Low T after ADT completion

[jmarsh]

As you can see in my bio, I had RP in 12/21 and ADT plus radiation in 2022. I completed ADT with Lupron and Abi + Pred in 6/24.

My T level is still very low; tested at 32 this month. My general health is good and I work full time in a high stress job with 1800 employees under my direction. However, since completing ADT and Pred, I have a lot of joint pain.

I am not suffering from adrenal insufficiency according to recent test at endocrinologist, though my regular morning cortisol level is low - only 5.0 last week.

Endocrinologist says my issues are due to low T. Says that it would be my choice as to whether pursue supplemental T therapy. She works closely with the oncology department at Duke, where I am being treated.

My question is: Is it ever safe to add T after spread to lymph nodes? This is a QOL question, and to be honest, I am not in misery. I just want to be back to my old self in terms of libido, energy and joint pain.

[Tall_Allen]

You might try jump-starting natural T production with a short course of clomid and hCG.

[Mascouche in reply to Tall_Allen]

Hi TA. I was wondering about your suggestion since I am not familiar with those drugs I asked AI about it and I am now even more puzzled about how this jump starts T production since it seems to be aimed at women.

Question asked: What are clomid and hCG used for?

Answer from AI

Clomid (clomiphene) and hCG (human chorionic gonadotropin) are both used in fertility treatments, but they serve different purposes:

Clomid

Purpose: Clomid is a non-steroidal fertility medication that stimulates ovulation. It works by causing the pituitary gland to release hormones necessary for ovulation.

Uses: It is commonly used in women who have difficulty ovulating due to conditions like polycystic ovary syndrome (PCOS) or other ovulatory disorders.

hCG

Purpose: hCG is a hormone that supports the normal development of an egg in a woman's ovary and stimulates the release of the egg during ovulation4.

Uses: It is used to induce ovulation and treat infertility in women. In men, it can increase sperm count and treat conditions like cryptorchidism (a condition where the testicles do not descend properly)5.

Both medications are often used in combination with other fertility treatments to increase the chances of conception. If you have more questions about these medications or their uses, feel free to ask!

[Tall_Allen in reply to Mascouche]

The solution is to not ask AI about it.

[jmarsh in reply to Tall_Allen]

Thanks. I know that this is my choice in the end, but what do the data say about T therapy re-starting the cancer?

[Tall_Allen in reply to jmarsh]

It can't "restart the cancer" if there is no cancer left to restart.

[jmarsh in reply to Tall_Allen]

Understood, but do you believe (or do the data suggest) that it will awaken and accelerate any remaining cancer, earlier than it would have otherwise?

[Tall_Allen in reply to jmarsh]

The whole reason for androgen deprivation therapy is that testosterone activates the androgen receptors of cancer cells, while castration levels do not.

[garyjp9 in reply to Tall_Allen]

TA, how do these drugs cause a jump-start? Might Clomid also jump start the pituitary gland to tell the adrenals to produce more cortisol (I also have adrenal insuffiency)? Also, when you say a "short course," can you advise on approximate duration and dosages? Thank you.

[Tall_Allen in reply to garyjp9]

2 weeks. IDK for sure if they have any effect on the adrenals, but probably not - their action is specific to the reproductive apparatus.

[GoBucks]

I am sure some will say "never". However, they are not living in our shoes. Watch this interview and research the topic. You'll find many well regarded Docs prescribing testosterone to their prostate cancer patients.

grandroundsinurology.com/in...

[London441]

I used HCG to jump start T as described. I didn’t like the idea of having to take exogenous T indefinitely and the risk involved. 4 months since completing ADT is not that long. Mine did not rise appreciably until around 6 months. Who knows how much longer it may have taken without the HCG?

You are only 59. Do you know what you me T was at diagnosis? How much do you exercise and what kind? Has your overall health changed since starting ADT? These are important questions.

[jmarsh in reply to London441]

One of my regrets is that I never had a baseline T test before I started ADT. It wasn't offered to me. I can only assume that it was normal because I had good energy and plenty of libido.

My exercise regimen is not very good, though I am very active - golf, walking, physical labor, etc. I know that I need to begin weight training, though.

[London441 in reply to jmarsh]

Yes. If you felt good and libido good before, you should be able to recover your T-but not necessarily.

Besides what I found to be a very good compromise between all natural T return and TRT (HCG), I also continued to lift. Not lifting on ADT is a huge mistake. Now you have a chance to make up for it.

Running, cycling, yoga, walking, golf etc are all great-and not enough on ADT. We all need to lift when we’re old (even more so on ADT) if at all able. Most do not. I don’t understand it and don’t want to understand it. It makes every bit of life better-especially in older age.

If you monitor your progress, the info you get is very helpful besides just encouraging. Lifting helps the T come back faster and more completely too.

[ron_bucher]

my T was 10 about six months after my final Lupron injection but it slowly climbed back to normal about a year after that final injection.

[Mascouche]

The gamble someone takes with T is typically about whether to have close to none (through ADT or orchidectomy) or to have some. Since you are on ADT vacation, then I do not think that having supplemental T is a higher risk than being on normal T. If the cancer is to reoccur it would do so whether you are on natural T or supplemental T.

Personally, if I had access to supplemental T I would use it when on ADT vacation. But I am not a doctor and my doctor, though he appears to agree with my rationale is hesitant to prescribe me any because he does not want to be different than the usual practice of his hospital. Peer pressure I guess.

[jmarsh in reply to Mascouche]

Your statement, " If the cancer is to reoccur it would do so whether you are on natural T or supplemental T" might be true. Are we certain of that? Also, might it also bring cancer back much sooner than otherwise have occurred?

[Mascouche in reply to jmarsh]

I am no doctor but my observations come from some such as Dr Mark scholtz who has those views. But just like is the case with BAT, there is no general consensus at the moment.

[j-o-h-n]

To jmarsh,

Unfortunately you seem to be getting mellow as you age since you mentioned your bio which I think went bi-oh bi-oh.

If possible can you re-do it? Thanks and Happy Holidays to you and yours.

Good Luck, Good Health and Good Humor.

j-o-h-n