Androgel (I use cernos) at 150 mg/day gets my testosterone up to 1598 ng/dl. Half-life is less than a day. So clears very fast compared to injectable esters (even propionate).
I had to do a mass spectrometry test to get my actual T value. My predictions based on studies and half-life was 1589 ng/dl. Good correlation between measured and predicted.
I was under the understanding that the gels weren't strong enough to produce a strong enough jump in testosterone for the Bat effect to work.
If all the research has been done using injectables with whatever their halflife is, is it wise to use something other than that.
Otherwise it becomes an n =1 study?
How do you use a mass spectrometer to measure your T value?
Wouldn't you be better off using a doc with a lot of bat therapy experience to supervise your bat treatment?
I discuss my program with my MO. I don't want to be bound by trials or what a specific BAT MO tells me to do. The mass spectrometer (MS) test is a blood test. Kinda like an ultrasensitive PSA test vs a standard test. It's more accurate than the standard test - it delineates testosterone vs. other compounds. In general practice, I think they should correlate well.
When I was only using gel I started with 175 mg/day and predicted 1880 ng/dl. The actual measurement was 1886. I've checked it numerous times but just became aware of the MS test so wanted to quadruple verify my tT before posting.
Seems he has proven that T gels can produced the high testosterone levels needed for mBAT programs. Normal replacement dose is 50mg daily so he is using 3 times that. An advantage over injectable T is the short half life, so you can get the testosterone cleared rapidly when goin on the “off” (castrate) part of the cycles. T-cyp does not clear adequately in 2 weeks as Denmeade suggested. It can take 3 weeks or more so not actually good for rapid cycling. RSH1 actually knows a lot about this and can guide along with his MO and careful monitoring.
Actually yes. The problem with injectable T-cypionate is it has an 8 day half life. So if you do monthly injections as in the original BAT trials, then you never get to castrate T levels! So it is actually not bipolar as they claimed. And underlying ADT makes no difference until the cypionate is near fully excreted. If peak T was 1000 for example, then successive weeks not lower than 500, 250, 125, 62, 31. Five weeks at least to become castrate.For that reason in my own modified BAT (3 months high T, 2 months off) I switch to androgel for the last month. Monitoring testosterone levels as well as PSA is essential.
I tried to get consults with a number of those guys but never worked out. I'm looking for a sports PED guy because I think that the low-hanging fruit for me is how anabolic and androgenic are each of the SARMs in reality. How dangerous are they, or how to cycle to mitigate dangers. YK-11 and Cardarine: are they dangerous? Cardarine in high doses is dangerous to mice. YK-11 is a myostatin inhibitor and I thought would be perfect and has a bodybuilding bro-sci endorsement. But it didn't seem to do a lot for me.
My use of gel getting tT to > 1500 could be due to my individual biology. The typical use of gel is about a third of what I am using. When I first ran this by my NMD he thought it would work as long as I dosed properly but he's only used it in lower doses. My MO doesn't have experience with it but she didn't see anything wrong with my plan.
Another possible wrinkle is that I put on half when I wake up and the other half maybe an hour later. I did that out of convenience but perhaps it is necessary? It works as is so I'm not going to try to break it...
My N-1 experience as CS and trying to have a BAT onco in addition to my current one.
Schweizer at U. Wash. Very responsive, helpful, "unlikely" could recommend BAT to CS me outside a clinical trial.
Johns-Hopkins: no response on numerous phone calls, faxes, and e-mails from Denmeade or (while he was there) Antonarakis.
Tulane: see my response below on Sartor and Barata.
Thanks.I contacted Schweizer but I sensed that I would only receive traditional advice. So I didn't followup.
I tried JH and Denmeade a number of times. Like you, nothing.
Consider also that absorption will be proportionate to body surface area applied. I maximize this when I use it.
Thanks. I divide the dose in half. Apply half, wait 30 minutes or so for it to soak in, and apply the second half.
"Nature Identical, which is equal to the Body's own T. Says it is better than Natural Gels. "
Here is the problem with that. What you say is logical.
But they really don't know how the treatment works. It might be working, in whole or part, because it is not natural testosterone. No one knows yet.
And the results are unpredictably erratic. Though apparently having the TP53 mutation is an indicator of likely success. So much they still don't know.
Cypionate is bio-identical once it gets into the body.
Be that as it may, my PSA when I started BAT was 0.17. It goes up to 0.2-0.3 on the high T cycle. Down to zero every low cycle. Something seems to be working - could be the power of my mind forcing my PSA low 
To each his own, but my mode of operation is researching, planning, implementing, and monitoring. And NEVER becoming emotionally attached to a preconceived outcome.
So while in practice there is indeed much that they don't know, I did not feel that it was prudent for me to wait until they ironed out every variable and contingency (decades?). I did it now. If it goes awry, I will be quick to bail and I am working with my MO on contingency plans.
I very much understand the desire to only do approved tested therapies. I would perhaps be more inclined to go that way if absolute lifespan was important to me (12 years is important, anything after that falls down the priority list).
That is a pretty low PSA to start BAT isn't it?
How did you make a determination that Androgen Deprivation therapy wasn't working for you?
Or are you using this as a substitute for ADT?
My PSA was 0.17.
The conventional thought would be to do ADT continuously until you need chemo or something else.
One of my priorities is athletics. Doesn't play well with ADT! Ouch!!! I did conventional ADT for 5 months and wasn't sure if I wanted to continue living.
So continuous ADT is not an option for me. My MO knows me and told me a couple of years ago that she would never ask me to do ADT. She knows that for me that is a fate worse than death. But I have learned a few things since I did the ADT and I think I could get some good Qol out of it if I ever had to go that route. I need to convey that to her.
I did 2 years of SPT. Now I'm doing BAT. It means absolutely nothing to most people but for me, it means a lot: I have gained 80 lbs since the lows of ADT and can now wrestle, hike, swim, lift weights. Half of the gain was in a few months following ADT but I'm still gaining 15+ lbs of muscle a year (4 lbs lean in the last month - hi T and stuff phase).
On a more practical note, I think that continuous ADT will eventually lead most of us to CRPC (unless we die first of something else). I don't want to go CRPC and am doing BAT with HSPC. Another out-there stab at things. I am only aware of one HSPC study of 30 guys - decent results.
"But I have learned a few things since I did the ADT and I think I could get some good Qol out of it if I ever had to go that route."
You really should visit Sartor at Tulane.
The last time I talked to him, he was interested in just using pure testosterone without the down cycle. But at some fairly elevated levels.
This is a fast-moving area, so I don't know if he still believes that will work. But I think he is very comfortable optimizing QOL with testosterone while treating prostate cancer.
I did continuous high testosterone for 2 years (SPT). It held my PSA at zero for the first year and then I had a slow rise to 0.17. My MO was convinced that it held my cancer in check after she saw my results. The way we look at it is that this was 2 "bonus" years and my PSA dropped to zero a little after a month of re-starting ADT (lead-in to BAT).
Johns Hopkins and some other hospitals and doctors are BAT proponents. More importantly, my MO likes what I am doing. Also very important is that government RCTs show good results (half a dozen or so completed and more in progress). Perhaps most importantly of all, I am comfortable taking risks to achieve what I want and, while SPT was the best, BAT isn't bad. If Sartor sides with the SOC docs that would be somewhat disappointing but not really actionable. I haven't talked to him though.
"I did continuous high testosterone for 2 years (SPT). "
Sartor expressed a belief in that concept.
It makes no sense to me unless you start with BAT and first see if you respond to that.
The real question is how you got your doc to go along with that?
Give us the story please.
Have you had both the color and Guardant genetic tests?
Do you have the tp53 mutation?
Any other mutations?
I've had two germlines - the first was the Tempus and the second one was the color test and was free as part of a research study, followed by one somatic a couple of months ago - guardant360. My MO would like me to repeat the guardant every few months.No mutations on any of them.
I did what I felt that I needed to do before I jumped off a cliff from doing ADT.
After about the 9th month, my MO was completely on-board because my labs were outstanding and I had gained more lean weight than I had before PCa diagnosis. Anemia was gone. WBC was normal again. Liver enzymes much improved. PSA <0.01, etc, etc.
Whether it makes sense, it felt to me that it was either try SPT or give up completely and wait for the inevitable.
SPT was wonderful. For two years I wore a smile on my face and got up early every day because I didn't want to miss a second. I had more energy than I ever recall. Libido was back. Muscle was back. Athletic performance was back. My memory was back. During the first year, I went from small shirts, to medium, to large, to xl. Shirt expenses were the biggest drawback.
What's SPT?
Supra physiological testosterone. Just getting T above 1500. As Nalakrats pointed out, the concern is probably the free and/or bioavailable T. tT is maybe just a marker.
If your SHBG is in the normal range then 1500 tT is probably fine.
So just started self medicating, and then your Doc got on board?
Yup. I got hold of her patient notes and I think that when I started seeing her she thought that I was loco. After a year of watching me and seeing my results, she has nothing but positive comments in her notes. I've been seeing her for over 3 years now and I would describe our relationship as truly wonderful.
Psa 0.17, ok. For me, after brachy boost therapy, zapping my only met and 10 months on ADT only, and then 6 months with no cancer medication, I have no evidence of disease, PSA under 0.1, B-alp and ldh good..
With BRCA2+, I have been following the BAT threads but am inclined to wait with BAT until there is some small sign of cancer progression e.g. PSA over 0.1. So I have something to measure against and to know that BAT is not futile maybe my alternative treatments are holding back the cancer. Or that BAT could somehow awaken the cancer from the NED stage.
Do you think my approach makes sense?
I think so. I waited until my PSA went to 0.17.
My MO is of the thought that if it ain't broke don't fix it.
I have not used BAT yet.
When the time comes I was assuming I would try it for one round, see how it works, then decide to continue or drop out.
How have you approached this issue?
How, and when, are you determining that it is working for you, or that it is not working for you?
My PSA was 0.17 going into it. I decided to do an ADT leadin to get my PSA low. It went to zero after 2 months. Then I started BAT. I set a PSADT limit based on my thinking that PSADT > 12 months is preferrable. I haven't come up to that yet but check each cycle. My PSA nadirs on each cycle have been zero. Not much I can do for PSADT from those! Good thing and unexpected.
I'm going into the 8th month and nadirs are still zero.
I don't know how to handle the high T measurements though. They are 0.2-0.3. My MO doesn't think that they mean much. I don't know and this is one of the questions I would have for a BAT MO.
By the way, there is some published statistical work (I don't remember where) that indicates when you have an adaptive replicating biological (such as prostate cancer of Covid or whatever).... the optimal and most effective strategy is to hit it hard with everything you have, kill as much as possible... then hold your fire, let it grow some more and then repeat.
The logic is that if you are constantly hitting it with treatment, it adapts to the treatment much more quickly.
Though translating that into a protocol is easier said than done. You sort of have to know its rate of growth and its rate of adaptation.
That's one of the possible benefits to BAT. Hit androgen insensitive cancer and let androgen-sensitive grow. Then hit the androgen-sensitive and let the androgen insensitive grow. I very crudely guessed at what the populations do. My MO thought it looked good. Nothing to hang my hat on - just a couple of upward trending sinusoids representing two different cell types. Be kind of neat if we could figure out the population sizes and growth rates. Then you might be able to get closer to figuring out the optimum high T and low T times for BAT.
Good chance that it isn't this simple. Could just be AR upregulation and mutation during ADT. If we know the upregulation and mutation rate we should be able to estimate the best duration for the low T phase.
"Be kind of neat if we could figure out the population sizes and growth rates."
Seems like Nalakrats has found a way to at least count them.
It seems (in my totally inexperienced useless intuition) that maybe you are hitting it up with too much frequency and perhaps promoting mutation.
My intuition is sort of useless.
But I Sartor's intuition is way so much better informed. Lol
It would be very interesting to hear his assessment.
If you ever go see him, would you be kind enough to pop me a private message. I would so much want to hear his current thinking on this subject.
Thanks
If I get into see him I will be sure to PM you and also post.
I'm currently doing 4-6 weeks for the high T phases and 4 weeks for the low T phases (PSA driven so could be shorter and could be longer).
The program used in most trials is one month total cycle (mine is 2 months or more). I think gels are the way to go. No 5ARIs except on the low T cycle. Patrick says that 5ARIs are needed but only when "DHT is no longer your friend" - grows cancer via ERs more than it controls it via ARs.
Estrogen replacement is critical for me. Might not be important for others but I start to lose my mind when both my T and my E are zero.
But duration?
Dr. Padro Barata works with Dr. Sartor and has run some of his own clinical trials. I was not able to see Dr. Sartor, but did have a couple of meetings with Dr. Barata. I was very impressed.
Here is an interview with Barata about a presentation he made at ASCO GU 2022. urotoday.com/video-lectures...
Thanks for this.He is aware of BAT and doesn't seem dismissive. practiceupdate.com/content/...
Edit: I read some more of his work and it looks like he has practiced BAT and SPT.
Completely agree. tT is rather useless. Just a cute little number.
Before PCa my tT was over 1000. I figured my muscle erosion had nothing to do with T. Believe it or not, I didn't know about bio-available and free T. Looking back at my labs, my SHBG was over 300!. So, when I had my free and bio-available T measured they were low. Once I got PCa I started studying biology. You can calculate free and bio T from tT, albumin (part of a CMP test), and SHBG. The calculations correlate well with measured values. That's neither here nor there - just a way to save money.
Sometimes I have everything measured just to make sure everything's kosher.
My last measurement of SHBG (when I also had tT and albumin measured) was 48 (it's been dropping steadily from 300 and is now 25, at first I thought it was because of estrogen therapy - not, then I thought the SPT - not, dropped on estrogen-ADT, SPT, and now on BAT.)
EGCG, sulforaphane, vitamin D3/K2, and curcumin are about the only supplements that I have used consistently since RP.
My last free was 620.1, bio-available 1460. (I overshot my tT target - too much gel and I also used a small amount of cypionate)
Plot of last 3 years of SHBG:
" have 4 different species"
That's interesting.
I assume you are talking about 4 mutational lines of prostate cancer.
How are they able to determine and measure that?
How much does it cost to do that? And who does that where?
If they can do that, you would think that would be a standard thing to do for all patients.
cancerresearchuk.org/about-... have one type: Acinar adenocarcinoma
I would go see Sartor at Tulane for a consultation.
He was involved with the original BAT trials. He is a believer in BAT.
He is a pretty clear and open thinker.
You will likely leave a visit with him with some new thoughts about your treatment.
If do you go visit him, don't forget to leave us a report here about what you learn.
Sartor looked like an excellent match. I tried to set up a consult. He responded rapidly and Tulane was going to set up an appointment. But then for some reason, crickets. Phone call after phone call, email after email, nothing.
Might be worth making another attempt.
My guess is he will be more receptive to doing a consultation as opposed to accepting a new patient.
He is an acedemic, he only practices part time.
I'll try reaching out to him again. But this time specify that I am ONLY interested in a consultation but that I am not in the need of an MO.
Thanks.
I have one type: Acinar adenocarcinoma
My MO is awesome. She didn't trust me at first. But after the results started rolling in she changed her mind.
I love it when someone is not stuck on something and is willing to entertain different ideas. I have found that it is more common in women than in men. Most of us men have some stupid machismo "gotta be right" stuff. Even if we try to hide it. I know that I have some but try to fight it because it just plain reeks.
The human body adapts and I would think cancer would adapt too (upregulate ARs, develop favorable mutations, change preferential fuel sources, etc). This is one reason why 95% of diets fail in the long run. 20 years ago I set out to drop fat and gain muscle over a summer. I cycled diets and workouts and the results were remarkable. I'm not sure why I stopped.
Maybe a tad off topic but I found that to be true too. My 'dude' doctor refused my request to prescribe metformin or refill my lorazepam (for occasional insomnia) prescription. He left the practice and was replaced by a female doctor. I made the same requests. Her response? No-problem-O. That made me realize what a prick I had been dealing with for years.
Just my experience that guys sometimes have some issues. My NMD was a bodybuilder in high school. He seems very humble, smart, and doesn't seem to be attached to his opinions.But some of the doctors were the bullied kids in school. The result is mental issues and low self-esteem with all the nastiness that goes with it. When I see a doctor that takes the "my way or the high way" attitude, I wonder about his past.
Girls don't seem to have the same issues. My work experience told me the same thing.
Interesting. Thanks
I am soon to add Lu-PSMA-J591 in Australia as a 2nd or 3rd strike for Evolutionary Extinction after SBRT for two newly visible LNs. They showed up on Pylarify scan after a year of my testosterone cycling. My PSA has not changed significantly, goes up to 0.17 on T, and back down to 0.1 off to T. So theorizing that testosterone has increased PSMA expression in my HSPC. Dr Lenzo in Perth agrees and wants me to have one month of high T leading into the Lu treatments. N=1 indeed.
Different view: SHBG exists for a purpose. Seems to me it acts as a reservoir of testosterone in reserve, to buffer short term variations in physiologic T. If so, then when starting a SPT phase, excess loading up front would be needed to reach new equilibrium. When going to a castrate phase, the reserve high bound T will take time to be cleared. That is what I found in practice. Took a longer time to reach castrate level.
It took me almost a week on Firmagon to go castrate. Norm is a couple of days.My T recovers very fast too. I did 2 years of SPT and my LH and FSH were zero. I thought my T would take months to recover (for some guys it takes over a year). In two months I was already recovering.
Maybe if your MO contacted his office and formally requested a consultation?
Good idea. I'll ask her during my next appointment.
What is SHBG?
From the NIH:
"Sex hormone-binding globulin (SHBG) transports androgens and estrogens in blood and regulates their access to target tissues. Hepatic production of SHBG fluctuates throughout the life cycle and is influenced primarily by metabolic and hormonal factors."
So, in the short-term, bound tT is relatively useless. I didn't know that it also binds estrogens. Something for me to look into... Also, why does SHBG bind it up? Is it like a suitcase for later need as Mateo speculates? The body already has multiple ways to regulate testosterone and estrogen.
T-cyp 400mg IM every two weeks for ~10weeks. Though now I will switch to a T gel for the last cycle to clear it faster. Then one month castrate, currently with Orgovix. Rinse and repeat.
You might want to measure your T on the gel. Works for me and I would think it should work for others but...
If it works you might want to do the last month with gel. Cyp takes about 9 weeks to really clear out.
I think that is exactly right. No sense wast ing money and time on Orgivix or Firmagon when T cypionate is still lingering. Will do that.
I don't know how Mateo means it but when I say rinse and repeat it's just doing it again immediately.
Would you consider doing high T during the treatments? I know that for radiation in general, this is a good strategy.
My off-T cycle, currently 4 weeks aims to be castrate. So I’m doing one month of Orgovix after the exogenous T clears out. Still refining the timing.
You mean topical not oral of course. I buy piles of it when I am in Mexico which is often. Over the counter in every corner pharmacy and not expensive.
Awesome! Next time I go to rocky point I'll load up.
Thanks for this I am finding this information very interesting from all the participants. I wonder what it says that one person feels very little effect from low T and others are wiped out by it. I checked the only SHBG result I have and it was 82 and my Total T was <1. I didn't feel that different than when my T returned to 450 approx 11 months later. The test couldn't calculate bioavailable, I assume because <1 was too low. The calculator I found shows 0.197 ng/dL = 21.9 %. My question would be do you think you would be doing this if ADT had not been so hard on you?As I am watching my PSA bounce around under <.1 now due to increased sensitivity at my lab I am seriously considering something like this if/when it hits above .1. If so I have a lot to learn. Keep it up and thanks to all participants above as questions are often as enlightening as answers.
I would be doing it if I had known about SARMs. Rad-140 seems well suited to ADT. It didn't seem to have any effect on my PSA but I maintained/gained muscle instead of wasting away. I don't know how it would work longterm though. I'd have to cycle it or perhaps use Cardarine in addition to Rad.
I am wondering if your reply to me was meant for somebody else? That said, have you always been a weight lifter? I could see where the loss of muscle mass would mess with your head if you were. It goes so fast when not kept up. I did not have issue with the mass I lost because I kept it where I wanted it most in my legs. As a cyclist I had early gains on speed and endurance which I have held until today and haven't seen a huge bump since my return of T. That said its early in the year and true gains would be determined at the end of the year. I feel pretty good about that all things considered.
Oh, I misread your question.
I think you were asking: would you still be doing BAT if ADT wasn't so hard on you?
I would because I think that ADT is going to lead to failure. BAT might also but then I think I could do ADT (or an advanced anti-androgen or radiation). Then again, if I followed ADT to failure I might have the options of anti-androgens, BAT or radiation. I don't have data to go by but I think that perhaps following BAT BEFORE ADT could mean that I will never be castrate resistant.
I've lifted weights for about 45 years other than a 2 year break for school.
I did notice that on the ADT I kept most of my leg strength. Upper body strength went down to the levels I had at 13 or 14.
Thanks again I am watching you and Mateo closely as well as listening to the others that have ventured out on their own. I am not saying I won't end up following the SOC route with recurrence but if I have enough time (I hope to retire this year) the decision will be a well informed one when I finally make it.
Right. Sorry. My Medicare D copay for 30 days Orgovix is $850. Ouch. But only need it every 3rd month on current schedule so average is more tolerable. A shot of Firmagon every 3rd month would be fully covered but don’t want to do the full 240 mg loading. Tried a shot of 80 but was not castrate a week later. Now I think it may have been the incorrect assumption remaining T-cyp is would wash out in about two weeks as reported in BAT. Seems that is not at all correct, may take considerably longer. That is why I am planning to switch to topical T for the last few weeks before ADT portion. Feel like I am fumbling around in the dark about this. 🤪
Russ, Paul, and Nal, thank you for sharing your thinking and N=1 studies. This is a post worth saving for sure. You are clearly on to something positive, and your intuition is probably right on. Best of luck to you Gentlemen!Mike
Bipolar Androgen Therapy (BAT) and CRPC
Bipolar Androgen therapy starting in January
Bipolar Androgen Therapy results?
Bipolar Androgen Therapy
Bipolar Androgen Therapy
