Testosterone Replacement Therapy ????

[G9doingfine]

Hello Brothers ! Wishing everyone a great summer ! Or winter …. If you are on the other end of the globe !

I am now almost over 5.5 years since my last Lupron injection and have had undetectable PSA for almost 7 years. My testosterone recovered to greater than 200 in late 2019. For 2.5 years testosterone continued to climb up to over 400 but then started to decline about 2 years ago. My last 2 readings were a level of 125 and my oncologist is now recommending TRT.

As I understand the procedure, once you start TRT you are on it for life.

Is there any chance Testosterone can go back to normal without medical intervention ?

It also appears that TRT does not contribute to an increased likelihood of recurrence. Am I correct in that assumption?

Thoughts or similar experiences ??

Thanks!!!!

G9DF

[Tall_Allen]

It sounds like normal age-related decline. IMO, after 5 ½ years, you can feel comfortable with TRT. I did it after 4 years. I only stopped when I was diagnosed with afib and had to take blood thinners (T raised my hematocrit a lot).

[G9doingfine in reply to Tall_Allen]

Hi TA, Thanks for the reply ! Can a drop in T from over 400 to almost 100 in just over 2 years (I will turn 60 in 5 months) be attributed to "normal age-related decline?" That seems like a significant and rapid decline.

I actually feel OKish ....but I wonder if undergoing TRT will improve my mood, energy, mental sharpness, etc.. At least significantly enough to warrant the TRT.

I also was hoping to find out if there are effective methods to naturally increase T through lifestyle choices (diet, exercise, etc.)

G9DF

[Tall_Allen in reply to G9doingfine]

You can try a brief stint of clomid and/or HCG to see if the testicles respond. If not, TRT may be your best option.

[Yzinger]

great news DoingFine. I dont have an answer to your questions but the guru has already answered. I am just curious, when DX were you metastatic?

[G9doingfine in reply to Yzinger]

Thanks Yz, There was spread to local lymph nodes.

[dave2]

Hi G9doingfine. 💗your screen name--so descriptive! My own diagnosis and treatment history is quite similar to yours in many ways (details are in my profile). I'm also G-9, had SV involvement, RP, RT to prostate bed and pelvic nodes, T that eventually failed to recover after D/C ADT, extended period of undectable PSA.

I've tried two different forms of TRT--injections and transdermal gel. I've been on the latter for the past 21 months and no indication of PSA rise so far. If I were in your shoes (in light of my personal experience and what I've been told), I would try the transdermal approach to TRT because it avoids the big swings in T that the injected forms cause. The injected form makes sense if you are doing BAT, of course.

My speculation is that the extent of my prostate cancer outside of the capsule was limited to the pelvic lymph nodes. I wonder if you also fall into that category, which as I understand it makes a durable remission easier to achieve.

[Don_1213 in reply to dave2]

Following this discussion with great interest - have had discussion with my MO who gave it the go-ahead, now waiting to see the endocrinologist who he suggested be the one to prescribe it and monitor it.....

[dave2 in reply to Don_1213]

Don, if you are going to try TRT, I suggest you monitor not only serum T, but also SHBG (sex hormone binding globulin). Labcorp's ref range for SHBG is 19-76. But my SHBG runs close to 200 (~4X the ref range mid-pt). This sometimes happens when you've taken the many meds we receive, and the result is that the bioavailabiliity of all of the circulating sex hormones (incl estrogen) are potential candidates for adjustment. It's something worth discussing with the endocrinologist you'll be talking with.

[Don_1213 in reply to dave2]

Dave - thanks. I just have to remember to ask about this. Maybe I can add it to the entry in my Google calendar that's going to remind me to go see the guy (in NYC, PITA to get there, but generally worth the trip.. I've encountered very few slugs at WC/NYP/Columbia.

[G9doingfine in reply to dave2]

Thanks D2, I will definitely NOT be getting the injections. Even though the last 8 years have removed any fear of needles !

I'm just surprised that my T went to 400 and now sits at 125 to 130.

Is there a noticeable uplift in mood and energy and mental acuity after undergoing TRT ?

[addicted2cycling in reply to G9doingfine]

G9doingfine wrote -- " ... Is there a noticeable uplift in mood and energy and mental acuity after undergoing TRT ? "

My ADT for G10 was castration in April 2015 did NOT want drugs. Had a 1 of a kind unique treatment protocol that included "T" biweekly injections beginning in Jan 2016. Chose to do my own BAT (of sorts) of having injections and stopping due to PSA rise.

After *T* injection level would be 1,600ng/dL then down to 450/600ng/dL and back up. FOR MYSELF, I experienced no appreciable rise in strength or energy or better mood/mental acuity. Actual recovery from 100+ mile bicycle rides was better when high *T* but no feeling like a stud likely due to NO BOYS.

OFF INJECTIONS right now due to PSA rise (went from 0.9ng/mL to 6.0ng/mL) and positive PSMA PET/CT scan where biopsy showed 3 spots of 3+3 in remaining left half of prostate. Now T,2.5ng/dL and PSA = 0.1ng/mL

YMMV + Good Luck

[dave2 in reply to G9doingfine]

I definitely experience increased energy and a mild uplift in mood from the hydrogel TRT. It is not as large a change as I saw from the injected form of TRT, but I find that okay. One way I assess my state is by observing my driving--average speed on the freeway; how patient vs aggressive I'm being. Higher T doesn't transform me into one of the many crazies I see on the freeway every day, but it does have an observable effect on how I feel and to a lesser extent in how I behave.

When it comes to mental acuity, I haven't observed any change that I would attribute to shifting my total T from <200 to a lot higher using the hydrogel. But I have seen a big improvement in mental acuity that I associate with D/C of ADT, and likely also from getting my estradiol to a healthy level (I've been using estradiol patches to help with this since 2015).

I just added some details to my bio regarding my experience with testosterone and estradiol management that you may find helpful.

[fast_eddie]

I have the feeling that my urologist would not authorize TRT under any circumstance. He is old school. Prostate cancer? No T for you !!! My PSA is NOT undetectable. You are lucky in that regard.

[Mascouche in reply to fast_eddie]

Maybe you can ask your family doctor to write you a prescription?