Do all get baseline testosterone before starting ADT

[Tinkudi]

my MO had told to do a testosterone test two weeks after starting ADT but I was wondering do most do that or also get one before starting ?

[JohnInTheMiddle]

Get one before you start. And then one little bit later. My doctors are not so enthusiastic about doing a testosterone test. The whole thing is complicated. But you can't compare before and after if you don't have the before. It's not such a big deal so you might as well. Part of the deal is the obsessive focus on PSA. PSA is only a proxy. Some people confuse it as it's the disease - it's only the indirect measure of what's going on. It's good to have the actual testosterone. Which of course is also not the disease but it's upstream of the disease and very upstream of the PSA.

[Cackalacky_cyclist in reply to JohnInTheMiddle]

I agree with getting testosterone levels prior to any ADT. I dd not, and when my T recovered after the first round of ADT, I was intrigued that it was on the low end of the normal range. I'll never know if that first ADT suppressed my testosterone production, though it is now useless trivia at this point.

[GP24]

Get it done. Should you decide to do intermittent ADT later you will want to know if the testosterone level has fully recovered.

[Tinkudi in reply to GP24]

Thank you 😊

[Justfor_]

Too late. Bicalutamide has already increased it, no one knowing by how match.

[Tinkudi in reply to Justfor_]

So dad’s pain in leg due to bone mets has substantially decreased since he started the bicalutamide. What would explain that if if increases testosterone ?

[Mascouche in reply to Tinkudi]

Bicalutamide does not increase testosterone. It is the opposite as it blocks its. It can be used by itself but it is often used for a few weeks when starting Lupron because the first Lupron injection can momentarily spike up your testosterone before it brings it down. In that case, Bicalutamide is what prevents the flare from happening.

[Justfor_ in reply to Tinkudi]

I have tried to explain it to you the best I could. I even used the parallel of the bank safe that has money in it but aunothorized people can't get hold of them, so you could understand that what isn't reachable, isn't by default non existing. Sorry, I can't do any better.

[Tinkudi in reply to Justfor_]

I don’t mean to disregard what you said 😊. Just wondering why his pains lessened on starting it. Am curious.

[Justfor_ in reply to Tinkudi]

Because the cancerous cells there CAN NOT get hold of the Testosterone they need to survive and multiply, so some of them have been killed (apoptosis) and some of them have gone to sleep (senescence), like bears hibernating during the winter when they CAN NOT find enough food to feed from.

[Tinkudi in reply to Justfor_]

Aaah ok. But are you for or against bicalutamide which ia given to be taken before lupron and sometimes along with it ?

[Justfor_ in reply to Tinkudi]

For Bicalutamide, against Lupron, unless it is absolutely needed. And the need verification shall come from actual blood tests and imaging of your father and NOT from some fancy doc that poses as an expert or some published paper. In engineering we have a proverbial phrase: " One test is worth the cumulative opinions of 10 experts" But, let us just not start this discussion, it doesn't have any practical meaning in your case. You will do what your docs say, no matter what and they will say Lupron- Lupron-Lupron.

[Tinkudi in reply to Justfor_]

Dad has bone mets. You still think the same ? Which blood tests ?

[Justfor_ in reply to Tinkudi]

For someone in his 60s or 70s I could accept some elevetated risk. But, for your father at 83 my first and bottom line is what Hippocrates said 24 centuries ago: "First, don't cause harm".

[JohnInTheMiddle in reply to Tinkudi]

Tinkudi, I had overlooked somehow that your dad already has long bone mets. This means that any agonist ADT that you start with will make it worse. Agonists work by overloading the system until the system can't take it.

In my case because I had severe Mets in my spine and vertebrae pressing on my spinal cord I started off with Firmagon that way. As an antagonist right away the masses started to shrink. And right away I was able to walk straight again and so much pain went away.

Had they started with Lupron the agonist then the cancerous masses on my spine likely would have caused damage to my spinal cord due to testosterone flare.

I'm assuming your dad does not have mets to his spine. It's still a question to figure out if you start off with the ADT agonist my understanding is that the pain will increase until it decreases. All other things being equal.

[Tinkudi in reply to JohnInTheMiddle]

Thanks. Starting with the relugolix today. Praying it goes well 🙏🏻

[lowT163]

wish I had but nobody did it before sticking me with lupron. Too late

[Hidden in reply to lowT163]

I don’t walk for shit!.,, I always thought it was because the cancer was pressing on spinal cord nerves.,,My doc says no, it’s because of damage the Lupron did ….But we had to go with Lupron (4 yrs worth) to keep you alive….So there’s always a trade off…No Lupron ever again for me…,,

[garyjp9]

Get the baseline T test if you can. My doc failed to order it, and I was too naive to press for it.