Testosterone Deficiency Is Not Protective Against the Development of Adenocarcinoma of the Prostate in a Type 1 Diabetic Patient

This document reports a case where a patient with well-controlled type 1 diabetes and hypogonadism (low testosterone levels) developed prostate cancer (PC). The case highlights that despite a lower incidence of PC in diabetic males, and the common belief that low serum testosterone might be protective against PC, regular prostate exams and prostate-specific antigen (PSA) measurements are still crucial. The development of PC is linked to dihydrotestosterone (DHT) levels within the prostate rather than serum testosterone levels. In hypogonadal males, intraprostatic DHT may remain high due to the conversion of adrenal androgens like androstenedione by the enzyme 5α-reductase 2, which is typically not dominant in a normal prostate but becomes significant in the development and growth of PC.