It has been six months since my robotic-assisted radical prostatectomy, and I find myself suspended in a strange middle space, grateful to be cancer-free, yet still struggling with a question I cannot fully answer: Is it safe for me to restart testosterone replacement therapy?

Before my diagnosis, testosterone replacement was not just a prescription; it was a restoration. I have lived with hypogonadism for years, and TRT helped me regain the clarity, energy, and emotional steadiness I had lost. It also helped with my sex drive. I am a 65-year-old man, but I still care about intimacy. And I also care about my workouts. I’ve always been the guy who hits the gym, pushes weights, moves with strength and purpose.

But cancer changes everything. The moment my biopsy confirmed prostate cancer, TRT stopped. I understood the rationale, but understanding doesn’t make the transition easier. The fog of low testosterone returned quickly: slower thinking, reduced motivation, a muted sense of self. On top of that, the sexual changes after prostatectomy, nerve recovery, sensation changes, inconsistent erectile responses, and the daily frustrations of urinary incontinence. All of that is real. In the exam room, I have always taught patients that uncertainty is part of medicine. Now I am living inside that uncertainty myself.

Today, at six months postoperative, my PSA remains undetectable. By all oncologic measures, I am doing well. But hypogonadism does not wait politely for the cancer surveillance timelines.

Every morning, I wake up feeling just a little less sharp than the person I was before surgery. I move through the day with a heaviness that is hard to name unless you’ve lived it. Low testosterone isn’t merely a hormonal imbalance; it affects mood, cognition, and even identity.

I miss feeling like myself. And yet, the fear of recurrence sits in the background of every discussion about restarting TRT.

Three experts, three views

Before surgery, I consulted three specialists whose opinions I valued. Their perspectives were thoughtful, yet different.

My urologist suggested a conservative approach: “I would wait a year before even considering testosterone.”

My radiation oncology colleague offered a different perspective: “The old belief that testosterone fuels prostate cancer… the data really doesn’t support that anymore.”

And my internist, who had guided my TRT for years, said: “If your PSA stays undetectable, TRT can be considered. But it must be monitored closely.”

Three experts, three views: none wrong, none entirely comforting.

Those conversations have echoed in my mind for the past six months. They remind me how much of medicine is interpretation, not certainty. And when you’re the patient, those differences feel far more personal.

What the data says about TRT and recurrence

As my recovery progressed, I turned to the literature myself: part habit, part coping mechanism, part hope.

• No increase in recurrence: In one of the largest studies to date, published in The Journal of Urology in 2025, researchers followed 5,199 men after radical prostatectomy, including 198 who received TRT. They found no increase in biochemical recurrence among men who restarted therapy. Recurrence rates remained below 2 percent at five years for both TRT users and non-users.
• Society of Urologic Oncology review: A 2024 SUO review looked across 15 studies of men receiving TRT after surgery. Across 697 postoperative patients, recurrence rates ranged from 0 percent to 6.5 percent, with no consistent evidence of harm.
• American Urological Association review: A 2025 AUA review aligned with this, again showing no evidence that TRT after prostatectomy increased recurrence, echoing the same less than 2 percent five-year recurrence risk in both groups.
• Randomized clinical trial data: Even beyond the prostatectomy population, a 2023 JAMA randomized clinical trial of more than 5,200 hypogonadal men found no increased rate of high-grade prostate cancer among TRT users.

Finally, a prospective phase 3 randomized trial is currently evaluating TRT after radical prostatectomy, examining not only cancer outcomes but also functional recovery such as sexual function and continence. The very existence of this trial gives me hope that better answers are on the way.

These studies collectively chip away at the long-held fear that testosterone “feeds” prostate cancer. The saturation model, proposed years ago, suggests that cancer cells respond to testosterone only at very low levels; once receptors are saturated, more testosterone doesn’t accelerate growth.

And yet, my physician brain believes it, but my patient brain hesitates.

The emotional calculus of survivorship

This is the part of survivorship no textbook prepares you for.

The first time I saw my postoperative PSA listed as “undetectable,” the relief was overwhelming. But so was the fear that accompanied each subsequent test. Even with strong data in hand, I find myself reading each PSA result as if it holds my fate.

Cancer reshapes how you interpret risk. A “low probability” feels different after you’ve been diagnosed. Every time I think, maybe I’m ready to restart testosterone, another thought follows: What if I’m the exception?

This is the emotional calculus patients perform every day, one I never truly understood until I became the patient.

Despite my hesitation, I still can’t pretend that living with untreated hypogonadism is easy. I miss the sexual confidence I once had. I miss feeling powerful in the gym. I miss the clarity and drive that testosterone gave me. These may sound like minor inconveniences on paper, but they shape how I practice medicine, how I show up for my family, and how I experience joy. Quality of life is not a luxury in cancer survivorship; it is part of healing.

Healing is not linear

And so I continue weighing two truths: TRT may be safe for me based on current evidence. I am still afraid to take that step.

Both truths coexist, and both are real.

Six months after surgery, I remain undecided. My PSA is undetectable, the evidence is encouraging, and medically, the path to resuming TRT is clearer than ever.

But I’m not ready. Not yet.

Not because the data scares me, but because cancer has changed my relationship with uncertainty. I need my mind, heart, and body to align before I take the next step. And that alignment takes time.

I’ve learned that healing is not linear. It doesn’t follow a postoperative timeline or a guideline-based schedule. Recovery includes fear, patience, vulnerability, and the courage to admit when you’re not ready.

Someday, maybe in another three months, maybe in a year, I will decide whether to resume testosterone. When I do, it will be an informed choice, shaped by evidence but governed by self-compassion.

For now, I continue to heal, to reflect, and to trust that clarity will come.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness. 

Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.

Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.