Does Hormone Therapy for mPC Affect Immunity?

[NecessarilySo]

I would like to know if hormone therapy increases or decreases or has no effect on immunity. I have my wife's fears that since I have cancer I am among the most vulnerable4 to Covid 19. My doctor, however, advised me the opposite, that it does not, that hormone therapy, unlike chemotherapy does not affect immunity.

Researching and thinking on my own, I have to think that a reduction in testosterone would probably NOT affect immunity. In fact, my white blood cell count has always remained in the normal range, under hormone therapy and during a four-year vacation, in which my PSA level rose and fell from <0.1 to 35, and back to <0.1. During the same period my WBC ranged from low of 4 to high of 7, all normal, except one strange test of 13, in 2015, (above normal) and several 7 lately( above normal). In general, I understand that white blood cells increase to fight invader cells, including many things such as cancer cells or bacteria or virus or pestides or other chemicals. But there are many types of white blood cells, each with different purposes. It's a complex matter, not easily understood.

Lately after my return to hormone therapy, Lupron injection every three months, with Xtandi nightly, I have watched my blood panel carefully, and all the white blood cells seem to remain in normal ranges, with one exception on the last test: my eosinophil percent rating went to 6%, highest ever, while eosinophil absolute vascilated but within normal range, with a slight upward bias. Trying to understand whether this is good or bad, I researched the net a bit and it seems a high eosinophil level can indicate a hereditary disorder, hiv (virus), or possibly a chemical reaction to medication, (Xtandi?), cancer, or a reaction to parasitic invasion of some sort. My unprofessional guess is that it is basically meaningless. However, it is the only thing on my blood panel that is drifting out of normal range, so I am currently attentive to it.

I have seen that older people with cancer are more vulnerable to Covid 19, and especially with other complications such as high blood pressure. I am nearly 75 with both. But I sense that I am quite immune, generally. I have been free from flu for a couple of years, in spite of not taking vaccine. Last vaccine seemed to cause a brief spat with flu a few years ago. I have had a chronic cough years ago, but I had a shot for chronic bronchitis which seems to have been effective against that.

I would like to see if anyone has comments on this.

[LearnAll]

Older age (above65) and high blood pressure and Diabetes are risk factors for severe Covid 19. And so is Low Vitamin D level.ADT like lupron or bicalutamide reduce the risk of severe Covid 19 ..according to research articles published in last few months ncbi.nlm.nih.gov/pmc/articl...

[NecessarilySo in reply to LearnAll]

Wonderful. Heading for my vitamin D gummies, which I have slacked off lately.😀

[LearnAll in reply to NecessarilySo]

Taking Vit D3 +K2 is probably the single most important thing you can do to protect yourself from Severe Covid19. Please keep yout Vit D level above 50.

[MateoBeach in reply to LearnAll]

What do you think of this (very educated) perspective on Vitamin D (1) vs D3?youtube.com/watch?v=QrU1yrm...(Not working as expected?)

Surprising for me.

[LearnAll in reply to MateoBeach]

Excellent Video. With PCa,,we need atleat 5000 IU of Vit D3+K2. every day preferably in oil based liquid formulation.

Sunlight is the greatest and the best source.. if we can afford to lie in bright sunlight without clothes with a thin layer of butter or coconut oil....for one hour each day.

No shower to be taken for at least 2 hours after SunBath.

,A combination of SunBath and liquid Vit D3+K2 has brought up my D level from 30 to 72 in 6 months.

[NecessarilySo]

Thanks, Nalakrats. My Hematologist/Oncologist also suggested recently increasing Vitamin D3 from 1000 IU daily to 2000. I slacked off only because the D3 gummies caused fillings to come out. But she has been good!

[noahware]

Most indication are, hormonal therapy may actually improve COVID outcomes for some men. But on the other hand, ADT can help lead to forms of metabolic syndrome and even diabetes, for some, which would obviously be a negative as relates to COVID.

[Tall_Allen]

Here you go:prostatecancer.news/2020/04...

[noahware in reply to Tall_Allen]

Do you have any links relating to how higher-than-normal levels of estrogen in men might reverse the immunoprotective effect of normal levels? When I was reading about the clinical trial for bicalutamide and COVID, there was an indication they thought that the associated elevation of E2 should prove beneficial. ("Bicalutamide elevates estradiol levels, which we think may be important for an improved immune response.")

[Tall_Allen in reply to noahware]

In women, a normal level of estrogen is immunoprotective; too much (as in pregnant women) has the opposite effect.

[noahware in reply to Tall_Allen]

Yes, but you also said "high levels, as in... men on Bipolar Androgen Therapy (because testosterone is metabolized to estradiol), reverses the protection." Just wondering about that, if we are merely extrapolating to men from pregnant women in theory, or if there are actual data for men regarding a potential reversal.

From what I understand, pregnant women could have other things aside from just increased estrogen that might play a role.

For that matter, have we seen anything yet on COVID in men undergoing TRT that tells us they are doing worse, or possible better, than other men?

[Tall_Allen in reply to noahware]

Part of the role of estrogen in pregnancy is to dampen the mother's immune system so that it doesn't attack the fetus. This is a well-known effect. Why would someone with covid-19 use TRT?

[noahware in reply to Tall_Allen]

Why would you ask me why someone with COVID would use TRT? I never suggested such a thing. What I asked was, are there any numbers in yet as pertains to COVID in men on TRT.

Clearly, many men are on TRT and have been for years, and some will/have get COVID. They are of course not on TRT because of COVID... it is merely that when they get COVID, they are already on TRT.

This is no different than observing what happens with men who are already on ADT. It needn't have anything to do with confirming or refuting an existing hypothesis, but certainly would generate one if it was observed that men on TRT were shown to do either much better or much worse than those not on TRT.

And while it may be a well-known effect that estrogen in pregnancy dampens the mother's immune system, it is also well known that men are not women and do not get pregnant.

I can only gather from what I've read that there is nothing to indicate a higher-than-normal estrogen level IN MEN reverses the immunoprotective effect of normal levels except for the observation that it can do so in pregnant women.

But per my comment, it would seem researchers doing the Casodex COVID trial do not agree, so I am simply trying to reconcile the two positions with any additional input or observations that might already exist FOR MEN who have higher E2.

[Tall_Allen in reply to noahware]

When men take estrogen for PCa, they reach serum estrogen levels similar to pregnant women, which is immunosuppressive.

[noahware in reply to Tall_Allen]

Okay, but you are giving what amounts to a definitional or theoretical answer: the serum estrogen levels of pregnant women are observed as immunosuppressive, and so are defined that way for men. What I am asking for is the possible existence of any studies, papers, observations or other data of an experienced immunosuppressive effect in men with high estrogen levels.

Surely if high E2 levels have an immunosuppressive effect in men then someone, somewhere, has observed and recorded some manifestations of this effect. It cannot seem possible that the effect exists for both men and women but is observed only in women.

Richard W, as I recall, suggested trying to reach E2 levels of pre-menopausal women, not pregenant women. So perhaps there is a distinction to be made between "high" and "very high" (= too high)?

And again, I am simply trying to reconcile "high serum estrogen is immunosuppressive" with "bicalutamide elevates estradiol levels for an improved immune response." The two don't add up without some sort of qualification, somewhere, wouldn't you agree?

[Boywonder56 in reply to noahware]

Take a breath noah....if you noah why are you asking......b.w.

[NecessarilySo]

First of all, Vitamin D needs to be taken with oil like A, E, and K. I was taking the tiny white pills for a long time and in spite of daily intake of 1`000 IU my blood levels were just barely above 30. It happened that in the Covid 19 early days I could not find anything but the gummies, everything essential was sold out. Same on Amazon. The gummies do actually contain some oil, (beeswax). However, even so, my blood D still, after months of the gummies, 2000 IU per day, my blood level remained, at last check, just above 30. So one question remains whether supplements actually do anything at all. Your body creates D3, and sunlight helps, although I reach very little sunlight in winter. How many supplements does it take? I believe D3 does not do harm in large quantities but I also believe too little is not good. I see on Amazon they sell many different sizes including 2000 IU softgels. I just have to decide what to do. Regardless of that, my question was about hormone therapy and this is getting a bit off of the subject. However, I do now have osteoporosis as a consequence of the ADT, apparently. So more D3 is good.

[noahware in reply to NecessarilySo]

As well as vitamin K, it is recommended by many that magnesium might also be added when dosing D3. Also consider that individuals will vary in the dose required to significantly raise levels. (If deficient to start with, a high initial loading dose may help.)

Many of the more prominent D3 researchers seem to think common dose of 400, 1000 or even 2000 IU per day may not be enough for many people (especially if obese or in a diseased state). They suggest 4000-5000 as perfectly safe, and more in line with a dose needed for real benefit, and some have no problem with 10,000.

It would be interesting to see what your doc said about 4000. That is the "official" upper limit, for those not willing to stray too far.

(BTW, in more northerly latitudes the winter sun is too low in the sky to help with D synthesis at all, no matter how much sun one gets!)

[treedown]

I would like to have your #s. Lupron, zytiga/pred or radiation, or a combo of,, dropped my lymphocyte count very low. It has come up but not to normal range yet going on 10 months. My absolute # and percentages bounce around on every test. So despite what I have read about the Italian studies and references to AFT and D3 being immunoprotective I have operated as if my immune system is compromised. This has lead to a few more changes than my normal precautions for flu season and extended them.

[NecessarilySo in reply to treedown]

Yes my abs. lymphocytes have also been low, bouncing from 21% to 23% to 18% and then up to 20% which is below normal range , for past six months. But it was even lower prior to the ADT, like 17%. Normal range is listed as 26 to 46%, and 20-40% in other places. e.g..

doctorshealthpress.com/gene...

So in general I have gone up to borderline normal and my HO has not made it an issue. Online literature says lymphoma can cause low lymphocytes. During my "vacation" from ADT which was four years, my PSA rose but my lymphocytes were flatline at 17% I now take Lupron and Xtandi, recently Eligard and Xtandii. So I have to say the treatment has improved my lymphocytes some 20% or so (from 17 to 23%).. My lymphoma seems to have reduced from barely noticeable to practically unnoticeable. As for Covid 19, I suppose my immunity is such that I am more immune with ADT but that would be "to some unknown extent". I don't know if I have been exposed or not. My guess is that by going to supermarkets and stores I do come into "some" viruses. So far I do not have Covid 19 symptoms.

[MateoBeach]

It is a very interesting question about ADT and overall immune status that I wonder about.

But first, since the conversation got turned importantly to Vitamin D, I suggest all consider this lecture on Vitamin D and prostate cancer. It convinces me that "regular" Vitamin D may be the way to go, and not 1,25(OH) Vitamin D (D3), as non hydroxylated freely enters the cells without needing a carrier. It is very interesting.

youtube.com/watch?v=QrU1yrm...(Not working as expected?)

As long as your WBC levels are adequate I would not worry about over-interpreting the variations. Especially since your overall immunity is obviously intact. But from a developmental viewpoint (speculating here), when we naturally have low testosterone signaling in childhood pre-adolescence, our immune systems are very strong. More resources are available for immunity and growth, the protection of the individual's survival and development. Then when reproductive potential is unleashed by testosterone immunity takes more of a back seat to reproduction and the competition that entails. So perhaps while on ADT we may benefit from a more conservative status of maintenance using some of the same epigenetic recalibrations. (Which I could not begin to detail!)

[CalBear74]

Apparently ADT affects the immune system. We can infer this from an Italian medical study published earlier this year reporting a finding based on 2500 person sample who were on ADT and only 4 of them contracted the coronavirus. Of those 4 all had very mild cases. Of course, we are all aware of how coronavirus 19 rampaged through central and northern Italy where the study was conducted. You will find this study reported widely in American medical press. Tall Allen’s posting is on target but fails to cite this study.

[immunity1]

You are right it is a complex issue, especially re immunity. As per Italian study men on ADT may have some advantage re resistance to acquiring SARS Cov2 virus - for unknown reasons. Similarly domestic animal species artifically castrated male animals are more resistant to certain parasitic infections compared to entire individuals. With the exception of substantial changes in different leucocyte (WBC) populations I would not overinterpret the absolute levels of them ; their function is as important as their presence. The immunological effects of estrogen per se in pregnant woman are unknown and confounded by the the presence of other hormones such as progestone which change. Perhaps the bigger question is what is the role of immunity with prostate cancer. Historically we have thought a solid immune response is beneficial but there are recent approaches that deliberately dampen down the inflammation associated with some immunologcal pathways, in order to prevent further metastasis etc. Hmm.

[Kevinski65]

Are u on medicare? If so how do u get Xtandi covered?

[NecessarilySo in reply to Kevinski65]

I guess it was through United Healthcare insurance. I stopped taking Xtandi due to high Q/T in EKG. (I had that for years due to a stent placement apparently.) My PSA has remained at <0.1 since stopping Xtandi over six months ago. It was expensive, $5,000 per month as I recall, but insurance covered it...or a small part of it. I dunno how that works. I paid very little, I think $20 per month. My plan is to restart Xtandi if my PSA goes up.

Also my hypertension was getting worrisome and that was part of the decision by MO to stop Xtandi. Although I thought the Xtandi was doing great job of lowering PSA with Lupron shots, lately my PSA has flatlined at <0.1.

I still have not gotten Covid symptoms. I have had the vaccines and booster. I feel fine but worry about hypertension more than PC. I mean here I am ten years into stage 4 advanced prostate cancer and my PSA is down to almost nothing, but my blood pressure is higher than ever.