Question in Preparation for pBAT

[Ichthus316]

For those who have experience with BAT:

I’m getting ready to start my first 30 day cycle of pBAT this week. But I have a concern about my high SHBG (sex hormone binding globulin) level, which is 79 nmol/L.

With Eligard ADT in the background, my pBAT program calls for 8 injections of T propionate eod at a dosage of 50 mg. That dosage is expected to yield peak total T of about 2,000 ng/dL. Knowing that my albumin level is 4.3 g/dL, I used an online calculator to generate the following results:

Free Testosterone: 339 pg/ml (34 ng/dL)

Bioavailable Testosterone: 795 ng/dL

It is my understanding that these T estimates are below the supraphysiological levels required for pBAT to work properly. “Free testosterone should be >40 ng/dL and bioavailable testosterone should be >1030 ng/dl” (p.57 of the online book on BAT).

Should I increase the dosage of T propionate to 75 gm? Or should I try to lower SHBG? Or something else?? Thanks in advance for the advice!

[KocoPr]

congrats on embarking on pBAT. I don’t measure SHBG, just total T, E2, and of course PSA at end of every cycle via ultalabs.

I inj 100mg first day then 75mg every other day. According to Russ the T peak will be 8 hours after injection so if you wanted to measure your T peak that’s when you would do it.

What are you using for ARinhibitor?

[Ichthus316 in reply to KocoPr]

Nothing yet. I'll wait until end of cycle and check PSA before considering adding an ARSI. I have an appt later this month w/ my MO and we will come up with a contingency plan for a rising PSA. I'd like to use daro, but may have to settle for enza. It may depend on which one Medicare approves.

[KocoPr in reply to Ichthus316]

Yes, i got daro approved on medicare. I don’t know how long it takes to clear enza out. Daro is 6 days

[Ichthus316 in reply to KocoPr]

I believe Enza washout time is much longer, as its half-life is around a week. Daro also supposedly has fewer/less severe side effects, doesn't cross the blood brain barrier (hence lower risk of seizures and cognitive decline than other ARSIs) and inhibits all known AR mutations. Is that your understanding as well?

[Ramp7 in reply to Ichthus316]

Daro is much better. Does not cross the brain barrier and washes out of the body in 5 days. You may qualify for the Bayer program, free. Check it out.

[KocoPr in reply to Ramp7]

Yes 6th day is when I inj T again.

[Justfor_]

My latest counts so that you may compare SHBG = 183.4 nmol/L, tT = 62.42 nmol/L or approx. 1800 ng/dL all endogenous, Albumin = 4.2 g/dL. No BAT, just low dose Bicalutamide.

[KocoPr in reply to Justfor_]

You have endogenous T of 1,800ng/dl? How?

[Justfor_ in reply to KocoPr]

Was 800-900 before taking any drugs. Rose to 1200-1500 after starting Avodart. Almost doubled this under standard dose of Bicalutamide. Now declined due to reducing Bicalutsmide dosing.

[Ichthus316 in reply to Justfor_]

Here is my complete T panel from last August. Free T is 0.7% of total T, due to high SHBG. My understanding is that free T should be around 2% of total. Do you know how likely the % is to change from 0.7 to something higher w/ SPT injections? Just trying to figure out if I can achieve the necessary free / bioavailable T to achieve therapeutic BAT on 50 mg eod without making any adjustments to the program.

TOTAL TESTOSTERONE 379.4 Reference range 250-1,100 (ng/dL)

FREE TEST (CALC) 28.4 L Reference range 46-224 (pg/mL)

FAI 16.8 Reference range 13-79

SHBG 78.5 H Reference range 22-77 (nmol/L)

[Justfor_ in reply to Ichthus316]

Sorry, I don't have any experience with SPT. I shared my numbers just to show that with high tT, SHBG gets high as well. I don't know if the proportion of the bount T stays the same with exogenous supplementation.

As to my fT/tT ratio, the mean value of 23 samples has been 0.771% with SD = 0.112%

[maley2711]

I have no idea of what pBAT is. Is there some reading source you would suggest? Do I need a deep biochem background to understand the program? So far, the lingo loses me completely!!

[Ichthus316 in reply to maley2711]

BAT is bipolar androgen therapy, which cycles very high (supraphysiological) levels of testosterone and very low (near castrate) levels. Put it in to your search engine and you'll get a ton of info. Clinical trials have been completed and others are ongoing, mostly for CRPC men, under the supervision of Dr. Denmeade at Johns Hopkins. pBAT is an experimental variation (which uses testosterone propionate rather than cypionate and many believe is an improvement) that some HSPC men are doing outside of the trials. There is an excellent $2 Kindle book on the subject on Amazon if you want to dig deeper.