Advanced Prostate Cancer

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ADT and mental issues

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I have done a dozen ADT sessions (4 weeks to 5 months). Each time I used a low or high-dose estrogen patch.

I did one in January/March and did not use an estrogen patch. So my testosterone was close to zero as well as my estrogen.

I have never had mental issues when I did ADT. This time I did. Depression, anger, extreme irritability, and even some paranoia. I ended up destroying a close relationship of 7 years. Today I stopped the ADT and went into a high testosterone phase. All of the mental issues seemed to clear almost immediately. Dr. Jekyll and Mr. Hyde is what I call it.

Anyway, the reason that I am writing this post is that if you are embarking on ADT it might be helpful for you to warn people in your life about the possible mental side effects (they vary from person to person and some guys don't have them). The other possibility is to ask your MO about giving you a low-dose estrogen patch in case the ADT mental and bone effects aren't tolerable. 0.05 mg/day seems more than sufficient.

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64 Replies

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Scout4answers1 year ago

Sorry to hear you are having difficulty this time, be well

in reply to Scout4answers1 year ago

Thanks my friend. Live and learn. I think I need to use estrogen patches every time I do an ADT session.

Scout4answers in reply to 1 year ago

that is good info to know

Spyder541 year ago

You are a good man Russ. You made a mistake with a long term friend. Explain the chemical imbalance and ask for their forgiveness. Hopefully they care enough to put it behind them. Thanks for the guidance on low dose estrogen. I am 15 months on ADT+ and hv never been offered Low dose Estrogen. Don’t understand the “Why’s” well enough to intelligently request it outside my MO’s SOC itinerary. Mike

in reply to Spyder541 year ago

Thanks, Mike. I think I messed up enough that they aren't going to forgive me. But the good thing is that I know what helps me so going forward, when I do ADT I'll always use a low dose estrogen patch!Russ

nonm in reply to Spyder541 year ago

Same here...Don't understand the "Why"s enough to request the Doc

in reply to nonm1 year ago

These might help:2. The Importance of Estrogen (Estradiol) in Men’s Health tctmed.com/estrogen-in-men/

3. Estradiol for the mitigation of adverse effects of androgen deprivation therapy in: Endocrine-Related Cancer Volume 24 Issue 8 (2017) erc.bioscientifica.com/view...

I think that the best thing is to ask your MO if will interfere with your ADT. If not, try it. You can always quit if it doesn't seem to do anything. I've found 0.05 mg/day is sufficient for me to feel good.

nonm in reply to 1 year ago

Thanks, RSH1. This is encouraging!

1 year ago

My wife knew I was a charismatic sociopath when she meet me 50 years ago. Things have never changed.

in reply to 1 year ago

Lol!

ARIES291 year ago

No chance of that happening in this Great down under backwater. PCA is not a good enough reason for the patch.

TylexGP1 year ago

I totally get it, I did great the first 6-months and then everything kind of went to hell. Thanks to an understanding wife and a Psychiatrist that specializes in PCA patients. I am much better still have some rough days but overall much better. I don't currently take an Antidepressant but still in my aresenal if I need it.

CAMPSOUPS in reply to TylexGP1 year ago

A Psychiatrist that specializes in PCa patients. Only in my dreams. I would like that before I just plain request an Antidepressant but wont happen in my world.

in reply to TylexGP1 year ago

Glad you're handling it okay. Dang, everything was fine and then boom! Suddenly out of control mind.

Anyway, I hope this helps someone. If we beat cancer but destroy our friendships, what's the point?

Shooter1 in reply to TylexGP1 year ago

Where did you find such a psychiatrist?? Never heard of one.

TylexGP in reply to Shooter11 year ago

MSKCC (Memorial Sloan Kettering Cancer Center) Dr. Andrew Roth. I believe he also does a lot of work with bereavement for family members with loved ones with cancer. For me he has been very helpful but what helps one person may not help another but wanted share my experience. I believe he has written a book called Managing Prostate Cancer (Just sharing not an endorsement of the book. As always your mileage may vary.

Shooter1 in reply to TylexGP1 year ago

As always, we are all different!!!

Nous1 year ago

thanks for sharing this RSH1

treedown1 year ago

I read that the symptoms you experienced might be associated with the return of T. Sounds like it hit you for the opposite. I did not end up having any of them recently but will be curious if they hit should I return to ADT. Thanks for the input. Glad you have figured it out for your future benefit.

in reply to treedown1 year ago

The sudden return of T cleared my head in 8 hours (I used a large dose of Androgel to get my T over 1500). The power of hormones on our bodies is just amazing.

treedown in reply to 1 year ago

I agree about the power of hormones and just throwing it out there. Have you considered its a cumulative effect of the extra hormone use/change that lead to the your mental issues?

in reply to treedown1 year ago

Geez, I hope it isn't. I hope it's just the lack of estrogen. If it was it's an easy fix. I do sometimes wonder what the constant hormonal swings are doing to my body.

E2-Guy1 year ago

The only ADT I have ever used is estradiol gel...going on four years next month. The ONLY side effect is little boobies! Last PSA was 0.012. I consider it a 'wonder hormone'!

in reply to E2-Guy1 year ago

My first 5-month session was with estrogen patches. Little boobies, no libido, and muscle loss. This is the first time I've done ADT without estrogen and I did not expect this (duh...).

E2-Guy in reply to 1 year ago

I haven't noticed too much of a change in my libido or muscles since I started using the E2 gel...lost most of my libido along with my prostate 17 years ago! Obviously my age has slowed me down considerably.

dhccpa in reply to E2-Guy1 year ago

Someone here mentioned something you could take for those boobs. Was it Tamoxifen? Something like that.

in reply to dhccpa1 year ago

Supposedly a SERM (e.g. Tamoxifen) might help. I was growing boobs and started Tam. But my MO convinced me to stop - I was about to give up on ADT anyway so stopped the Tam.

Her reason was cardiac risks. I didn't look into it - not actionable for me.

E2-Guy in reply to dhccpa1 year ago

Yes, it was Tamoxifen. There seems to be a question as to whether a drug that counteracts something that another drug generates, can reduce the efficacy of the primary drug? Frankly, at my ripe old age of almost 79, it's not a big deal! I see many old men who could easily compete against me in a boob contest, and they are barely visible when I'm wearing a shirt. I am reluctant to modify my tE2 regimen since I'm having great success with it after 47 months. They stopped growing after about a year, and if they really bothered me, I would probably consider surgery to reduce them. IMO, this minor side effect is a small price to pay to keep the cancer at bay!

Thank you for your input,

Ron

EdinBmore1 year ago

Sorry you're going through this. Some guys are really lucky and seem to have few if any side effects. Others, like you (and me) are devastated by this shit. It took a long time for ADT to leave my system and not sure I'll agree to taking it ever again. Anyhoo, I feel your pain and hope you're feeling better soon.

EdinBaltimore

RonnyBaby1 year ago

Thanks for the feedback - I'm in full agreement with you ......

SteveTheJ1 year ago

I'm a little skeptical. You're saying you were sweet as pie before this started? As a depressed, irritable person who sometimes pisses off my friends and family, I can say that ADT has only improved my outlook generally and not made me more of an a-hole than I was before.

If you're truly claiming these things are byproducts of ADT, then there's good news. Many medications available to help you and you don't necessarily need to see a shrink to get them. Continue your ADT, whatever works the best, and deal with the side effects.

Reducing testosterone is definitely a mixed bag. If I wasn't stage 4, I wouldn't have done it but I know that I am less irritable with other people (I get pissed off at myself all the time) but still get just as depressed.

Best of luck.

in reply to SteveTheJ1 year ago

Thanks.

I wasn't sweet as pie. I was a normal person. For the first week with no E or T I think I was rather normal. Then, wow, I really went deep into depression, incredibly irritable. Everything! would piss me off: drivers who inconvenienced me, a light in the house left on, my son making a mistake on a homework problem, finding a rotten apple. One poor guy was trying to get a parking spot so I had to wait 5 seconds. I jumped out of my car and started running towards him. He jumped into his car and took off. Trust me when I say I am NOT LIKE THAT.

I don't think it was a coincidence that I took T and started feeling sane within hours. 8 hours later I was in tears thinking about my behavior. I wish I could find that guy and apologize.

SteveTheJ in reply to 1 year ago

I lost track of your acronyms: E? T? No need to respond, I just wish everyone here would spell things out.

Weird that with reduced testosterone you got MORE aggressive, is that it? Everyone is different.

Be irritable, it's fine; be depressed too but don't take it out on other people. The golden rule. I'm glad you found T, whatever it is, to help with that. I'm trying to counsel a friend with mesothelioma who now has PTSD, says it's all he can think about. There are good treatments for that too.

If you've found your treatment, very glad and happy for you. Everyone else should take heart from your story.

in reply to SteveTheJ1 year ago

Thanks G,

E, T = Estrogen and Testosterone.

With zero Test and zero Est I became extremely irritable. Hence waiting 5 seconds made me furious.

I've done 9 cycles of ADT. I used estrogen for 8 of them. This is the first (and last) time that I did not replace estrogen.

Oldie68 in reply to 1 year ago

What od you mean by "9 cycles"? How long does each cycle last? What med for ADT were you given?

in reply to Oldie681 year ago

I'm doing bipolar androgen therapy (BAT). PSA driven to end cycles.

So far my cycles have lasted about 3-10 weeks. First week or so is a high testosterone phase and the remaining portion is a low testosterone (ADT like) phase. The ADT phase is the PSA driven one.

It's working well to control my cancer. My PSA goes to 0.2 during the high testosterone phase and then to zero on the low testosterone phase.

The first thing I did following surgery in 2018 was 5 months of continuous ADT. I used high doses of estrogen patches to get my testosterone to zero. My PSA bounced once or twice but most of the time it was zero.

ADT meds: I started with estrogen patches, went to Firmagon, and now Lupron. For me the Firmagon shots were not fun. Lupron no problem.

Oldie68 in reply to 1 year ago

Thanks. Good to know you ar doing better on Lupron.

Boywonder56 in reply to SteveTheJ1 year ago

Your a dr...acrynoms are part of your language.....or ar you just a hunter thompson fan.....🥴

SteveTheJ in reply to Boywonder561 year ago

I am NOT a medical doctor. I am a technical writer by profession and I spell out every damn thing I possibly can.

Boywonder56 in reply to SteveTheJ1 year ago

There in lies the answer......im a carpenter.....i glue evrything i nail together......but imho it makes me lmao off at those who try to force their prefferences on others who try to kiss......just funnin....apc is a not a lot of fun.....bw

CAMPSOUPS in reply to SteveTheJ1 year ago

Fear and Loathing in Las Vegas: A Savage Journey to the Heart of the American Dream is a 1971 novel by Hunter S. Thompson and illustrated by Ralph Steadman. The book is a roman à clef, rooted in autobiographical incidents. The story follows its protagonist, Raoul Duke, and his attorney, Dr. Gonzo, as they descend on Las Vegas to chase the American Dream through a drug-induced haze, all the while ruminating on the failure of the 1960s countercultural movement. The work is Thompson's most famous book, and is noted for its lurid descriptions of illegal drug use and its early retrospective on the culture of the 1960s. Thompson's highly subjective blend of fact and fiction, which it popularized, has become known as gonzo journalism. The novel first appeared as a two-part series in Rolling Stone magazine in 1971, and was published as a book in 1972. It was later adapted into a film of the same title in 1998 by Terry Gilliam, starring Johnny Depp and Benicio del Toro who portrayed Raoul Duke and Dr. Gonzo, respectively.

Boywonder56 in reply to CAMPSOUPS1 year ago

And i quote from book..." there is nothing like a man in the throughs of a ether binge ...".... great book...

CAMPSOUPS in reply to Boywonder561 year ago

Yes!

in reply to Boywonder561 year ago

Or the throws of estrogen and testosterone deprivation.

Boywonder56 in reply to 1 year ago

Heard that......i used to be called a tyrant on my job sites....now i would just sluff of shitty work....my biggest thing has been deppression and anxiety...before adt ...never went to dark places....now.....i cry at the mention of sadness.....ive heard others express the same....the treatment for me has been by far the worste thing ive gone through and ive been down the road.....

in reply to Boywonder561 year ago

Ask your MO if a low-dose estrogen patch would interfere with your ADT. If not, I'd at least give it a shot. Who knows, might make a world of difference, might not but then you could junk it.

Boywonder56 in reply to 1 year ago

My problemo is im in the titan trial ...for erleada and have been...i have to run evrything by them and mo running trial has said nooooo....my thought is they dont want anything that skews results...but its in open label faze now so i might try again....the meds are 16k amonth and have kept me undectectble 4 yrs....so i will plod on ...but i can tell you this double barrel aproach may keep the cancer/ mets at bay ...for now but qol...sur takes a nose dive ..

in reply to Boywonder561 year ago

I understand. Yes, they don't want to skew the results. But you are you. If it was me I'd do what I had to do.

Good luck!

1 year ago

"Previous studies have reported cognitive and affective symptoms following ADT, particularly in the elderly. Symptoms include emotional upset (tearfulness, irritability, and anger), decreased motivation, hopelessness, and cognitive interruptions in attention, memory, and visual processing. Some studies have linked ADT use to depression, although it is not clear whether such effects are a direct consequence of ADT itself or perhaps associated with age, comorbidities, hot flashes, fatigue, and insomnia"

sciencedaily.com/releases/2...

Low estrogen causes similar mental issues.

CAMPSOUPS in reply to 1 year ago

I've seen that before and unfortunately I check all the boxes except the hopelessness box. Although it wouldn't surprise me if I had that as well but it just manifests in a way I am not aware of. I'm pretty sure I had ADD as a kid. Probably continued in adulthood and definitely have it now.

Anyway the irritability, anger, etc. this is way out in left field because you are looking at hormone swings with bat but ADT alone is enough for me to not handle change or more than one thing at a time on my plate. I go from panic to lashing out if outside forces push me beyond what are now very minimal limits mentally and physically.

Did you have in the background extra "stuff" stress related?

in reply to CAMPSOUPS1 year ago

Nothing much at all stress-related. Well, now that I think about it I bought eggs from Costco last week and one was cracked.

I don't think it was hormonal swings. I've been through a lot of them and for the most part stay even keel. I really think it was going zero testosterone without any estrogen replacement. This is the first time I've done that and the mind games were insane.

The only other time I've had mental problems even close to this is from an oral steroid (Dianabol). I have never had an oral or injectable steroid affect me like Dianabol does. Dianabol gave me irritability and anger. No paranoia or depression.

Horse128881 year ago

I too was a mental and emotional wreck. Same SEs as yours, though maybe more depressed than angry, though there were plenty of both. I felt like I was being tortured.

E replacement is a great idea. Outside of the US, MOs prescribe high-dose transdermal estradiol as a castrating agent. Works great, minimal SEs outside of gynecomastia.

MateoBeach1 year ago

I have concluded the same: The body-mind just works much better with some sex hormones present. If not T then E. For those whose narrow minded MOs will not consider this, perhaps consult a more enlightened Naturopath or Family Physician to provide whole-person support around “the raggedy edges of SOC”.

mrscruffy1 year ago

I screamed and carried on with my wife and two female friends, told them to get out of my life and some pretty bad stuff. They new my situation and new that wasn't me. I was ready to kill them and myself. Those fools jumped in bed with me and refused to get out. Their love is unending and has no boundaries. Thank God for Psychiatrists and Cymbalta.

in reply to mrscruffy1 year ago

I wasn't quite that bad but very close. I take Nardil for the PCa and maybe that helped take an edge off (Nardil is an MAO inhibitor used for depression)

mrscruffy in reply to 1 year ago

Ya my Cymbalta is a game changer

j-o-h-n1 year ago

to RSH1,

'I ended up destroying a close relationship of 7 years'

Give us that person's mailing address (home or email) and all of us can write a commendation/recommendation letter about you.

BTW "He jumped into his car and took off."

That was me, you SOB......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 3/15/2022 3:32 PM DST - Beware the Ides of March

in reply to j-o-h-n1 year ago

If you are serious I'll take you up on that! I feel like crap. Feeling like crap doesn't change that I acted like crap.

j-o-h-n in reply to 1 year ago

Sure I will write the letter.....Missing your exit on the highway and you know that all the miles going the wrong way will have to be traveled going back to that exit and "your friend in the passenger seat says "holy shit you missed the exit"...... Now that's feeling like crap....and the best time not to have a loaded revolver in your pocket.

They say "same crap, different flies"....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 3/15/2022 3:47 PM DST - Beware the Ides of March

in reply to j-o-h-n1 year ago

Helped. Thanks!

j-o-h-n in reply to 1 year ago

Good to hear....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 3/16/2022 1:56 PM DST

diamondrn1 year ago

I have snapped at my wife for no good reason a couple of times. So far, thank God, she still forgives me.

Gudgelm1 year ago

I hear you. I did two years and had my moments but no substantive change. I went off for two years and started again eight months ago…a real difference in round two. I suffered from crippling depression and cognitive issues. I flooded the house. Forgot I was running dishwater and later left the gas stove on! I’m in Seattle and Fred Hutchinson cancer center has a palliative care psychiatric team. I’m on meds for depression. The interesting thing is since I’ve been off Lupron my memory and cognitive issues are not as serious but my testosterone hasn’t returned yet. My conclusion is the medication causes some of the issues not just the lack of testosterone.

in reply to Gudgelm1 year ago

You might ask your MO about a low dose of testosterone replacement to get you into a low-normal testosterone zone.

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