Short answer: PSA usually rises a little on testosterone, so the question is how much. The Endocrine Society guideline says to check PSA and do a prostate exam 3 to 12 months after starting, and to refer to a urologist if, in the first year, PSA rises by more than 1.4 ng/mL from baseline (confirmed), goes above 4.0 ng/mL (confirmed), or the exam finds an abnormality. After the first year, follow standard prostate screening. In the TRAVERSE trial of 5,204 men screened to exclude high prostate risk, high-grade prostate cancer was rare on testosterone (0.19%) and placebo (0.12%), with no significant difference.
Fear of prostate cancer has shaped testosterone prescribing for decades. The reality, based on current guidelines and the largest trial so far, is more reassuring than the old fear, but it still depends on careful screening before and during treatment. This article covers what to test, when, which numbers trigger a urology referral, and what the TRAVERSE trial found. For other routine labs see hematocrit on TRT and total vs free testosterone.
Prostate-specific antigen (PSA) is a protein made by the prostate and measured in the blood in nanograms per milliliter (ng/mL). It rises with prostate size, inflammation and cancer, so it is a signal to look closer, not a diagnosis. Testosterone supports normal prostate growth, which is why PSA often moves when therapy starts. The Depo-Testosterone label notes that natural androgens drive the "growth and maturation of the prostate."
The 2018 Endocrine Society guideline recommends against starting testosterone, without further urological evaluation, in men with:
The Depo-Testosterone label lists "known or suspected carcinoma of the prostate gland" as a contraindication.
The guideline's monitoring plan is to check PSA and perform a digital rectal exam 3 to 12 months after starting testosterone. The overall monitoring statement in the guideline abstract says clinicians should evaluate "prostate cancer risk during the first year after initiating T therapy."
The guideline recommends urological referral if, during the first 12 months, there is:
"Confirmed" matters. A single high reading should be repeated before it drives a decision. After the first year, the guideline says prostate monitoring "should conform to standard guidelines for prostate cancer screening" for your age and risk.
Say your baseline PSA is 1.1 ng/mL. A 1.4 ng/mL rise means a confirmed value above 2.5 ng/mL within the first year would meet the referral threshold, even though it is well under 4.0. That is why a baseline value matters so much: without it, the 1.4 rule cannot be applied.
TRAVERSE is the largest placebo-controlled testosterone trial. Its prostate safety analysis (Bhasin 2023) included 5,204 men aged 45 to 80 with low testosterone, symptoms, and heart disease or high heart risk. Men with PSA above 3.0 ng/mL or an IPSS score above 19 were excluded. Participants used 1.62% testosterone gel or placebo for a mean of about 22 months.
For context on who was studied: at baseline, mean PSA was 0.92 ng/mL and the mean urinary symptom score (IPSS) was 7.1. Follow-up covered 14,304 person-years. Testosterone was adjusted to a target range in the main trial (350 to 750 ng/dL), so these results describe treatment kept within that range.
The authors' own framing is careful: in men "carefully evaluated to exclude those at high risk of prostate cancer," prostate events were low and similar. That does not apply automatically to men who skipped screening, to men with high baseline PSA, or to doses above the trial's target range. TRAVERSE also used a gel, not injections. The main TRAVERSE paper found testosterone noninferior to placebo for major heart events, with more atrial fibrillation, acute kidney injury and pulmonary embolism (Lincoff 2023).
PSA is a slow-moving number that only makes sense as a series. In Dose Track you can add each PSA result with its date, keep your injection history alongside it, and note urinary symptoms in daily check-ins. At your 3-to-12-month visit you can show baseline, current value and the change in one place, which is exactly what the 1.4 ng/mL rule needs.
Questions about the app? See the help center or join the Dose Track community.
Every number in this article comes from one of these sources, checked on October 22, 2026. This article is for education. It is not medical or legal advice, and nothing here is a dose recommendation.