/WHAT_IT_IS
PSA is a protein made by the prostate. Elevated PSA can signal benign prostate enlargement, infection, or prostate cancer. Every man on TRT should track PSA regularly.
/NORMAL_RANGE
<4.0 ng/mL is the conventional cutoff. Age-adjusted ranges exist: <2.5 (40s), <3.5 (50s), <4.5 (60s), <6.5 (70s). PSA velocity (rate of change) matters more than absolute value.
What does high PSA mean?
- +Benign prostatic hyperplasia (BPH).
- +Prostatitis (often dramatic, often reversible).
- +Recent ejaculation, prostate exam, cycling, or biopsy (transient).
- +Prostate cancer.
- +TRT can slightly increase PSA (~0.3–0.5 ng/mL on average).
What does low PSA mean?
- +5-alpha reductase inhibitors (finasteride, dutasteride) cut PSA roughly in half.
- +Naturally low for younger men.
/ON_TRT
TRT does NOT cause prostate cancer, but it can fuel the growth of pre-existing cancer. Baseline PSA before starting TRT is mandatory. Recheck at 3 months, 6 months, then annually. A PSA increase >1.4 ng/mL within 12 months, or PSA velocity >0.4 ng/mL/year, warrants urology workup. Avoid ejaculation, prostate exams, and cycling for 48 hours before the draw — false elevations from these are common.
/RELATED
FAQ
/01Does TRT cause prostate cancer?+
No. Decades of evidence show no causal link between TRT and prostate cancer development. However, TRT can accelerate growth of already-present cancer, which is why baseline and regular PSA monitoring is mandatory.
/02How often should I check PSA on TRT?+
Baseline before starting, again at 3 months, then 6 months, then annually. More frequently if PSA is rising rapidly, you're over 50, or have family history of prostate cancer.
/03What PSA on TRT means I need a biopsy?+
A PSA rise >1.4 ng/mL in the first 12 months of TRT, PSA velocity >0.4 ng/mL/year, or an absolute value above age-adjusted thresholds usually triggers urology referral and possible biopsy. Free PSA % and MRI can refine the decision.
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