i posted an update on this after 9 months and all was well with my PSA, T and my liver panel CMP numbers were all in the green.
So this is my 1 year update below.
By the way i just finished first BAT high T cycle ( T-propionate) 2 weeks. I’ll do a BAT post soon.
The only number that was off was my E2
This E2 councided with a worsening skin health (scabs, flaking, bleeding). The other side effect from low E2 is mental health, (no desire for anything, easily angered, depressed). Those mental health issues is definitely not my normal me.
I did stop both osterine and Carderine for a few weeks before i started pBAT and noticed cramps in calves and hands and joint pain in hands.
PSA <0.02
T 14
E2 <10
AST 32
ALT 18
ALP 87
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KocoPr
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Joint/muscle pains and cramps: possible fixes are the SARMs, NPP, estrogen patches (or cream), and also electrolytes. High T can mess with the electrolytes. Plus you probably find it easier to workout intensely and therefore sweat a lot.
I have to replace lots of electrolytes and use a Nunn tab before and after WOs. Salt tablets work the best for me though.
Low E2 = irritability, hostility, depression, and paranoia. Reduce it with an AI. That wipes it out from the cancer cells. Add it back as needed with patches or creams.
I was/am hoping my hight T will repopulate my E2. I am taking.625mg letrozole every three days during high T. I will measure E2 on near end of next high T cycle. I will add it back if needed for sure. What i noticed in my situation is after 9 months on daro and orgo my E2 finally dropped below 10 whence it was hovering around 30 for a few years. I just realized that might have been to high, from a recent post you had on E2 levels and prognosis.
I think we've discussed this but just in case, after talking to Friedman I decided to use an AI continuously. This reduces E in your system AND intratumoral E. Then I add back some systemic E (during any kind of ADT) with 0.1 mg/day patches.
Look forward to your post on first BAT circle (please do not delay it😉), as I'm starting myself with first cycle of BAT with propionate by the end of July/beginning of August and fine tuning it now while undergoing Carbon Ion 12 fractions to prostate. I havean issue with elevated E2 when normal level of testosterone, so letrozole expected to play big part in my BAT protocol. Currently on Orgovyx 7th month and 4 weeks on Nubeqa, my E2 is around 10-12, testosterone around 10 as well. So how to properly dose letrozole is still a question.
Your in the nearly identical scenario i am in. I also have an issue With unmetoblized estrogens. For me it is two heterozygous CYP1B1, two CYP1A1, COMTV158, and a homozygous GSTP1 gene all of these are involved in metabolizing estrogens from phase1 to phase2. When this doesn’t happen these unmetabolized estrogens damage DNA in the form of depurinated adducts. At least my aromatase CYP19A1 is good or I would really be in a world of hurt.
Here is a detailed post on one of the reasons i got PCa. The other is FGFR4 homozygous which I will post soon on.
Thanks, To be honest some info is a bit complicated for me to dive in about metabolism of estrogen.
How much letrazole did you use in this BAT circle while injecting testosterone?
How often you test your E2 during high testosterone phase and was you adjusting letrazole dose?
I don’t have any issue with mood on Orgovyx and now short course of Nubeqa with estrogen around 10-12… so only bones could be a concern. My aim will be to keep E2 between 20-30 on high testosterone phase and around 10-12 on a castrate level.
Did you use Cabergoline and monitor your prolactin’s levels?
Russ currently helping me to design protocol for the first 3-4 circles.
As I have normal mood with low estrogen, I’m ok to keep it low during castrate phase and between 20-30 on high testosterone phase and not planning to use estrogen patches… but I need to figure out the dosage of letrazole for that, I would probably start with higher dose of letrazole to be on the safe side … as I prefer even 0 estradiol for few weeks than estradiol in hundreds…
Look forward to your first circle BAT results post and good luck with it👍
I haven’t tested E2 on my first and only so far High T phase, but my E2 is less than 10 prior to it. I was taking .625mg every 3 days on high T only. I just tested got my E2 today after 10 days back on Darpo and Orgo and it is <15. I would think would want my E2 to be steady through every phase between 20-30.
Enlighten me on Carbergoline and prolactin. Not familiar, but i do monitor LDH quarterly per my OC. That is probably one indicator of many to predict troubles ahead. I asked my OC why and what numbers on LDH. He said if it is in the several hundred’s and i lost weight rapidly then they would act on that and do further testing. To me THAT IS WAY TO LATE.
I agree that 20-30 of E2 through all phases would be optimal, however may take time to find right dose and plenty testing to achieve that. I think only way when with castrate level of testosterone on Daro and Orgovyx to achieve 20-30 E2 is to use estrogen patches, I will skip patches for now, may use them later at some point if time however.
I think it is important to measure testosterone and E2 on high testosterone phase to get an idea how far testosterone raises and to adjust letrozole dosage to contain estrogen, I intent to do so… but it still may take time to get dosage right…
Prolactine, it is speculative and with human I think only one case was published of successfully containing cancer by lowering prolactin level it is possible that considered by some that high prolactin same as high estrogen in some cases may be feeding prostate cancer and promoting mutations and keeping it on a low level of normal sounds like a good approach at-least on high testosterone.
Russ, I think Patrick as well (not sure about him) controls prolactin with Cabergoline. Nal was advising dopa mucuna to control it. Also if you by any chance high dosing with melatonin, you might very well have elevated prolactin levels. My prolactin levels on normal testosterone (not in high testosterone) are on border line high of normal and I use some Cabergoline to keep very low.
I assume on high testosterone if I do not use Cabergoline it might shoot out through the roof together with Estrogen levels, so I might increase dosage of it or test and see how it reacts on high testosterone.
LDH I control once in few month and I think it is a good idea.
You did two weeks of propionate injections, how long you intend to stay on castrate level in each circle?
Are you planing to use Daro in each circle?
How long you gave for Daro to wash out prior to testosterone injections?
On what day after last testosterone injection in a circle you start Daro?
Do you use finasteride?
I know it will be easier to wait your separate post for BAT😅… but I’m starting very soon … so need to finalize my program and your feedback is very helpful.
You did two weeks of propionate injections, how long you intend to stay on castrate level in each circle?
I think my castrate cycle will be about 2 weeks depending on PSA results.
Are you planing to use Daro in each circle? YES, and I also start and stop Daro and Orgo at same time. I do do the Orgo loading dose of 3 pills when i start my castrate cycle.
How long you gave for Daro to wash out prior to testosterone injections?
I give it 7 days.
On what day after last testosterone injection in a circle you start Daro?
Next day because i don’t want a mediocre level of T feeding my cancer. It needs to be Superphysiologic levels.
My comments and my personal opinions, please remember I never done BAT as yet. A lot of these opinions influenced by Russ.
"Me: Are you planing to use Daro in each circle?
You: YES, and I also start and stop Daro and Orgo at same time.
Me: Stopping them at the same time means you will be waiting 7 days for Daro to washout without orgovyx prior to testosterone injection , meaning that without Orgovyx you may give chance for testosterone to raise in the meantime to 100-200 which is probably most cancer feeding level. I give you an example... 4.5 months into Orgovyx I missed 3 days of taking it because forget to take them with me when traveling, my testosterone raised to 100 (usually it is less than 20 on Orgovyx). We all of course individual and may react differently, plus you were longer (around a year on continuous Orgovyx), so your testosterone might not recover that fast, but it is something to keep in mind.
You: I do do the Orgo loading dose of 3 pills when i start my castrate cycle.
Me: From my experience for me Orgovyx brings my testosterone to castrate level in 2-3 weeks after starting/restarting it (I did it 3 times in total and did measurements on a weekly bases)... so I'm worrying of stopping Orgovyx on short circles and will keep it during first couple of my modified BAT cycles orgovyx on background when injecting testosterone. When I move to longer circles 5-7 weeks on high testosterone - I will be dropping Orgovyx for undetermined yet period of time.
Me: On what day after last testosterone injection in a circle you start Daro?
You: Next day because i don’t want a mediocre level of T feeding my cancer. It needs to be Superphysiologic levels.
Me: Interesting approach and I might try it once later on to see how it works. It looks like with this approach you are trying Superphysiological testosterone and castrate levels to kill cancer and not allow it a chance to survive 😀 I think high testosterone above 400 (some think 250-300 if you subscribe to saturation model) is still quite acceptable and not dangerous level to be. I will not be using Daro every cycle and first 2-3 cycles will not use it, but on 3rd-4th cycle will use. So, I will let proportionate to washout naturally for the first 2-3 cycles.
Finasteride, I don't know should you use it or not. I think washout period from few days to a week (if used prolong period of time) and I will use it only on some BAT cycles, certainly on the ones when I use daro.
If you have tested, I would be interested to know your PSA and testosterone levels before first testosterone injection and next day after last testosterone injection in first cycle (before you load yourself with 3 orgovyx and daro pills) and then same tests two weeks after you on Orgovyx and Nubeqa and any later tests (if you decided to stay castrate longer) that you will do prior your second cycle of propionate injections.
How much of testosterone propionate you did in your first injection? And how much in each consequent?
Thanks for testing your T levels whith Orgo! That is very important information. Knowing that I will stay on Orgo continuously for these short BAT cycles. I also want to do a longer T cycle in the near future depending on my PSA numbers.
Tand PSA testing: i think after several cycles and several testing points we will have plenty of testing data points.
I do what the T-prop expert Russ does. Start at 100mg then every other day 75mg
So taking the DHT inhibitor finasteride sounds like a great idea for Daro washout. Where do you get yours?
Finasteride like the Nubeqa has also a washout period, Finasteride from few days to a week (as it a bit accommulates from prolonged exposure). So I’m planing take it on the same days that I take Nubeqa and stop at the same time as Nubeqa , in the cycles when I will use Nubeqa.
If I don’t take Nubeqa in a low testosterone part of the cycle and decide to use Finasteride then I will stop it one week before next testosterone injection.
Finasteride 5mg - I just buy in the pharmacy either in UAE (not required prescription and cheap) or in the Caribbean where I have a doc knowing me good and understanding my experiments, that prescribes me what I ask. Prices for medication in US is of course rediculous. Example in Austria I can by Orgovyx for cash 308 Euro per bottle, in the states for cash if I buy there I pay 2,400 US… just plain silly.
There maybe an option to try to take Finasteride to block DHT on a high testosterone cycle, but I’m not there yet to consider it.
I’m not planning to take Finasteride in every cycle , as I want to make cancer guessing and not to get comfortable knowing what to expect 😅
I’m not member of cancer hackers lab, I think I filled their form in the past, but never heard back … maybe it because I was not ready to commit for weekly meetings or I don’t know.
When you have your blood tests coming please keep me updated or here or by private message. Thank you and good luck with results!
Good thoughts about the finasteride. I think it might help with mAR/iAR manipulation. In short, it might be a benefit to use it every 2nd or 3rd cycle. Or it might be a benefit to include it halfway through a high T cycle. I'm going to try that approach (and also include darolutamide) in the cycle I'm presently doing.
Note, I was just going to focus on the standard therapy that I know works, but muscle atrophy during low T with darolutamide is driving me to experiment. I'm having a Pylarify scan soon and my MO and I think that this will be a nice test of mega modified BAT. It won't be conclusive of course no matter what the outcome of the scans.
Thank you. I think finasteride in every other cycle and then maybe in two in a row, and then maybe be one cycle to omit, then finasteride in two in a row, etc...... just to add to cancer confusion without confusing yourself😅.
Adding it through half the cycle may confuse you instead of cancer in that case in regards to results that you will get from it. Maybe better to try whole shorter high testosterone cycle on finasteride ... let's say 4-8 days on high testosterone and stay through it on finasteride and start finsateride day before first testosterone injection and finish it when testosterone reaches castrate level? That might get you a better idea to judge the effectiveness, myself however will abstain for now from this experiment during my first 3-4 cycles of modified BAT.
Muscle atrophy is indeed worrisome and I'm planing to catch up on muscle building and fat loosing during high testosterone phase of BAT, but I completely understand you and your drive to experiment. Just please keep in mind that experiments need to have a good chance to be beneficial or useful... and not just experiment for the sake of experiment or to try to achieve perfection😉
Good luck with your scan results, may they be better that can be expected by you and your cooperative MO!
The reason to use finasteride and darolutamide halfway through a high T cycle is mAR/iAR manipulation.
PCa ARs "should" be upregulated after the prior ADT/darolutamide phase. Ripe for iAR destruction via androgens.
After inducing the DNA DSBs, myc, plasticity changes, cell cycle arrest, etc., the daroltuamide/finasteride/high T "should" block iARs (and/or intracellular DHT) but leave some mARs open for testosterones actions. This is an approach that Friedman thinks should theoretically control more PCa cells and last longer.
In addition to extra control, it might mean more muscle protein biosynthesis. And along with it more bone anabolism.
I think it's extremely low risk. I'm planning to follow it up with a traditional ADT/darolutamide phase in preparation for SBRT. And if it helps control cancer (I think I can get some idea from PSA and scans) it might be a semi-permanent addition.
I would certainly keep your cycles simple for now. As your cancer progresses and mutates in response to BAT, you might start modifying things. Best thing now is to get a good clean baseline. Without that we have no idea if our mods are making a positive, neutral, or negative contribution.
Make sure to measure T, uPSA, and also E. You'll need to do ultrasensitive or mass spectrometry or men's and children's E measurements. You could prob just do E2. Sometimes I measure E1, E2, and E3.
With the E info we can fine tune the AI. I need half the standard dose.
Best thing might be to reduce your E to zero and then add back some systemic E using low dose patches (0.1 mg/day). I don't think you'd need to do that during high T but on the low T periods, patches come in handy.
Thanks a lot for your response, I completely agree with your thinking and intend to do just that. I will hold on from E patches for now however, as I can tolerate low estrogen for now just fine and I hope it will be easier with BAT, maybe from 2nd or 3rd cycle I can add Estrogen 0.1 mg/day patches (thank you for a dose suggestion).
Also in some Caribbean places - ultrasensitive PSA might be a challenge...will look for it, as before just last few months... one last digit after the dot was more than enough😅
what difference does it matter if your E2 is <10 or <15 to use a specific E2 test. My E2 i want to be between 20-30 so instead of spending extra on tests and a week delayy for results i just get the standard E2
The resolution matters. If resolution is 15 then the bins are likely 15, 30, 45... Variability in test measurements is usually +/-1 bin.
That said, if your real measurement is 16 and you vary by a bin + you have a bin of resolution, you might see a reported number of 45. Or < x - which could be read as zero but was actually 16.
But if ultrasensitive bins are 0.5. Then an ultrasensitive test result should be 15 to 17.
For my education, I had one done a year or two ago. Result < 10. I had an ultrasensitive test done the following day. Result 14.
If you just want a crude measurement, the women's test is fine.
KocoPr - Thanks for sharing your n=1 trial experience with those reading here at FPC.
With a <10 E2 lab, I'd be more concerned about bone health than anything else. As BAT is a future treatment consideration of mine, I'm curious why a SERM (like tamoxifen) is not used to block E2 alpha (and not the E2 beta that is positive for bone health) for a possible rising E2 during the high T phase?
After being on a daily 10 mg tamoxifen for several months as a pharma bridge to getting scheduled for RT for gynecomastia, I'm currently continuing on a low dose of tamoxifen @ 1/2 tab every other day. With a bicalutamide boosted total T of +800, I'm expecting the low dose tamox will maintain my E2 in the 20s, while helping to block E2 alpha.
Estrogen and bone health in men and women, Steroids. 2015 Jul;99(Pt A):11-5. doi: 10.1016/j.steroids.2014.12.010. Epub 2014 Dec 30.
Best wishes for better than expected results from your BAT trial and thanks again for the update.
Stay S&W, Ciao, Kaptin K9
PS - From a strictly theoretical POV, it has seemed to me that the combo of a SERM with a SARM would be an simple and effective treatment approach to PCa. However it appears the SARMs have yet to prove their effectiveness, while SERMs are mostly relegated to treating BCa. I'm sure if you have been doing a Ostarine and Cardarine stack, you are aware of this info:
KocoPr - Carefully review the SEs for tamoxifen before using it. With no history of personal or major familial cardiac issues, I could have just stayed with the tamoxifen and not done the low-risk RT. However, I also have a blood cancer, so it seemed a better long-term solution to do the RT. My doc is going along with my continued use of tamox (along with daily bicalutamide and possibly dutasteride or finasteride), so I'll monitor my PSA, T, DHT, & E2 over the next year or so and change the dosage or drop it altogether depending on those results. Some PCa people have taken another approach to the management of estrogen by using Arimidex (anastrozole);
It may seem an odd place to look for information for PCa, but people who are trying to modify their sexual ID turn first to hormones. I learned more here about the action of bicalutamide than I did from all the other med/pharma sites or cancer forums put together. There are also some good podcasts on hormones for both men and women. I learned a lot listening multiple times to this one with Peter Attia and Andrew Huberman.
As Attia says somewhere therein ~ "We learned most of what we know about TRT from the body-building crowd. They showed us the limits." It seems that is also the case now for SARMs, such as the one you have been using over the last year. Before having his entire history deleted from HU, Russ Hollyer (aka smurtaw) had provided a lot of extremely useful information on BAT, TRT, SARMs, drug half-lives, and may other related topics. As is the case with many others who have met similar fates at HU over the last year, I now wish I had copied out those posts and replies for my use and to share with others.
As you may know Russ is now active at a BAT Facebook Group and at Prostate Cancer Hacker Lab. If you are not already wired in to these two resources for your BAT trial, send me a PM and I'll give you the links to both. (I also have a copy of his spreadsheet for his 2-month pBAT routine I will gladly share.) And while I've just scanned the site, Hacker Lab looks to me like a true pioneering effort to link patients with MD clinicians, PhD/MD researchers, and diagnosticians in an open, free-ranging patient-centered format. I gave info on it to my MO this past week, saying that as advanced cancer patients, we can ill-afford to wait 10 years for the next CT to produce another "new" non-curable treatment option. You, me, and many others are n-1 examples of that sentiment - and that's why your sharing of those n=1 outcomes is so valuable.
It's also why we all need to continue to Be Safe and Stay Well - So let's try to keep it that way.
Thank you for the links and support . I agree about the transgender sites. I visited the site before from one of your past posts and they know hormones.
I am a member of cancerhacker lab and using Russ’s protocol and spreadsheet.
I used to be a member of Peter Attia “The Drive” podcast but the cost was to much for more than one year. I follow him for free on YouTube tho.
BTW, Howz Russ doing? (HU is as close as I get to social media, so I haven't yet joined the FB Group - but feel sure I eventually will.) Let him know his smarts are sorely missed here at FPC.
I, too, find that PA's podcasts all eventually show up on YouTube. He's not focused on cancer, of course, but the fact he runs a clinic gives him credence others just doing lab research lack. That he, Huberman. and many others so willingly share their knowledge and experience fulfills at least one of the initial promises of the internet - as a tool for learning.
Keep those updates coming and Stay S&W.
Ciao - Kaptin K9
PS Since you are using Russ's protocol, the following comment you might have missed by Ed Friedman should make you feel good about that as a BAT framework;
"I am not a physician and can only offer theoretical advice, not practical advice. Unfortunately, I don't know of any physicians who are doing BAT the way in should in theory be done. However, Russ Hollyer seems to be doing it the best from what I've seen reported...:
You might want to ask your primary doctor and MO about the tamoxifen. A few years ago I was preparing to take it but my MO asked me to rethink it. My MO said it increases cardiac risks. I didn't look into it much after that, I just listened to my MO.
Also, it seems like we're not really sure the hows, whens, whys, wheres, whats of ERa and ERb. ERb usually good but not always. ERa usually bad but depends on cell lines and stage.
I doubt that unless extremely high quantities are used (dangerous) SARMs are not therapeutic. They only help with muscle and bone.
Good report kocoPr. Osterine activates the AR and suppresses PC growth similar to BAT high T phase. So I would use it only during your pBAT and not the castrate phase. Add E2 patch during that phase instead. Letrozole might not be necessary. My E2 was just 18.8 on three months of high SPA and no gynecomastia noted.
If you need a SARM during castrate phase Rad140 does not activate the AR much and also does not repress PCa growth per cell line studies.
Hi MB, i think you’re referring to the article below which uses SuperPhysiological Osterine. I am just taking a small dose and have been for a year along with Darolutamide and my PSA has dropped to 0.02 after one year from PSA of 15.
This is the article which i posted awhile back but it is a great article on how these SARMS work and it also has good references to follow down the rabbit hole. Micheal D Nyquist seems to be a good MD to search on pubmed on this subject.
Also i have certain gene mutations in the estrogen metabolism pathway that increases and does not metabolize my estrogens building up unmetabolized estrogens. I posted a detailed post on why i think i have prostate cancer.
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another undetectable 
