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Does Donald Trump have low testosterone? What his very low PSA tells us

Donald Trump actually has a negative or normal PSA despite his doctor saying all of his tests are “positive.” This is a good example of why “only positive results” is undesirable. Trump’s PSA is reported as 0.15 and the cut off for a positive screen (a potentially worrying result) is 4.0 ng/ml.

Trump’s PSA doesn’t really matter as his doctor says he is extraordinarily healthy. The USPSTF recommendation on PSA-based prostate cancer screening is Grade D meaning not indicated. There is actually evidence that PSA screening causes more harm than good (for those of you who want to know more I have included a wonderful video that explains PSA screening below). The American Urologic Association still recommends PSA for men over 40 who “wish to be screened,” although apparently they are updating their guidelines. 

So Trump likely didn’t need a PSA, but he had the test and he told us about it. One could say his doctor even bragged about it, so it’s fair game to review. What does his really low PSA tell us?

Screen shot 2016-08-16 at 4.51.00 PM

What exactly is PSA?

PSA or prostate specific antigen is secreted by cells in the prostate. It can be bound to a protein or free and a typical PSA measures both the bound and free levels. Normally PSA stays in the prostate and only a small amount spills into the blood stream. With cancer or inflammation or an enlarged prostate (BPH or benign prostatic hypertrophy) more spills into the blood. The level also rises normally with age.

In general a PSA of < 4.0 ng/ml is considered normal, although up to 5.0 may be a normal range for men between the ages of 60 and 69 (like Trump probably was when he was tested). 

The PSA testosterone connection

There is a definite link between testosterone and PSA. A study looking at the relationship between the two found taking age, race and ethnicity, and a variety of other factors into consideration “those with a higher serum testosterone had a higher serum total PSA.” PSA levels of < 0.8 ng/ml, like Trump’s, were found to have the lowest testosterone levels.

What can lower testosterone? Aging, alcohol, and opioids are probably the most common causes. Trump’s doctor claims Trump doesn’t drink. He’s on a statin according to the letter, but his doctor doesn’t explicitly say that Trump doesn’t take any other medications.

Medications and PSA

There are medications that can directly impact the PSA level. The drugs dutasteride (Avodart) and finasteride (Propecia) used for hair loss and to treat benign enlargement of the prostate are the known offenders. They block the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT). Some tissues need testosterone to develop and others need DHT. For example muscles need testosterone, the prostate and hair follicles need DHT. The enzyme 5-alpha reductase is present in tissues that need DHT. Less DHT and the prostate shrinks and male pattern baldness also stops. The 5-alpha reductase blockers are known to lower PSA levels by 40%.

Why is Trump’s PSA “very low” and does it matter?

At 0.15 ng/ml Trump’s PSA is “very low,” especially considering his age as levels typically rise, so that part of his doctor’s letter is accurate. This very low PSA level could be from taking dutasteride or finasteride for baldness or an enlarged prostate (totally fine if he is, but all medications should be in his doctor’s letter) or he could simply have a naturally lower testosterone level. As long as that isn’t from opioids then a lower testosterone level in a man whose “physical strength and stamina are extraordinary” would mean very little and be about as relevant as the size of his hands.

 

Screen shot 2016-08-16 at 5.08.11 PM

Discussion

10 thoughts on “Does Donald Trump have low testosterone? What his very low PSA tells us

  1. Would you please forward these comments to HILLIARY? Might help her explain his erratic moods. His vanity for a head of hair is making him mentally ill?

    Posted by Judith Vance | August 18, 2016, 6:43 am
  2. `Healthiest President ever` – I presume Dr Bornstein has seen the medical records of ALL the other Presidents ? ( Tongue in cheek ) .

    Posted by Jim | August 18, 2016, 6:52 am
    • That comment definitely raised eyebrows, especially among medical professionals. I also would never describe a physical exam in the manner as done on this alleged letter from Dr. Bornstein or refer to blood test results as astonishingly excellent. However, considering the multiple superlatives used in this report. it’s far more likely that Trump wrote whatever he wished and had his physician sign it for him.

      Posted by Kate | August 19, 2016, 5:47 am
  3. Interesting that the only test for which an actual result is given is the PSA.

    Posted by Mary | August 28, 2016, 11:47 am
  4. I am not a urologist and I have had little success searching the medical literature for the incidence of a PSA level of 0.15. I found one article in PubMed showing a low level range of 2.1 among 400 patients in a urology clinic, implying that 0.015 is an unusual finding. A 2013 article shows that levels below 0.65 occur in 8.4% of patients investigated for low-T syndrome. Another web site lists 10 (ADAM) criteria screening for low-T. Mr. Trump implies by his public behavior and comments that he does not suffer from a reduced libido or sexual performance impairment – if his statements can be trusted.
    A very common cause of a low PSA level is treatment of prostate cancer with prostatectomy or radiation therapy, following which PSA is expected to drop to zero. Rising PSA above 0.2 raises questions regarding recurrence.
    I am surprised that the media has not picked up on this question.
    If the low PSA and the indication for ordering a testosterone level is secondary to low-T syndrome, then the only implication is that Trump’s libidinous braggadoccio is intended to mislead and adds little to an assessment of his suitability for office. If, on the other hand, he has failed to disclose treatment for prostate cancer, then a PSA of 0.15 in combination with a normal testosterone level might indicate recurrent prostate cancer resistant to anti-androgenic therapy which would have major implications for a president of the United States.

    Fred Grannis MD Long Beach, CA

    Posted by Frederic Grannis | October 12, 2016, 3:06 pm

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