PSA testing, Testosterone Replacement Therapy (TRT) can be deemed permissible in prostate cancer patients treated for localized prostate cancer.

Does TRT Cause Other Types of Cancer?

In addition to worries surrounding the prostate, many men wonder if TRT can cause other cancers in general. Here's what 2025 research says. 

Colorectal Cancer

No confirmed association of TRT and Colorectal Cancer exists. In fact, by lowering abdominal fat and chronic inflammation testosterone may help. 

Breast Cancer in Men

Male breast cancer is extremely uncommon. There are some single case reports that reported hormone therapy did cause some changes in breast tissue (gynecomastia), but no firm clinical association between TRT and male breast cancer emerged. 

Hematological Effects and Cancer-Like Risks

There is no evidence that TRT causes anything with blood-derived cancers, but TRT does increase red blood cell production—potentially leading to a condition called polycythemia (because it looks like a blood condition), which increases the risk of clots. This risk is easily monitored through laboratory checks.

Which Risk Factors May Influence Cancer Outcomes on TRT?

While TRT is not a direct cause of cancer, people should take their risk factors into consideration. 

Age and Genetics

Older men, especially those over 60 years old, and those men with a family history of cancer need to be careful. Either TRT shouldn’t be offered, or genetic counselling and increased monitoring need to be included. 

Preexisting Prostate Conditions

While benign prostatic hyperplasia (BPH) is not cancer, it causes difficulty in evaluating future diagnoses or monitoring responses. Men with elevated PSA results or abnormal prostate exams should complete appropriate evaluations in advance of initiating therapy. 

Lifestyle Factors

Poor diet, smoking, sedentary lifestyle, alcohol abuse, etc., all increase the risk of cancer. It is fascinating that it may be possible for TRT to mitigate some of these as a result of metabolic effects, but in order to fully benefit, changes in lifestyle are still recommended as well.

Importance of Monitoring While on TRT

Safety is paramount. Regardless of positive research findings, TRT should involve consistent medical monitoring to remain low-risk and effective.

Routine Screening Checklist:

• PSA Testing: every 3-6 months early on and annually afterwards
• Digital Rectal Exam (DRE): Annually
• Complete Blood Count: check for polycythemia
• Liver and Kidney Function Tests
• Hormone Panels – including Estradiol
• Imaging: every as needed per PSA change

Things to Watch For:

• PSA trend
• Urination difficulty
• Chest swelling or soreness
• Unusual tiredness, weight changes, or moods

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Conclusion

In 2025, the opinion is clearer than ever—Testosterone Replacement Therapy is NOT associated with a significant risk of developing cancer when testosterone is managed properly and with monitoring. 

Despite earlier studies that sparked concern, with modern approaches, it is abundantly clear that with appropriate screening and management, testosterone therapy is acceptable in most men, even men with a history of prostate issues. 

The overall risk for the individual man depends on many things including age, genetics and lifestyle. But managed well, testosterone replacement can improve a man's quality of life without compromising his health into the future.

FAQs 

Does testosterone replacement therapy (TRT) increase the risk of prostate cancer?

The recent data shows that TRT doesn't significantly have an increase in prostate cancer risk when it is managed properly. The early fears were based on studies that were old and do not reflect the clinical standards of today. 

Can men with a history of prostate cancer take TRT?

Yes—especially if the cancer was localized and treated successfully. With regular monitoring of symptoms and PSA, testosterone replacement can be considered in complex management strategies under expert care.

Are there any types of cancer besides the prostate that TRT may affect?

There is very little evidence that relates to TRT with other cancers, such as colorectal or male breast cancers.  Screening regularly helps to identify any changes that require further investigation.

What are the warning signs to monitor while on TRT?

Any increase in PSA level, tenderness or enlargement of breasts, trouble urinating, fatigue with no known cause, or changes in blood counts are warning signs that can represent the need for medical intervention or perhaps treatment changes.

Is it safe to use TRT long-term?

Yes, you can safely be on TRT for a long period of time as long as you are being monitored by a physician. Longer-term TRT has been shown to positively improve mood, energy, and physical function and has a low side effect or adverse event rate when managed correctly.