Testosterone Replacement Therapy in Hypogonadal Men with a Prostate Cancer Diagnosis: A British Society for Sexual Medicine Consensus Statement

Abstract

Hypogonadism in men with a history of prostate cancer presents a complex clinical challenge, with longstanding concerns that testosterone replacement therapy (TRT) could potentially stimulate cancer recurrence or progression. This paper provides an up-to-date review of the evidence on the safety and efficacy of TRT, focusing on its use in key clinical scenarios such as active surveillance, post-radical prostatectomy, and post-radiotherapy. We examine the latest data on oncological safety, including risks of disease progression and biochemical recurrence, alongside the benefits of TRT in addressing hypogonadal symptoms such as fatigue, mood disturbance, and sexual dysfunction. The discussion also considers how TRT safety aligns with advancements in prostate cancer biology, including the saturation model, and how these insights are reflected in guidelines from major organisations such as the British Society for Sexual Medicine (BSSM), American Urological Association (AUA), and European Association of Urology (EAU). Gaps in long-term data and areas for further research are identified, underscoring the need for careful application in clinical practice. This paper emphasises a multidisciplinary approach in patient selection, rigorous monitoring protocols, and fully informed decision-making. By presenting a comprehensive review of the evidence, we aim to clarify the role of TRT in improving quality of life for men in remission from prostate cancer, while ensuring that oncological safety remains the highest priority.