High Dose Testosterone

For the past 5 years since diagnosis (PSA=29, Gleason=10, numerous lymph node mets), I have burned through every available drug (triple blockade; Zytiga; high dose ketoconazole; Xtandi; Lynparza).

Now my Med Onc offered 2 choices: chemo (which he said I was not ready for) or flooding my body with testosterone via AndroGel in an attempt to resensitize cancer cells for second use of Zytiga.

I am about to jump off the bridge and take option 2.

PSA has been on increase even after proton beam radiation. No bone mets.

Anyone out there tried this? I know that Dr. Bob Liebowitz in California uses bipolar testosterone, but he is not my doc.

Thanks for your input.

17 Replies

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  • Hi Vandy,

    I am 4 weeks into the testosterone phase of my home-grown rapid cycling therapy. In fact, I just injected 0.5 cc T cypionate into thigh muscle.

    I used to be on AndroGel 5 mg, until they lowered the options from 5 & 2.5 to 4 & 2 mg. The "high" dose (4-5 mg), I reckon, added ~500 ng/dL to what I had been making myself. 4 mg was OK but I doubt that it would bring every man, post-ADT, above 650 ng/dL.

    When my insurance warned me that from 1/1/2015 they would be questioning every T prescription (AndroGel is expensive & fashionable), I switched to the shots. A 6 month supply with syringes is not even $20 / month (without insurance), & my insurance did not question it, so I pay almost nothing.

    With the shot, my T is above 1,000 ng/dL even after a week. I see no reason to go higher. Note that 1,000 is just within the normal range (on some scales).

    When you start out castrate, T makes the PSA rise. You just have to hold your breath. Dr. Myers says that this makes him nervous for patients who insist on TRT. But the PSA has settled down by the time T gets into the normal range. You will not see the trend until that happens.

    Note that this is exactly what happens in the off-phase of IADT.

    "The prostate saturation model suggests that the androgen receptor (AR) is saturated at serum testosterone levels of 150-200 ng/dl, and that additional serum testosterone above this level has limited, if any, effects within the prostate." [1]

    Abraham Morgentaler is the originator of the saturation model, & the reason that everyone now calls testosterone "T". He is the author of related papers [2].

    Sam Denmeade (Johns Hopkins) is the guy behind Bipolar Androgen Therapy (BAT) [3].

    I believe that estradiol [E2] should be monitored. As T increases, PCa will aromatize it to E2. Ideally, IMO, E2 should be ~20 pg/mL. It should never go above 30 pg/mL. Arimidex will control it.

    -Patrick

    [1] ncbi.nlm.nih.gov/pubmed/?te...

    [2] ncbi.nlm.nih.gov/pubmed/?te...

    [3] ncbi.nlm.nih.gov/pubmed/?te...

  • Good Morning pjoshea,

    Thank you for your thoughtful and informative reply.

    I just left the script for AndroGel at my local CVS, so I will begin this new chapter later today.

    How long have you been on this therapy?

    What was your PSA at start and how high did it rise?

    What is your current PSA?

    I am trying to prepare myself for the numbers!

    Thanks again.

  • We are all different, of course.

    I began using T plus Arimidex over 10 years ago. My cancer settled down & I had ~5 really good years before my PSA inched up. Reluctantly, I began cycles of 3 months castrate & 3 months normal-high T.

    In 2015, before my met at L5 was radiated, PSA after a cycle of T was ~37. After a castrate cycle it was ~1. The next T cycle ended with a PSA of 13.5, so a lot of cancer cells had been killed by the radiation.

    & so I now cycle from 1 to 13 & back.

    My PSADT is very short, but I think I have done better than I would have done on IADT. I don't know how many cycles I can manage before resistance sets in, but I will be 70 in 6 months - an impossible goal, it seemed, at age 56.

    Regarding your numbers - don't panic! They will probably dismay you at first, but you will not be able to see the trend from the first few nembers. & remember that you can become castrate again quite quickly.

    In your case, you are hoping to lose cells that have become used to low T & can't cope with normal-high T. You will be selecting for cells that more like pre-ADT cancer cells.

    With rapid cycling such as BAT, the cells never have time to get used to low T, so it's a different situation.

    There are other things you might also do, if you are not already:

    - take 4 x 500 mg Metformin daily. (Work up to that dose over a month.)

    - monitor inflammation factors (see my posts)

    - monitor coagulation

    - consider a statin

    - try to get trigycerides down to the HDL-cholesterol level. This will be way easier with normal T. Avoid carb-heavy meals/snacks

    - & much else (see posts)

    Best, -Patrick

  • Hello Patrick,

    I read your post with great interest. I have a couple of questions.

    I've just started BAT. The way I started was to stop Zytiga and Lynparza, but I remained on Firmagon. Then after 14 days I took my first shot of T cypionate 400mg. I was quite surprised when I (14 days later) went to my oncologist for my monthly Firmagon shot and I learned that my PSA had risen from 0.8 to 4.9! It has been 4 years since my PSA was in that range! And it happened in 1 month!

    Do you think this rapid rise was partly due to going 2 weeks with only Firmagon before my T shot? Was it a mistake to stagger these shots? Should I take Firmagon and T at the same time?

    I am enormously encouraged to learn from your post that "When you start out castrate, T makes the PSA rise. You just have to hold your breath". I've been in castrate range for 8 years so your statement ties in nicely with this.

    I would like to try at least 3 cycles before I "give up" this approach. I take my 2nd shot of T day after tomorrow. I agreed with my oncologist that I would take a PSA and Testosterone test 2-3 days after that. I am particularly interested to see if I achieved a supraphysiologic level of T.

    For this purpose do you think 2-3 days is too soon to measure T?

    Your opinions will be much appreciated.

    Kind regards

    Terje

  • Hi Terje,

    As you know, T cypionate is injected into muscle (weekly for TRT). I have not seen a graph of typical T levels on day 1 through 7. But I once tested T on day 8, after ending my 3 month T phase & T was above 1,000 ng/dL. I imagine that 2-3 days after the shot, T will be higher than on day 8.

    It would be interesting to know what a 30 day curve looks like. Specifically, for when T falls to castrate, & how many days one is castrate before the next shot.

    You give your dose as 400mg. Mine is 0.4cc /week. The bottle says 200mg/mL which I think is the same as 200mg/cc, so my weekly dose is only 80mg. 400mg should give you an impressive T level, although the Denmeade trial had men who did not achieve a supraphysiologic level of T. 1,000 ng/dL is high-normal & I don't know what benefit there would be if T were a lot higher. But that is the Denmeade goal.

    You should have some indication of benefit after 3 cycles, I think. With even a modest incremental benefit, it would be worth staying with it.

    Best, -Patrick

  • Thanks Patrick! You're such a great asset to this site!

    Terje

  • Hi Patrick!

    I thought I should follow up with my latest labs!

    You were right (about holding my breath)! My initial PSA after 1 month on BAT was 4.9 (which was an increase from 0.8) and today after 2 months on BAT the PSA was 0.6!!!

    As you can imagine, I'm super thrilled. I can hardly believe it!!

    We discussed measuring the Testosterone 3 days after my 400mg shot and it was 1315. So I think that is a supraphysiological level as per Dr. Denmeade.

    Kind regards

    Terje

  • Great news! -Patrick

  • This.very complicated I have been on casodex 50 mg to now 150 mg + avodart for the past 7 yrs. and t ranged between 8oo and 1050. Never took arimidex and now breast are enlarged. Not sure what effect the estradial has on the pc except patches are given to block it so why lower it with arimedex or dim. Can anyone help with this quandry. Anyhow the immediate problem is that the cas + av. Isn't working any more. Psa rose from 2 to 6 in the past yr. and now will see my m.o today about lupron + exstandi. Took the lupron yrs ago with r.t in jan 2000 with a pas 160 but low gleason. than again for a psa reccurrence 2.8,yrs later. I find that ones that can block the T. before supress it survive longest. Androgen blockade with antiandrogens before adt. Even worked better on higher gleason as seen in early studies with flutamide. Well today may be my turning point with my monthly psa. If what were thinking is right I should get a good response with adt with all that T.swimming around for the past 7yrs..I know you guys are up on this stuff. If you like to have a stab at explaining. the above and the next move please do. It would be helpful to you, me.and hopefuly save a lot of greif for others out there. Rocco

  • Good morning Patrick,

    Many thanks for sharing your experience of BAT. Much appreciated!

    May I ask what regime you used during the alternating 3-month cycles of BAT and ADT? Was it . .

    1. Intramuscular testosterone (T) cypionate or enanthate 400 mg on Days (D) 1, 29, and 57. ADT was continuous OR

    2. A 3 month cycle of ADT followed by 3 months of intramuscular T?

    Thanks again!

    ~ Frank

  • If you are willing to go to Baltimore, Dr Denmeade has opened arm C of the RESTORE study to naive abi/enz patients with rising PSA. You must be on ADT. NCT02090114

  • My husband is Mcrpc patient (dr david chism- oncologist) vanderbilt . 5 year post prostectomy- now psa 112- finished radium 223 march 2017. Doubling psa 3 months - appt June 27th to see about trials at vanderbilt. What advice can we get on treatment & vandy 69- are you being treated at Vanderbilt cancer center? Age 82

  • Hi Charlesd,

    You broke the code--graduated from Vandy in 1969!

    I am being treated by Dr. Oliver Sartor of the Tulane Cancer Center and he has just started me on the high dose testosterone road, or Testosterone Replacement Therapy (TRT) as it is known. Either that or chemo, so we will see how it works.

    BTW, I just turned 70.

  • Dr.david Chism(oncologist vanderbilt Ingram Cancer Center) is entering me in new trial/ KPT-8602 (SINE) HEM 15112-A Phase . "This study drug KPT-8602 works by trapping "tumor suppressing proteins" within the nucleus of the cell and thus causing cancer cells to die or stop growing. it is not known if KPT-8602 will treat your cancer." Quote from research study info. This has not been used "On Humans" for Castrate Resistant Metatastic PROSTATE Cancer. Very thankful to be able to be part of this trial.

  • Mark?

  • Yes, you broke the code!

  • 'Been on Health Unlocked off and on since 2015, mostly to keep up with newest treatments and to ask questions from a different person's perspective. Answers have varied, some helpful, some still painful. I respect your friend's privacy, so questions and comments will be passed over and remain unread. As with all of the others, wishing the very best of results. Keep the faith!

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