Testosterone Replacement and PCA

There have been a number of posts on TRT and PCa. According to Dr. Morgentaler's saturation model 250ng/dl seems to be the cut off point...the androgen receptors are saturated and raising the T level with TRT for quality of life will not make the PCa worse..The problem is most oncologists do not view Morgentaler's research as proven.



8 Replies

  • Gus,

    It is logical. Example: monotherapy of 150 mg of Casodex increases testosterone while decreasing both the PSA and the tumor burden.


  • Maybe.

    Casodex may allow testoserone levels to remain higher in the blood, and the issue may be the testoserone levels in the cell, or in the cell nucleus.

    example: pretend that T levels in the blood are 100. ARs increase the T levels in the cell to 200.

    Eligard might reduce the T levels in the blood from 100 to 010, but ARs multiply on the cell wall to increase the T levels in the cell to 080, despite the fact that T now diffuses out of the cell into the blood faster.

    Casodex on the other hand does not inhibit the production of T in the testes, or the level of T in the blood (does it??), but it inhibits the activity of the T inside the cell, or increases its exit out of the cell (unlikely).

    I made this up.

  • Casodex blocks the ARs on the cell. It dampends down the production of androgens from the adrenal gland.


  • Well explain what you meant by saying "It is logical".

    I don't understand why you make that remark in the context of a post on testosterone replacement therapy.

  • Something is not correct in the current thinking about testosterone. This line of thinking may help change the mental models.

  • Gus,

    Dr Myers has said that in the off-phase of IADT, while PSA rises as T increases through the hypogonadal range, it matters not whether T stops rising at 350, 450, 550, etc. The PSADT is not affected by T rising through the normal range. This backs up the Morgentaler theory.

    The sad thing, giving that IADT is supposed to give one a vacation from castration, is that it can take 6months or more to get back into the normal range. Many men never make it, or do not get much beyond 350 ng/dL.

    A rapid restoration of T would give one the QOL that is supposed to come with IADT. My feeling is that it is better to spend as little time as possible in an estrogen-dominant state.

    With a T patch or other external T application, T can be brought back down quickly if necessary. The injections into muscle take a long time to clear.


  • Patrick,

    I believe it was Myers who said a slow recovery of T is a good thing...the longer it takes T to recover is proportional to the length of the off-phase of IADT.


  • Dr. Freedland has said that the off-phase is largely a continuation of castration.

    Once T has reached 350, the PSADT is what it is. For some, there will be a speedy return to the on-phase. However, Myers claims some success with durable responses (very lengthy PSADTs). &, as he has said - you only get 2 or 3 cycles of IADT.


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