G’day esteemed space cadets
This is a further report on my self-administered experiments in Bipolar Androgen Therapy (BAT). Previous reports can be found on my profile and the last was: healthunlocked.com/advanced... . It summarised my previous experience with BAT and asked the question: “Is BAT repeatable?” (at least for me). The short answer is: not indefinitely. However there is a story to it and although it’s a sample of one it may be of interest to add to the store of anecdotal experience. It sure as hell ain’t gonna get a big definitive trial (no money in it).
Up until BAT my treatment was pretty much linear SOC: surgery, radiation, IADT, ADT. When the ADT failed (castrate resistant) news of the first Johns Hopkins phase 2 trials results caught my attention and I spoke to my medical advisers who pleaded that I should at least try bicalutamide first. (Note that I am not persuaded that BAT will not work with just ADT alone. Patrick has argued that the earlier you start using the bipolar phenomenon the better) Anyway the bicalutamide failed at 12 months and I decided to go ahead despite strong contrary advice. The treatment was simple: continue ADT, stop the antiandrogen (bicalutamide), wait about a month (to let the antiandrogen wash through), then a monthly intramuscular injection of 400mg Testosterone Cypionate, continue until PSA starts rising, then rechallenge with the antiandrogen. The testosterone phase lasted about 8 months, the rechallenge lasted about 6 months before failure.
The repeat was: stop bicalutamide, wait a month, then start T injections. You don’t do a PSA test after the first month, however the PSA after 2 months showed a meaningful increase, but not above my self imposed higher limit of PSA 4-5. I decided failure was imminent. As I had already done the 3rd T injection I waited 2 weeks for T levels to lower to normal physiological levels, then re-introduced the bicalutamide. PSA halved after 2 months then increased after 3 months. I concluded that my error had been in waiting until failure before going on to the next stage and that a better procedure may be to simply do 3 months of the BAT phase followed by 3 months of the rechallenge phase, rinse, repeat. My aim in future is to try to keep PSA within a 0-5 range, the range it has shown since castrate resistance first set in. However I suspect that BAT is nearing the end of its usefulness. I am trying currently for another repeat. So far BAT has prolonged the usefulness of bicalutamide by about an additional 21 months after the initial failure at 12 months. So an acceptable but not spectacular response. I doubt it can be repeated indefinitely.
It should be born in mind that the BAT treatment has so far been shown to be helpful in cases of resistance to abiraterone and enzalutamide. Mine is the first “experiment” I know of to use it to manage resistance to bicalutamide. I have not been exposed to abi or enza (or chemo for that matter). There are suggestions it may even help after docetaxal. That would not be surprising. Abi, enza and bicalutanide are all interventions along the so-called androgen axis, as is BAT itself, so it’s not surprising that there will be similarities in the mechanisms of resistance and the means of countering them. Chemo might seem to be another matter. However its becoming likely that our nasty adaptive critter only has a limited number of ways (maybe about 8) that it can adapt to unfavourable circumstances and there is a lot of overlap, so its quite possible that there may be similar strategies for resistance even when the mode of action (of eg androgen treatments vs chemo treatments) it is resisting can be quite different.
Something about estradiol (E2) is worth noting, thanks to the discussions of Patrick and Nal. I had not previously paid any attention to E2 but during the BAT phase I took a T and an E2 test a week or so after an injection when T is peaking. Yikes! My result was 163 however it’s not quite as bad as that. The result was in different units than used in the USA. Mine was 163 pmol/L, which roughly equals 44pg/mL, still uncomfortably high. PJ and Nal argue that 12-20 pg/mL should be the aim and if it gets above 30 then seek an aromatose inhibitor to reduce the level of E2 produced in response to increased T. (this is also discussed on body building sites) In my units, that range is about 40-70 pmol/L. I did an E2 test when T was lowest (just before the next injection) and it was in a comfortable 60-70 pmol/L zone. I spoke to my onco, who snarled what do you expect for playing with hormones and no, I am not going to prescribe Arimidex. (our relationship is under review from both sides)
However there a couple of over the counter aromatose inhibitors that I am trying during the next T phase. They are obviously nowhere near as powerful as the big pharma products (which have to be used very carefully by males). They are: indole 3 carbinol (I3C), di indoly methane (DIM), bitter melon extract (BME) and Chrysin. All have been discussed on HU posts. DIM is a metabolite of I3C but I think take both. Since bio availability is an issue I also think take them all (especially Chrysin) with bioperine or a similar nutrient absorption enhancer. We shall see how things go.
So: conclusion. BAT for me is a useful but limited means to control resistance to antiandrogen therapies. There is a high variability in individual responses to BAT. We don’t really know who it will help although most people so far have benefited in some way and generally very few have ended up any the worse for a carefully conducted BAT. I would suppose that my experience is fairly average at best. Many do better and some do worse than me. But small samples.
