The position of most urologists has been to view the therapeutic use of testosterone, especially for men with enlarged prostates, with great skepticism, since its presence is needed for the development of a benign prostatic hyperplasia or BPH. Other reasons for urologists reluctance to use testosterone include: (1) early testosterone enthusiasts promoted the belief that testosterone held the key to the fountain of youth, a view ridiculed by conventional medicine, (2) the fact that since the 1940's, it has been known that the growth and spread of prostate cancer was largely dependent upon the presence of testosterone, and (3) the abuse of testosterone analogues or anabolic steroids by athletes, resulted in the FDA classifying testosterone and derivatives as dangerous drugs.

Although the predominant view about benign prostatic hyperplasia or BPH is that it is due to a buildup of DHT, this hypothesis is far from proven. Two conditions must be present for BPH to occur. They are: (1) a man must be at least in his forties or fifties, as it never occurs in younger men, and (2) DHT needs to be present for BPH to occur. But, as men grow older, their blood levels of testosterone and DHT tend to decrease rather than increase. A more characteristic finding in BPH is that estrogens and the estrogen to testosterone ratio tends to increase with age in men. It is this increased ratio of estrogen to testosterone that may be more responsible for the development of BPH and prostate cancer than DHT and testosterone.

Dr. George Debled's Testosterone Treatment
This is the argument presented by European urologist, George Debled, M.D. Since the mid 1970's, he has run a clinic for men, which specializes in sexual dysfunction and prostate problems. During this time, he has treated approximately 2,000 patients. On all of these patients, he orders a battery of blood tests, which he calls a male hormonal profile. What he's found is that young men with impotency or libido problems often have hormone profiles similar to older men with similar problems and BPH. Testosterone and especially free testosterone levels are reduced and other hormones, such as estrogen and prolactin are increased.

Dr. Debled points out that testosterone is necessary to nourish all of the tissues of the male urinary and reproductive systems, including the prostate. It nurtures the development of muscles and is necessary for proper muscular functioning. When the muscles of the bladder and the prostate do not receive sufficient testosterone, they tend to function poorly, atrophy and fibrose. This may then help to explain some of the symptoms of BPH. Rather than trying to inhibit the formation of DHT, Debled administers testosterone to all of these patients. Having successfully treated over 2,000 patients with impotency and prostate problems over the past 15 years, Dr. Debled believes that he can forestall BPH surgical procedures for at least 10 years by giving men testosterone. He has also noticed that his patients have a much lower incidence of prostate cancer than would be expected, suggesting that testosterone rather than causing cancer may actually be a preventive. Next week I’ll conclude this series on the male andropause.

Men receiving Dr. Debled’s testosterone treatment reported improvement in urinary and sexual functioning, as well as a broad range of generalized improvements, including positive effects on muscle strength, the cardiovascular system, the immune system and drive and motivation. Incidence of prostate cancer was reduced, rather than increased.