ART How to Increase TET Naturally; Dr Rena Malik, M.D.

[RMontana]

ART How to Increase TET Naturally; Dr Rena Malik, M.D.

Here is a good set of 5 recommendations on how to improve your TET naturally. I am coming off 21 months of ADT and at month 6 my TET is 185! Sounds low but I am thrilled to high heaven...thought it might never come back. At month 5 I suddenly noted I had hair on my arms and 'low and behold,' some on my chest! FIRST hair on my body in more than 18 months...I note some changes as well, including higher libido...told me wife I was 'seeing' things on the beach I had not noticed in a long time; was smacked, but I told her its all in my recovery!

Anyway, I think some of what this Dr recommends is plausible and at worst cant hurt. I weighed 268 Lbs when I was incubating this cancer and now weigh what I did in high school (180 Lbs)...will stay at this level no matter what! Especially after what this Dr states; lower weight allows even moderate exercise to boost TET production naturally!

Supplements were not found to be statically significant boosters of TET in this podcast. But I started taking ANDRO-T, by Earths Creation at the start of my ADT vacation...was told by my Brother who manufactures supplements, that this works. Dont know if that made a difference OR that my TET was just coming back anyway, but mention this if anyone is interested. Some highlights to the podcast;

PODCAST: 5 Ways to Boost TET naturally:

MIN 0:21: Symptoms of Low TET. Most important for me were low Libido and loss muscle mass.

Number 1: Lose Weight

MIN 1:00: Lose Weight. Fat cells convert TET to Estradiol (female hormone)...yeah...how much do you lose?

MIN 1:37 46 Lbs average loss needed before increase in TET noted. BUT...

Number 2: Exercise

MIN 2:01: Exercise allows TET to increase naturally starting at 26 Lbs loss!

MIN 2:20: Exercise increases TET...what type? High intensity leads to more production of TET. But, after 12 hrs this boost disappears. Going for a walk therefore works and is better nothing.

Number 3: Diet

Min 3:55: Diet changes. Avoid processed foods. KETO diet is best.

MIN 4:20: NHANES Study. Diet study in USA. Diet correlation to TET levels studied. Restricted FAT intake decreased TET levels (yeah)...but, normal weight men should not reduce or eliminate FAT. Obese men should cut down Fat to lose weight but neither group should eliminate FAT completely.

MIN 5:45: Soy products have ISOFLVANES (estrogen type hormone); should they be avoided? 47 studies compiled. High Soy intake did not reduce TET levels. Control study of young men (18-25 yrs) noted. Study found 41.5 grams per day intake did not reduce TET in 4 week study. So Soy is good for you and a good source of protein.

Number 4: Sleep

MIN 7:04: Sleep. 2 studies, 2300 men in NHANES Survey. For each Hr of sleep deprived TET levels dropped by 6 points. Another did sleep depravation over 8 days, dropping to 5 hrs per night; 15% drop in TET. Time that you wake in morning may be factor; sleeping-in may help if you dont sleep for long periods.

Number 5: Avoid BPA's

MIN 8:50: Endocrine Disrupting Chemical. Found in BPA's (Bisphenol A), which are found in some plastic. These chemicals disrupt endocrine actions which TET production depends on. NHANES Study again found correlation between high BPA's and lower TET in pubescent boys. Use glass, metal and dont warm food in BPA plastic containers.

youtu.be/lef5duf6ylQ(Not working as expected?)

[ElRanchoDePoisonIvy]

So you bounced back from 3?

[RMontana in reply to ElRanchoDePoisonIvy]

…yes. I was so surprised. At three months in on my ADT vacation I tested 3 ng/dL. Why did they bother. They should’ve just said zero. Three months later is 185 nano-grams per deciliter. For me that was a wonderful shock.

I’m holding my breath for the next three months. I was 279 ng/dL going into my surgery. Low but I didn’t feel any different back then. Heck my libido was fine. I had great sexual function before surgery. Of course, neither my surgeon, nor my radiologist took that into account, nor ever discussed my sexual health. Nor did the doctor and sexual health specialist that I hired, take any of that into account when he was following me. No one never counseled me on what ADT would do to my sexual organ, that it would end my ability to get natural erections, and that I would atrophy overtime. In all of the 3 years of treatment not once have I had a one on one session that explained to me what low testosterone would really be like and what ADT would do to my sexuality. I have yet to publish a great podcast that lays this all out; will do so soon.

Again going into surgery I had great sexual function and as such it’s a consideration much more significant for me than anyone ever made out. Yet my sexual health was never taken into consideration or planned for during any of my treatment. At the time like most of us, I just was focused on killing this cancer. There was no other consideration for me. That’s why calmer heads should’ve prevailed but there were none to be found. I suppose I should be happy that this disease was not worse than it was.

Everything I’ve done to date to recover my sexual health has been a matter of self discovery. I really do feel that the PCa medical community is satisfied if you just don’t die. Sexual health is a third rail that no one wants to touch. It’s also the most important thing that you think about if you’re lucky enough to have caught this disease early, have a good sexual function and follow the path of nerve sparing surgery, and all that other bullsh#t that promised ‘recovery’ when we went into this journey. All pie in the sky.

But the hair on my chest is getting longer, thicker and turning black; my body had been as bald as a babies ass for 18 to 20 months so I’m cautiously optimistic.

…of course I’m not out of the woods. This disease can come roaring back. But for now I’m hopeful. I’m just starting to get my libido slowly return . I pray that this disease will pass me by. But I won’t know for quite some time; 10 years, not 5!. Like all of us I live one day at a time. I’m thankful that for me each seems to be better than the last. That’s all I can ask for. Sorry for the long reply.

[ElRanchoDePoisonIvy in reply to RMontana]

No, no. Listen, I can't tell you how much I appreciate your input. You're the reason I pulled the plug and got a penile implant two weeks ago. the discomfort is dying down to a dull roar now and I feel like a perv every time I go out in public, but I'm so grateful that you tipped me off to what was coming down the pike and I was able to get this done now rather than after the rad and certainly after ADT if it comes to that. It is absolutely jaw dropping to me that none of the side effects of the treatment are even glancingly mentioned by the MDs. None. I asked my Uro, "I've read that 30% of the men who get ADT never get their TET back, is that true?" He got this expression like I'd caught him with his hand in the cookie jar and said, "Yes. But I don't think it's *that* high. Maybe 20%." But that's quibbling. Even if 20% is accurate, it's a huge risk and should at least be discussed with the patient. No medical person has ever even mentioned penile shrinkage to me. And yet when I read books and these boards, I find it's a pretty big deal. Same with the nerve sparing RP. No mention that there would be something like an 70% chance I'd lose erectile function.

My estimate is that I'll need rad by November, when I get close to the magic 0.2 number. Honestly, I'd do it tomorrow, but want to wait until I've healed from the implant. Also, my urinary function is good, but I can tell it's still improving and I want that to get that as good as I can get it before I get rad.

The issue I'm trying to get to the bottom of at the moment is whether or not simultaneous rad and ADT is efficacious. I understand and accept that if rad fails then I will have to do ADT. But everyone seems to feel that there is a synergistic effect to having rad and ADT at the same time, yet I can't seem to find the mechanism for how that synergy occurs. My suspicion is that it doesn't really exist, or if it does, that it's in the noise range. I suspect that the synergy that everyone sees is only apparent, and that it is a statistical artifact that is caused by the 30% of the men who get short term ADT never getting their TET back. In other words, the 30% of men who get short term ADT are, in effect, actually getting long term ADT because their TET never recovers. So that study cohort gets a cure benefit when it really shouldn't. Those 30% should be weeded out of the study results, and maybe they are, but I haven't been able to find out much on that.

The proper thing to do would be to compare simultaneous rad + ADT with sequential rad *then* ADT and then look at the 5 and 10 year OAS and Met numbers for both cohorts. Maybe those studies exist, but I sure haven't seen any. Have you?

Barring a miracle, I'm leaning toward doing rad and sitting tight to see the results, and only doing ADT if the rad fails. But I'd love to see some studies if they exist.

Again, thanks for sharing your story. Without it, I wouldn't have have plunked down 21 large and got this IPP, certainly not when I did. I don't think I realized until after I got the surgery done how much the ED was bothering me and I'm grateful it's behind me and I won't have to deal with it anymore. I'm 16 days out, but I'm starting to feel a lot less discomfort and am looking forward to my post-op visit with my surgeon in 28 days.

[RMontana in reply to ElRanchoDePoisonIvy]

...one more thing. This sounds creepy, but take images and use a ruler to measure and document your IPP status. You will lose the ability to remember where you were when you started and see if you are making any progress. I am an engineer by training so I think about these things, but how do you know you are 'improving' if you dont measure. The brain does weird stuff. So measure from the pubic bone to the edge of the Glans, NOT to the tip of the penis. That is the most critical measurement and the one Dr's use the most. Measuring to the tip of the glans really is not as good as that length changes according to your ability to engorge the head of your penis. I have lost all that function, so for me its not helpful. But take images and keep notes. I have a 'Baseline' that I took post IPP surgery and now I know where I am 6 months later. I see growth so I keep going.

Measure FPL (flacid penile length), EPL (erect penile length) and EPC (erect penile circumference)...all three are important. Make up a table and update it; measure 2 times a week (more than that is not needed). For circumference you will need a cloth tape, like is used for sewing...for FPL and EPL use a childs wooden ruler...push hard to find the pubic bone; if you have fat in your ponch then the real length is not 'visible' but should be measure. Note that up to 50% of the IPP implant length is inside your body; what you see is the working part that we most value...use Inches or cm/mm...but inches makes more sense for us in the USA...

Hope this helps...Rick

[ElRanchoDePoisonIvy in reply to RMontana]

Good to know. I’m a geologist and Dad was a mech e, so that sort of thing comes naturally to me. I have spreadsheets you wouldn’t believe. I figure if you pay 21k for something it’s only common sense to make sure you’re getting your money’s worth. The surgeon recommended cycling it twice a day for up to a year.

[RMontana]

Good for you!!! My God how I wish I had moved to get my IPP right after surgery and at the point where I knew I needed both ADT and RT...I had a solid 7 inch erection and now am at 5 1/4 inch with the IPP...its different, but I am thankful. NEVER did ANYONE tell me my penis would shrink...trust me. I am an engineer by training and that point, if it had been made, would have burned a hole in my skull...NO ONE told me anything. What enrages me is that I had the good sense to hire a 'Sexual Health' doctor in Tampa, FL (he is very well known: wont say his frigin name here), BEFORE I had surgery...he told me nothing about what was coming. When I noted to him that I had Peyroneys at the base of my penish he said; 'Yeah, that happens.' I am NOT kidding this was pretty close to what he said. THEN when I complained that the TRIMIX injections hurt like hell he said; 'Just get used to the pain.' Sooooooooo, I gave up trying to rehabilitate my penise NOT knowing it would atrophy...I caught it by accident one year later, when I pumped it up with a VED and had the shock of my life...the rest is history.

OK...you acted just right. Your IPP will heal. You need to stretch it out now and maximize its size during ONE YEAR of 'exercises.' My implant Dr recommended the following exercise, which I have seen elsewhere. I include some other sessions you can check out as well. Dr Perito is a cowboy but he was the only Dr I saw on line that was honest. There a MTP podcast where he says at 3 months post RP you should have a sonagram made of your penis and if you don’t have the ability to trap blood, if you have venous leak, you should move to an IPP…AT THREE MONTHS!!! I waited 2 ½ years! Madness…

The Exercise; youtu.be/WJaZCeJjxIM(Not working as expected?)

Rehab Following IPP: youtu.be/F3bBZRee854(Not working as expected?)

Post Operative Pain n Penile Atrophy: youtu.be/7Ceyowsf4Rw(Not working as expected?)

Using the exercise I grew my implant, from the baseline after surgery, by 25% in 6 months...NOW, did you know that your girth (circumference) is the same as your length…yeah…so plus 25% is a 3 dimensional growth, JUST LIKE losing 1 5/8 inches was a 3 dimensional hit caused by my ignorance…why is this not told to men when they go into PCa treatment. I would still have done everything that I did, but I would have saved size and size matters. Look, at least I have a 5 plus inches left! Can you imagine our Brothers who had 3-4 inch erections prior to PCa treatment that now face very small organs…so this matters and the medical community has a lot to answer for…just wish I know how we could blow this thing up to the size it deserves (lots of metaphors here).

Something else though lurks that is not mentioned even by the good Dr Perito. You will lose sensation in hour penis. This is the dirty little secret inside the IPP world; they all have their skeletons. They adverstise that sensation is the same; its not. You may experience some numbness for weeks, if not months. You may not be able to orgasm right away…it takes time. I was finally able to orgasm just last week, 9 days short of 6 months after I got my IPP. This may not be the experience of ‘most’ men, but most men get IPP’s for diabetes and have healthy organs. You many not suffer this as you moved earlier than I did. But if it happens be forearmed. Your sensation will return over the 1st year of the implant, but I suspect its never going to be the same as before. Dr Eid is more honest here than Dr Perito and Dr Clavell beats them all with this video;

Penile Implant; Does Sensation Change? youtu.be/wfZ2eZLOCFs(Not working as expected?)

So, good job! Spread the news. Heal and get back to normal. I feel great with the penis that I have. I moved late, but not too late. It does not matter that PCa comes back, I am made whole again. Our Dr’s don’t care about sexual health and only focus on us living through the treatment…it leaves us like a cored apple, whole on the outside but incomplete…no matter.

As far as ADT and RT…here are two studies; I don’t know if I shared them. In the 1st study ADT use, both short term (STADT) and long term (LTADT) with low dose salvage radiation (LDRT) helps with PCSM (mortality). STADT with LDRT does not; the OR (odds ratio) is 0.71 but the ‘p factor’ (chance that the outcome is wrong) is only 0.119…statistically insignificant. It must be at least a ‘p’ = 0.05 to be dependable. So by this study LDRT without ADT should be about the same.

ADT Use w RT: healthunlocked.com/active-s...

This is a small sample size study in China that shows that SRT significantly improves three key metrics of cure; 5 -year biochemical progression-free survival, androgen deprivation therapy-free survival and metastasis-free survival were

Outcomes of SRT for Recurrent PCa After RP: healthunlocked.com/active-s...

Again, sorry for the long reply. Rick

[ElRanchoDePoisonIvy]

Thanks again for the quick reply. My surgeon was Clavell, lol. Someone should write a prostate primer. So many guys go through this and 99% of us are like babes in the woods. I sure was. Now I at least know how much I don’t know.

The thing I’m trying to tease out is comparing SRT+STADT administered simultaneously with SRT and then a pause of up to a year, followed by STADT to see if the results are similar. Seems like it would be well stuffed but I can’t find it.

I used a VED for at least 30 min per day after my RP and I didn’t notice much loss. I’m sure glad I don’t have to use Tri-Mix anymore. Didn’t work anyhow.

[RMontana in reply to ElRanchoDePoisonIvy]

As far as when to administer ADT, before or during, I believe before is the SOC. See MIN 20:04 of this podcast. I dont think the ADT has time to 'shrink' the tumor if you do it during the sRT. Does not make any sense. Then, just wait...see if your PSA rises and what the doubling time is...dont hit it with ADT again before you have to. But with your IPP you dont need to worry about atrophe again.

healthunlocked.com/active-s...

healthunlocked.com/active-s...

You may want to look at these case histories as well...its a really good way to learn from others.

I had my IPP 2 1/2 years after my RP and had Peyronies at the base of my penis. That cut off blood flow almost completely to 1/2 the organ. Again, where was my Tampa "sexual health" Dr when I needed him...right there, when I called him at about 6 months post RP to report the Peyronies, he should have told me; "Dude, get an implant now." Guess what? He does implants! And is sort of well known for them...would not send my pet to him for flees. So you were in good shape at almost a year out and especially if you did not have Peyronies. Mine may have been caused by the radiation...I think it was as its at the base. My entire pelvic area was radiated to hit LN outside the fossa...

I did do a 'primer' which is shown at this link. Its my 'woulda-shoulda-coulda' list of Do-Overs that, by some miracle, I would follow; in my next life...

healthunlocked.com/active-s...

If it helps anyone I am glad. If you think its worthy pass it on when the time comes. NO ONE should go into PCa treatment without full knowledge of what the heck is going to happen. AND the pie in the sky bullsh#t about recovery of natural erections has got to stop...my surgeon said his rate of recovery was 50%...actually said that. My RO countered and said his Radiation treatment, in lieu of a RP, also had a 50% rate of "recovery" for sexual function. Those are abosolute untruths (wont use the "L" word). Also, how the heck do they know? No one has ever call me after my RP, or my sRT, to even ask if I am still alive...how do they know they are 50%? Its all a bunch of bullsh#t. In the Nethelands they tell men there is a 5% chance of natural erections after a RP...FIVE...not FIFTY...so, we have a lot to work on with our Dr's regarding recovery of sexual health. Good luck...Rick

[ElRanchoDePoisonIvy]

And by the way, I keep forgetting to tell you congratulations for getting your TET back. I can imagine what a relief that must be.

[RMontana in reply to ElRanchoDePoisonIvy]

...its 185 but I think its going to keep going up. Am doing all I can to help it. By the way, 6 months of ADT is far easier to tolerate vis a vis TET...after my 1st 6 months of ADT, just prior to sRT, my TET roared back to 258 in 3 months...then I had to go on long term ADT...was supposed to stay on for a full 2 years, but I added the 6 months prior to sRT to the 15 months after sRT and would up with 21 months...for me that is enough. Now I see what happens to my uPSA (ultra low PSA) and go from there...there is a LOT of good research on this as a predictor of progression. Here are some good references...after you get sRT (if you need it), use the assay that gives you 3 digits at the uPSA level. Again, your Dr will say its a waste of time; NOT...it the best predictor of progression and can give you 12-14 months heads up you have a problem...take a look at these podcast...Rick

healthunlocked.com/active-s...

healthunlocked.com/active-s...

healthunlocked.com/active-s...

healthunlocked.com/active-s...

healthunlocked.com/active-s...

[ElRanchoDePoisonIvy]

cool. Thanks!

[RMontana in reply to ElRanchoDePoisonIvy]

…sorry one more thing and then I promise not to send any more messages. I miss spoke earlier. My Perrone’s was evident to me after my surgery and not after my radiation treatment. That was my mistake. Everything else was true. I did call my sexual health doctor and told him about this developing issue. He made light of it. And he’s an implanter. Could’ve easily told me; “Dude. Get in here right now let’s talk.” But nothing. Crickets.

So I just wanted to let you know because you are potentially headed in salvage radiation. I did not want you to think that this treatment gave me Perrone’s. That was a miss statement and I got my timeframe is wrong. From the radiation I don’t believe I have suffered any ill effects that I know of at present. It went pretty smoothly and hopefully I’m cured. Time will tell. Thanks and sorry for the constant replies.

PS another detail. My RO was not in favor of me going on two years of ADT. He felt that it was not needed. My urologist did and gave me some research to look at which convince me otherwise. But my radiologist believed that the salvage was enough. Just for you to know.

[ElRanchoDePoisonIvy]

I see. Was the RO recommending no ADT or just six months?

[RMontana in reply to ElRanchoDePoisonIvy]

…just a six months. In fact, there is one study that I did not send you. He provided that to me and showed that 6 months ADT treatment prior to radiation was efficacious for men who had PSA recurrence after surgery. Let me see if I can find it and I’ll send it to you.

But all he recommended was the six months prior to radiation and nothing afterwards. I, on my own decided to add 15 months onto that. Most of that was because of my Decipher score. It was stunningly high. I only wish I had your score of 0.66. Mine was 0.97. I don’t know why they just didn’t make it 1.0. In my pathology I was a Gleason 4+3, but “pattern five noted at the margins” was in the report. So because of the decipher and the fact that there was pattern five noted, I decided to add two years onto the six months. I was the classic high risk prostate cancer patient that benefited from long-term ADT plus low-dose radiation, as found in the study of over 23,000 men that I sent you.

But as I stated, I stopped at 15 because I did not see any benefit of continuing and when I added the six months before radiation I had a total of 21 months which was close enough. I was also very concerned of losing my testosterone forever. I would now rather just see what happens with the uPSA monitoring, then use PSMA PET to find a kill this thing if it returns. Rick.