There have always been concerns regarding Testosterone Replacement Therapy (TRT) and prostate safety because of the central role of Testosterone (T) in prostate tissue. Even though there is a body of evidence supporting that the benefits of TRT outbalance the risks of prostate disease, this matter is still debatable and represents a common concern among T prescribers.
The aim of this article is to review the influence of T on prostate pathophysiology and discuss the potential impact of TRT on the most common prostate pathologies, including benign prostatic hyperplasia (BPH) and prostate cancer (PCa).
We have performed an extensive PubMed review of the literature examining the effects of TRT on the prostate and its most common affections, especially in terms of safety.
TRT has been shown to improve components of metabolic syndrome and decrease prostate inflammation, which is related to the worsening of LUTS in patients with BPH. Studies evaluating the link between TRT and BPH/LUTS have mostly demonstrated no change in symptom scores and even some benefits. There are a significant number of studies demonstrating the safety of TRT in individuals with LOH and a history of PCa. The most recently published guidelines have already acknowledged this fact and do not recommend against T treatment in this population, particularly in non-high-risk disease.
TRT could be considered for most men with LOH regardless of their history of prostate disease. However, a discussion about the risks and benefits of TRT is always advised, especially in men with PCa. Appropriate monitoring is mandatory.

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