Hypogonadism and prostate cancer (PCa) often coincide with increasing age. Recent reviews have found no evidence to suggest an increased risk of developing PCa with testosterone replacement therapy (TRT). The same lack of PCa risk is found in studies looking at men receiving TRT after radical prostatectomy for PCa. Reports on TRT in men on active surveillance are very few. In summary, current evidence does not support an association between TRT and an increased risk of PCa. Nevertheless, sufficiently powered trials with longer follow-up are warranted before making final conclusions.