My ADT treatments (Lupron/Abiraterone/Prednisone) ended on May 02 2023 at which point both my PSA and Testosterone were flat lined.
Here are the results of the four times I have been tested since the end of the ADT.
* Aug 18 2023: PSA is 0.09, Testosterone is 3.3 nmol/l (95.2 ng/dL), Testosterone FREE is 52 pmol/l, Testosterone BIO is 1.26 nmol/l
* Oct 6 2023: PSA is 0.14, Testosterone is 11.3 nmol/l (326.0 ng/dL), Testosterone FREE is 138 pmol/l, Testosterone BIO is 3.49 nmol/l
* Dec 5 2023: PSA is 0.22, Testosterone is 10 nmol/l (288.5 ng/dL), Testosterone FREE is 129 pmol/l, Testosterone BIO is 3.34 nmol/l
* Feb 6 2023: PSA is 0.39, Testosterone is 9.6 nmol/l (277.0 ng/dL), Testosterone FREE is 141 pmol/l, Testosterone BIO is 3.65 nmol/l
The PSA began to come back along with the Testosterone which was expected since I still have a prostate even if it was heavily radiated. So we are monitoring the PSA and if it goes as high as somewhere between 1.0 and 1.5, then we'll do some scans to see if there are spots to irradiate outside of the pelvic area.
What puzzles me most is the Testosterone levels. The recovery seems to have peaked in October but then its gone down on each of the subsequent blood tests. The doc says that maybe its because it is warmer in Summer/Fall than now. For my part, it initially felt like I was slowly and progressively getting more energy after the ADT stopped but I don't feel that my energy levels are as high now as they were in late summer. Think it is seasonal or are my testies not recovering any longer?
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Mascouche
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Complete shot in the dark but maybe in warmer months you’re more active which maybe increases T level. I know weightlifting is supposed to increase T levels. Maybe other activities do as well? Again complete conjecture on my part.
My routine (sleep, food, supplements, training) is the same all year long. I do the same things and even wake up/go to bed at the same time whether it is the week, weekend or whether I work or am on vacation.
Regardless of the season, I do calisthenics at home every day and I do weight training at the gym every 3 days or so ( I do not recuperate enough if I go every 2 days).
Being in Quebec, it is very cold in the winter so I do not spend as much time outdoors as I do during the summer. I know that spending time outdoors can impact Vitamin D3 due to sun exposure but I have not heard whether the sun could also impact testosterone or not.
I understand that in the morning Testosterone is highest but my understanding is that when it comes to doing tests, the important thing is to keep things the same to eliminate confounding factors. Always same lab, always same time.
If all my tests has been done at 8h00am rather than 12h00pm, each time the absolute level of the 8h00am results would likely have been somewhat higher than the results of the 12h00pm, but relatively they should also have shown the same type of decline month after month.
Unless I am mistaken on the logic in the previous paragraph, and I am open that I could be, then I do not see how testing at 8h00am would not also show a decline in testosterone month after month. What am I not understanding?
I would add that T will fluctuate day to day and possibly seasonal but I've never read anything on seasonal variations. I was always instructed by my urologist to have T test performed early in the morning for best readings. How far a decline from 8 am to noon could have variations that make it hard to compare noon time tests. Maybe the 320 is the outlier and the other readings are the new normal. Time will tell.
Are/were you on monthly or quarterly Lupron injections? Has your MO considered Xtandi? Although rising, PSA looks good, while on Lupron Testosterone (free) should be <40 and bio <2.5. Maybe consider Lupron w/ 1/2 dose Xtandi+low dose Prednisone to help with side effects. 🙏
You did not state or I did not see it what T you started with prior to ADT. It is my understanding that the higher the T to start with the faster it returns if it is going to return.
Also some guy’s T return but reach a low zenith. Lenth of time on ADT can have an effect.
You are at a T range that hopefully your residual SE from ADT are minimal. I read that point is around 150.
Prior to ADT my T level was of 18.1 nmol/l or 522 ng/dL. At 277 522 ng/dL, I am still at barely over 50% from my pre-ADT level. I understand that it can take a while to recover. My concern is that instead of slightly increasing on each blood test, it is trending down.
Published online 2022 Jun 22. doi: 10.1155/2022/6093092
PMCID: PMC9242810
PMID: 35782408
"Seasonal Variation of Testosterone Levels in a Large Cohort of Men"
"Conclusion
In a large cohort of men with a wide range of age, BMI, and comorbidities, month of testing was independently associated with total and bioavailable testosterone levels. These data provide strong evidence that seasonal variation has to be considered in clinical practice."
"Seasonal variation of testosterone and waist to hip ratio in men: the Tromsø study"
" Abstract
Studies of seasonal variation in male testosterone levels show contradictory results. We report here a cross-sectional study of the seasonal variation in total and free testosterone, LH, and SHBG levels in 1548 men living in north Norway, a population exposed to a wide seasonal variation in temperature and daylight. Total testosterone showed a bimodal seasonal variation (P < 0.001) with a small peak in February, the nadir in June, and a more prominent peak in October and November. Free testosterone also showed a significant seasonal pattern (P < 0.001), with the peak in December and the nadir in August. These patterns persisted after adjusting for age and waist to hip ratio (P < 0.001). Lowest testosterone levels occurred in months with the highest temperatures and longest hours of daylight. Waist to hip ratio paralleled the change in daylight and temperature, with the highest values during the summer and was thus inversely related to the seasonal testosterone variation. The variations in hormone levels were large, with a 31% difference between the lowest and highest monthly mean level of free testosterone."
The search estimated "About 847000 results". Some of the other top 10 results also appear to be possibly relevant. I strive to consider the preponderance of information and the source & indications of scientific rigor when coming to conclusions, and then to be open to considering additional info while recognizing the nature of probabilities; i.e., a one-in-a-million probability does not mean impossible; it means improbable.
Very interesting and thanks for bringing this up. The article says "Lowest testosterone levels occurred in months with the highest temperatures and longest hours of daylight". So if highest T is in winter and lowest T is summer, this means that seasonality does not explain the downward trend of my T as my T should have been going higher during the winter.
T fluctuates a lot under normal conditions; recovery after ADT is as heterogeneous as the disease itself. Mine was quite up and down before settling at what would be considered high normal, and that took around 8 months.
‘Normal’ levels for you may shake out to be lower than they were at diagnosis due to consequences of the ADT and/or advancing age, as I’m sure you know. Beyond the lower end of normal, any difference in how you feel is likely psychological due to saturation effect.
Get stronger and more fit if you can. You don’t need 3 days rest between lifting sessions if you’re training your legs. A separate day for those would give the upper body plenty of rest, and you’ll feel so good it won’t matter what your T does.
Presently I train all muscle groups in the same day and take 2 days of rest afterwards. I might try to go back to 2 training days out of 3. I had attempted that when I was on ADT but at the time the higher frequency was making me feel worse and more drained. I heard Dr Eric Berg mention on a podcast recently that sometimes even 2 or 3 days of rest after exercise is not enough to recover for the 50+ and older, and that it can take up to a week to regain the full energy.
I am in agreement with you that psychology might play a factor in how I feel. But whether or not it is in my head, things were more fun in late summer when I was having morning erections and when I was bulking up faster. Since fall, I have a wet noodle and my muscles are more in maintenance mode than in growth mode now. Though they are still way better than they were while on ADT when the only thing that was getting bigger despite training was my belly.
I can’t help but think the contrast between late summer in Canada and what you have the rest of the year makes more of a difference than average.
The assertion of 2-3 days of rest being a must, or possibly even not enough, is not applicable if you train body parts separately, even if only upper/lower half. If you insist on training the entire body on the same day then yes I suppose you’ll need more rest.
Of course, whatever makes you happy and keeps you exercising is beautiful, but this is exactly why I train the legs separately. 😀
I am not knocking the idea of doing legs separately. I did say "I might try to go back to 2 training days out of 3" :). Now is not the best time for me to try this because of abnormally hectic work days these past couple of weeks. They don't leave me much time during lunch to hit the gym more ofte, especially with the winter roads we got. Spring should be better for yet another attempt.
But even when I do not go to the gym, I am not totally inactive. I do calisthenics every morning, gym or not. 4 sets of Wim Hoff breathing sessions (I am happy to say that on 3 occasion, I was able to hold my breath for a full 3 minutes, though my average is around 2m30s for the past 2 years), freezing cold showers, push-ups on emptied lungs, squats, dumb-bells, stretching, etc...
My friend, I can tell you that there are some days in January and February where the water is so cold that at around the 2 minutes mark, I begin to wonder if I am burning or freezing as the water feels like steel nails hitting my skin :). But when the shower is over, I feel so great. It's like waking up for the second time that day but this time its fully awake
However if I should try it, I don't want it 40, 45 degrees, etc. Forget easing into it, I want the real deal. I'm planning to visit Norway soon, That should provide my golden opportunity. 😀
One thing I've never gotten used to is getting the ice cold water on my scrotum. Even after all this time, it feels like it is ripping open under the icy droplets
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