Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels. During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.
Additional information can be gained from measuring dihydrotestosterone (DHT) and estrogen; two substances to which testosterone can be metabolized. These can affect the amount of testosterone available and can cause unwanted side effects, such as breast enlargement, hair loss and prostate enlargement. A baseline PSA must be obtained to screen for preexisting prostate disease. Monitoring growth hormone, thyroid hormone, leutinizing hormone (LH), DHEA, lipid profile and blood count are also clinically prudent in a comprehensive hormone optimization program.