In part 3 of this Exclusive Interview, Dr. Ronald Swerdloff talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about testosterone replacement and prostate cancer, and the affect of added testosterone on pre-existing cancer.
Ronald Swerdloff, MD is a professor of medicine at David Geffen School of Medicine at UCLA, the chief of division of endocrinology and metabolism at the Harbor UCLA Medical Center, and the senior investigator at the LA Biomedical Research Institute.
Transcript of this video segment:
Steve: Can the male person without diabetes with prostate cancer add testosterone to his treatment without the fear of causing the cancer to become more aggressive?
Dr. Swerdloff: We don’t know the answer to that. There will be long-term safety study that is going to look at the issue whether or not the treatment of patients will low testosterone, not necessarily diabetes, whether or not there will be an increased risk of that treatment on the cardiovascular system and on any types of cancer, like the prostate cancer. That long-term safety study will begin fairly soon, but we won’t know the answer to that for perhaps 5 to 7 years.
Steve: For a person with diabetes and prostate cancer, or for a person with a remission of prostate cancer, is it safe to add testosterone to his treatment?
Dr. Swerdloff: I would say that the recommendation and FDA’s position is that it is not safe to do that. However, some practitioners who are carefully monitoring patients have treated people with testosterone when they have been “cured” from their prostate cancer in order to treat their clinical manifestations of low testosterone. But let’s turn back to the diabetes issue, because that’s really what the conference here is about. We have the following questions: what is the relationship of low testosterone to diabetes? That is very complicated, because people with low testosterone tend to have increased obesity. And people with increased obesity tend to have low testosterone. And obesity and low testosterone add to what we call metabolic syndrome. When you have metabolic syndrome it causes a number of other complications. We have this complex interrelationship. If you lose weight, your testosterone level tends to go up. So, the recommendations are that we should treat people with diabetes and low testosterone first with what we call improvement in lifestyle. That means we are asking those people to lose weight and we ask them to exercise. If they fail to improve the testosterone levels, we recommend that they be treated with testosterone. Not specifically to treat the diabetes, but to treat the symptoms of low testosterone, or what we call hypogonadism. Maybe in the future we will be more aggressive. We may say in the future – if the data supports that – that we will treat people with diabetes even if they didn’t have the symptoms of hypogonadism to improve their blood sugar control but we don’t know that comfortably at the present time.
Steve: There are different forms treating with testosterone. There are creams, and even nutritional products…that haven’t gone through FDA approval. What are the different forms of testosterone that can be given to a patient?
Dr. Swerdloff: There is a number of different formulations and means of administering the medication. The most popular at the present time in the US is the transdermal testosterone. Gels, for the most part, are put on the skin, they are absorbed and they have affect on the whole body. There is also injectable that you inject either subcutaneously or into the muscle in order to get adequate blood levels of testosterone. There are oral testosterones, which are experimentally being developed and are available in other countries but not available in US at the present time. And, there are long-term injectable; things that last for a long period of time after injection. Or, even pellets that can be put under the skin. They all work, including the creams. They all increase testosterone and you aim to get testosterone into the normal range. There are some differences in side-effects because of different routes of administration. But for the most part you can think of the different formulations that the patient with advice from the doctor can decide which is the best for them. Some people like gels on the skin, some people like injections, and some people would prefer to have pills if they are available.
Steve: Can we say emphatically that testosterone does not cause cancer, or do we still have a big question mark there?
Dr. Swerdloff: Most of the feeling at the present time is favoring not causing cancer. However, as I said, the medical community and the group of investigators are going to do a long-term safety study to hope to answer that question.
Steve: As far as causing cancer, that is one question. The other question is for a person who already has prostate cancer, let’s say the prostate is removed, and they are trying to reduce the number of testosterone by giving hormones because they feel it could cause the cancer to come back, or if there is a little bit of cancer still left, does testosterone fuel the cancer. Where are we with that?
Dr. Swerdloff: The recommendation is not to treat people who have existing prostate cancer with testosterone. However, as I mentioned earlier that in some instances if the cancer has been removed and the markers of cancer are absent, then some doctors – urologists and andrologists – have been more aggressive and willing to treat those patients with testosterone if there are symptoms of low testosterone is causing them more problems or serious problems.