How long after treatment for testosterone replacement?

[VN6465]

Diagnosed August 2019 at 81 yrs with Gl 9 and PSA 6.7. Treatment: Casodex followed by HDR Brachy, 25 sessions IMRT and 18 months ADT. Treatment ended just about a year ago and PSA remains undetectable. Testosterone was 300 just prior to diagnosis but thus far it too remains undetectable. Have always worked out but now can't use weights due to osteoporosis diagnosis during treatment. No stamina, strength or energy and frequent hot flashes. Feel very fortunate for where I am at this point but would like some T replacement so I can function. Uro advises a total of 2 years post treatment before that should be considered. Would appreciate any thoughts, experience or advice?

[ARIES29]

I guess I am in similar situation but you have certainly been through the mill & I asked my MO what my T level was he said not to worry about that & not to use any T replacement.Your PSA is undetectable because your T level is also is my guess.

[Tall_Allen]

2 years sounds reasonable to me. The risk is that it may obscure a recurrence, not that it will cause one. It seems prudent to make sure you have a couple of years after ADT wears off before you tamper with the evidence.

[Hidden in reply to Tall_Allen]

How does T Therapy obscure a recurrence?

[Tall_Allen in reply to Hidden]

It encourages BPH.

[VN6465 in reply to Tall_Allen]

Thanks for the reply TA but a question. A member of my support group was diagnosed same year and month with similar numbers. We received identical treatment from the same MO. The other guy is 6 years younger and his T has rebounded to just under 200. Just for comparison, if T replacement were to bring mine up to that level now, how would that be obscuring a recurrence for me? Would his T at 200 not be obscuring a recurrence for him as well or am I missing something?

[Tall_Allen in reply to VN6465]

Sudden external T may have different effects than endogenous T. Try clomid and hCG first.

[maley2711 in reply to Tall_Allen]

healthline.com/health/mens-...

" It shouldn’t be used by men with prostate cancer, certain brain cancers, or uncontrolled thyroid disease. " ???

[London441]

You say you cannot lift weights due to osteoporosis. Where did you get that from? It’s nonsense. Lifting is the best thing for it. People are often fearful of hurting themselves lifting weights, but by avoiding it they are creating or exacerbating weakness. Not lifting with suppressed testosterone is crazy. Get a trainer if you can afford it.

Your desire to feel better is understandable, but the return of your ability to ‘function’, as you call it, will be enabled more through exercise than adding testosterone. Both cardiovascular and strength training. Gotta dig out of that ADT hole now. Waiting until you feel better not a plan at 81. Start relatively easy and be consistent. A little goes a long way.

[Grandpa4 in reply to London441]

I totally agree. Exercise is the answer if you want to feel better.

[VN6465 in reply to London441]

Thanks for the input. Weight under control and exercise 4 to 6 times a week , mostly aerobic and what some may remember as the daily dozen calisthenics routine. Dumb bells the only strength work as a rotator cuff is shot and not ready for shoulder surgery. Ortho cautions me about my osteoporosis but there seems little that can be done - waiting to see if Prolia helps at all. It’s like being between a rock and a hard place trying to dig out of that “ADT hole”, especially going on 85!

[London441 in reply to VN6465]

Hey not so fast, you’re a lot closer to 80 than 85😀.

Calisthenics are GREAT. You just have to do a lot of them. Ramp up! They absolutely cannot hurt you.

I don’t know about the daily dozen, what I can tell you is I was in the heart of my ADT treatment during the 2020 lockdown, so gyms were closed including mine. I owned no weights, so I did calisthenics daily-1000 push-ups and 1000 squats on alternate days, pullups, yoga.

Looking back, I don’t know how I did all that on Lupron. I guess it was just a healthy fear of the consequences. Onward!

[Hidden]

I waited seven years and then, my MO had to convince me with what do you have to lose? Any rise, you stop and it’s back on Lupron. DX’d with Mets in 2004; stopped Lupron in 2010; and added Androgel in 2011. Started T Injections in 2022.

GD

[Horse12888]

I'm reluctant to comment here, given all this solid medical advice, but as someone who's been desperate for T recovery, here goes. You could simulate the natural recovery of endogenous T with a gel or patch, so that it returns slowly over a period of say 6 months.

If I were 81, I might have very limited appetite for extreme caution.

A side benefit of this approach is psychological; you'll know that you are on a path toward feeling better; I really think that the sheer hopelessness was what screwed me up the most.

[kiskadog]

I'm in a somewhat similar situation with questions. I had one LU 177 treatment in Germany, followed by a year and a half of Lupron and Zytiga. I had been recently diagnosed stage 4, with several visceral mets in lymph nodes along my descending aorta. I had had RP about 7 years previous. At treatment time I also had a single bone met on a rib. Dr Baum said, you are smart to have come here early, and I think one treatment will take care of you. My PSA had quickly dropped to <0.02, and has stayed there even now, another year and a half since stopping the androgen deprivation treatment. My testosterone has gradually climbed to around 275, but I am still experiencing sleep issues due to hot flashes. While on ADT, the hot flashes were horrible with one every 30- 60 minutes every night, but now only about every 2 hours.I'm thinking, that some supplemental T, accompanied by Finasteride, or Avodart, to prevent T from converting to DHT, may help my QOL in many ways.

Any thoughts, would be appreciated.

[MateoBeach]

I have a different perspective from most of the above. You completed optimal therapy including 18 months of ADT and now considerable extra time with castrate T. Enough already. You deserve to have the considerable benefits of restored male testosterone levels. In the possible development of a recurrence somewhere, your PSA will indicate it. I doubt you could possibly ever develop BPH at age 81 and with all the radiation your prostate has received. Nonsense. Here is an illustrative thought exercise that I have heard from two different prostate cancer oncologists:

Suppose there are two twin brothers who both get prostate cancer at the same time. They both go through the exact same treatments, including HDR brachytherapy, EBRT and 18 months of adjuvant ADT. They both come off the ADT and have undetectable PSA. However one brother has testosterone recover naturally to normal range, but the other has no or very little testosterone recovery. What would be the difference if the second one received testosterone replacement that brought him into the normal range? In other words testosterone replacement in such cases should not be treated any differently than spontaneous recovery.

Life is short and the body works much better with restored testosterone. (I have advanced PC myself and use cyclic testosterone replacement which has been authorized by my MO and two consultants.)

[London441 in reply to MateoBeach]

I do not disagree he should ditch the ADT and roll the dice. I also do not disagree the body works much better with restored testosterone.

I also believe strongly that a strong body works much better regardless of T level, and that testosterone is not necessarily the panacea it’s cracked up to be. Strength can be built and maintained on ADT, despite folklore to the contrary. Easier with T no doubt.

This ultimately only to say I hate to see men wait for their testosterone to return before hitting the exercise as hard as possible. The time to do it is always now. Not only is it a better course of action, it enhances T recovery big style.

The reverse is also true; excess fat and poor conditioning inhibit it. Age is admittedly a factor, but physiological age is more important.

I returned fully, at age 66, to over 700ng/dl, in 6 months after 18 months of <10ng/dl induced ADT. I am virtually certain my strength and fitness habits were a major factor.

[j-o-h-n]

84 years old...... God Bless You.... Keep Fighting...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/05/2022 10:57 PM DST