Hormone diagram/flow chart

[jdm3]

Interesting diagram for anyone who wants to do a deep dive into hormones.

[NPfisherman]

Thanks for posting this, jdm3....Indeed, why abiraterone works so well is by inhibiting CYP17... Abitraterone drove my T<3 and my estradiol to sub normal levels... some info on CYP17 inhibitors:

ncbi.nlm.nih.gov/pmc/articl...

We can see that Progesterone can be used to make Testosterone or Estrogen... They all come from cholesterol and here is some information about cholesterol and steroid hormones:

ncbi.nlm.nih.gov/books/NBK2...

In the end, people get MCRPC because tumors figure out a way to generate their own hormones intratumorally... Figure out a way to block that process permanently... is the game over?? Some info on intratumoral hormones and resistance...:

ncbi.nlm.nih.gov/pmc/articl...

If I ever end up on IADT, I believe I am best served by being on Dutasteride, and possibly Tamoxifen or exemestane...

Anyone else have some thoughts on this one??

Fish

[jdm3 in reply to NPfisherman]

I'm taking Dutasteride and very low dose Simvastatin. Still pondering and getting mixed messages about the estrogen and associated metabolites. My estradiol is within normal ranges, but higher than some on this site think is advisable. My MO at DFCI just rolls his eyes when I ask about the estrogen. He was not opposed to Dutasteride ("we do not prescribe it, but don't think it will hurt"), but no comments on E or E2. My naturopathic oncologist is not concerned about E2 either. She says my E2 is proportional to my T, which is what they look for.

[NPfisherman in reply to jdm3]

Sounds like you are in good shape...WNL--within normal limits is the key... Stay safe and be well...

Fish

[Hidden in reply to NPfisherman]

Do you need dutasteride? 5-10% of your T converts to DHT via 5-AR. If your T is zero do you have any DHT?

[NPfisherman in reply to Hidden]

Because DHT is a driver of PCa...I think dutasteride is important to prevent conversion of T to DHT....estrogen is important for cardiac, bone, and brain health so I was surprised to see my MO not give me some E when it was low... I like him, but there are certain things he does not address...E can be converted to T and then DHT....keeping levels in balance of E and T and keeping DHT low should slow the progression of PCa...thus, the use of dutasteride and finasteride and when E gets above normal-an aromatase inhibitor...

[Hidden in reply to NPfisherman]

I think I misread. On IADT you're talking about doing duta on the hi t cycle? Or the low also? T should be practically zero during the low cycle.

[NPfisherman in reply to Hidden]

I am on vacation...so I am monitoring levels now...waiting on a DHT....I will be on dutasteride soon as I have waited for things to "wash out" initially... 22 months of zytiga plus Lupron will take some time to wash out...6 months is a good guess...my vacation has been less than 3 months...

[Hidden in reply to NPfisherman]

It's my thought that if T is zero, then E levels don't matter. And E is cardio protective and also necessary to prevent bone loss.

I'm doing SPT (T>1500ng/dl - mine is 2000-3000+). So I need to use an AI (I use femara). But when I did ADT I used estrogen patches, T was zero, E2 was 400 or so (that's how it works, feedback with LH and FSH reducing T production from testes - so zero T).

[jdm3]

No worries. I did not expect anybody to do a deep dive here. Just posting because it illustrates the complexity of the endocrine system and some of the pathways we are concerned about with PCa. Fascinating, but way above my pay grade.

I do appreciate Fish's response as he helped contextualize some of the meds and treatments. I know he has the knowledge base to get deep into the weeds, but he was nice enough to keep it simple for guys like me. Thanks Fish.

[cujoe in reply to jdm3]

Thanks for posting, jdm, but I'm having a difficult time finding the "You Are Here" flag on the chart? Also, my GPS is no help & I stll haven't be able to find Waldo either.

Glad to hear you are on treatment cruise control. Hope the spouse's vision is headed back to 20/20. BW -K9

[NPfisherman in reply to jdm3]

You are welcome, jdm3. Glad you continue on your vacation voyage. Don't ever retire. It is worse than work doing those chores that I put off. Margaret is just doing some consulting work, so she has cut waaay back. She also finds retirement to be real work. Maybe it is the way the word breaks down...Re / tired.... like repeatedly tired.Fish

[jdm3]

Just curious if you have any insights into taking an Aromatase inhibitor (like Arimidex) to control E2 and/or a 5-Alpha Reductase inhibitor (Dutasteride) to control DHT if not on ADT and T has recovered.

I assume you have read Ed Friedman's book... but if not you may find it interesting.

amazon.com/New-Testosterone...

[jdm3]

Agree. I have done my own dosing study with the Arimidex and the levels vary considerably. I try to keep it between 15 and 30. Also blocking most DHT with Dutasteride every other day. 🤞 🙏🍀 💪

Your BAT protocol is interesting to follow and encouraging to see the results. As always, we appreciate your insights and willingness to share research and ideas. Thanks.