Neil Baum, MD, and Abraham Morgentaler, MD, discuss the history of testosterone and prostate cancer

In this interview with Neil H. Baum, MD, Abraham Morgentaler, MD, reflects on the decades-long effort to overturn the longstanding belief that testosterone promotes prostate cancer, discussing the historical origins of the dogma and the evidence underlying his recent Journal of Urology publication proposing a new framework of androgen adequacy vs inadequacy.¹

Morgentaler explained that his interest in testosterone therapy began early in his career while treating men with severe sexual dysfunction at a time when few effective therapies existed. Drawing on prior research into testosterone's effects on sexual behavior, he began prescribing testosterone to carefully selected patients, despite the prevailing belief that even a single injection could trigger aggressive prostate cancer. He noted that this fear, ingrained in generations of physicians, effectively prohibited testosterone therapy for more than 60 years and persisted largely because clinicians avoided using the treatment altogether.

A central focus of the discussion was the historical foundation of that belief, which Morgentaler traced to the landmark 1941 publication by Charles Huggins and Clarence Hodges.² After revisiting the original paper in the Harvard Medical School library, Morgentaler found that the widely accepted conclusion—that testosterone stimulates prostate cancer growth—was based on limited evidence. Although Huggins reported that testosterone increased acid phosphatase levels in men with metastatic prostate cancer, Morgentaler explained that the conclusion ultimately relied on data from a single untreated patient who received testosterone for only 18 days, while another reported patient had previously undergone castration. Despite the limited evidence, the findings shaped clinical practice for decades and contributed to the widespread belief that testosterone was inherently dangerous in men with prostate cancer.

Morgentaler said his recent Journal of Urology paper represents the culmination of more than 30 years of research evaluating the relationship between testosterone and prostate cancer, conducted in collaboration with Abdulmaged M. Traish, PhD, MBA. According to Morgentaler, a comprehensive review of the available evidence reveals no convincing data demonstrating that testosterone drives prostate cancer development or progression. Instead, he argued that the field has continued to rely on an unchallenged historical narrative rather than evidence-based medicine. The new publication aims to systematically reexamine the literature, address the weaknesses of the original hypothesis, and provide a new conceptual framework for understanding the role of testosterone in prostate cancer.

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