The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone.
Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com forward slash subscribe.
My guest this week is Dr. Ted Schaeffer. Ted was a guest previously on episode 273 in October of 2023 and episode 39 all the way back in February of 2019 I wanted to have Ted back on to speak about one very specific topic, testosterone and prostate cancer, given a recent study that came out since our last conversation. Given the interest in this topic that we see in our practice, in addition to all of the questions that are constantly coming at us through our site and social media, I figured it would be great to have Ted back on to speak about this.
Throughout this podcast, we referenced the Traverse Trial, and we talk about what the trial directly showed, in addition to what was not entirely clear from the study. This is a study I've written about in the past, discussed some of its limitations. But really the essence of our discussion today was understanding the role testosterone plays in prostate cancer initiation and propagation. And even though this is a topic I spend a lot of time reading about and discussing with experts, I came away quite surprised with some of the insights from Ted.
Given the ubiquity of testosterone replacement therapy today, this is an important topic for anybody who's ever considered it or anybody who cares about somebody who's ever considered it. Unfortunately, there is a lot of bad information out there when it comes to the role of testosterone and prostate cancer. Yet fortunately, the literature actually provides a lot of evidence for how testosterone can be safely used and when it should not be used. Ted is an internationally recognized urologist and prostate cancer oncologist, author and speaker. He's the chair of the Department of Urology at the Feinberg School of Medicine and the Urologist-in-Chief at Northwestern Memorial Hospital. He's also the program director there as well. He is also co-author of one of the definitive textbooks in urology, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. So without further delay, please enjoy this special episode with Ted Schaeffer.
Ted, good to be sitting down with you here. We're going to do something a little different, which is we're going to take a quicker drive than normal and really try to laser focus in on one topic, a topic that you and I spend a lot of time discussing internally, but through a number of back and forth emails, we decided this would actually make for a great short podcast. Let's give folks a little bit of background as we jump right into this. So there was a study that was published a year ago called the Traverse Trial that set out to ask the question, does the use of exogenous testosterone increase the risk of ASCVD in men? I've written about that trial. We're not going to go into great detail with respect to its primary outcome of ASCVD. The short answer is it did not increase the risk of ASCVD. And on some level, this was viewed as the answer to the question, testosterone, exogenous testosterone does not increase the risk of heart disease. But where you and I found ourselves discussing was more along the question of prostate cancer. So maybe tell folks a little bit about what we did and didn't learn with respect to prostate cancer from the Traverse study.

**Ted Schaeffer** (4:06)
The Traverse study really looked at men who were hypogonadal, who presented with some degree of symptoms. And then the idea was to replete the testosterone, bring it up to a ugonadal level. The bump that they had in the Traverse was pretty small, 140 nanograms per ml. So a tiny bump with bearing in mind about a 60 plus percent dropout rate at five years.
So very few people were actually maintaining the protocols that they originally set out to kind of do at the beginning of the study. With that in mind, the idea was, does supplementation of someone's endogenous testosterone with exogenous testosterone increase one's risk for being diagnosed with prostate cancer with the implication that this could address two potential concerns. One, exogenous T would fuel the progression of an preexisting prostate cancer, and or exogenous T would induce a cancer de novo in somebody with a low T state when you bring them into a higher testosterone state. So that's how they kind of took on the study. Now, as we talked about before, there's a lot of detail about who was enrolled in the study. So everybody was hypogonadal.