TESTOSTERONE THERAPY ?

[frankgeorge]

Prior to June 2015  my sexual life was GREAT with the help of testosterone therapy . Found my PSA was 3+4 and had brachytherapy. Now my PSA is 0.01 and my sex life is 0000.  My GP said he will write a Rx for testosterone IF my urologist approves. Can I start back on testosterone ?  OPINIONS PLEASE ! Thanx

[gwhaia]

No matter what your doctor tells you I would do a lot of research on my own. A lot. And not just on the internet. Go talk to several doctors who are experts in the field. This is a decision that could have life-threatening consequences.

[pjoshea13]

You don't say what your testosterone [T] level is.  Presumably well below 350 ng/dL.

Depending on T, you could be above Morgentaler's saturation threshold, where prostatic androgen receptors have all the T they need.  In which case, additional T will not make any difference, according to Morgentaler.  1,000 ng/dL is no riskier than 500 ng/dL or 350 ng/dL.

If you were not hypogonadal, a PSA of 0.01 after brachytherapy would not require you to also be castrate, so why shouldn't you have normal T?

What if your T is well below Morgentaler's number (which I think is in the low 200's, but don't quote me)?  Your PSA might rise a little during T therapy, but should plateau quickly as T reaches & goes beyond saturation level.  {Dr Myers has described this.} 

The thing about T therapy is that it can be halted at any time.  (With daily patches, clearance is going to be much faster than with weekly injections.)

The benefits of normal T go well beyond libido.  Cardiovascular, for instance, & reversal of metabolic syndrome symptoms.

-Patrick

[ng27868168]

Testosterone Replacement Therapy is a controversial issue. I am a 23 year prostate cancer (PC) survivor, age 75.  A year following prostate removal surgery at age 52 that basically took away normal sexual activity, my PSA started to rise. I had 35 treatments of radiation. a year later my PSA again rose and I opted to have an orchiectomy (testicles removed) to stop the making of testosterone  which supposedly feeds PC, rather than hormone injections.  Cancer was stopped, but hot flashes became the norm as well as loss of energy.  I tried many different meds to control the hot flashes but nothing worked.  I went to a new urologist and because I had no signs of recurring PC in 18 years,  he recommended I go on testosterone injections once a month to control the hot flashes. It was a miracle drug!  No more hot flashes and my energy level rose, I slept and ate better.  However, 2 1/2 years ago I had a heart attack which required a stent placement, but I remained on testosterone. 9 months ago I had another heart attack which required another stent.  At that time the medical consensus was that testosterone could be a cause for heart problems and I was taken off the injections and fatigue and hot flashes came back. 

SINCE THEN..., a European study of 83,000 men age 65 and + showed increasing testosterone levels seemed to show a heart BENEFIT and I am back on testosterone injections with the blessings of both my Urologist and my Cardiologist.  

My doctors went on line to pubmed.gov. (I did as well) and read that very study which showed these results. The topic is called "Association between Testosterone Supplementation Therapy and Thrombotic Events in Elderly Men".  Good Luck.          

[pjoshea13 in reply to ng27868168]

IMO, the reaction to the two papers [3 & 4] that reported increased CVD risk with testosterone [T], was unseemly.  First, there were the people who seem to find the idea of older men having sex distasteful.  One reads of the "manopause" as being natural & even desirable, & that aging men should get over it.

A more reasonable bias was shown towards younger men who bypass their doctors & obtain T without even knowing their T levels.  A common view seemed to be that these men suffer from nothing more than midlife blahs & hoped that T would rejuvinate them.  Never mind that hypogonadism is vastly undertreated & unrecognized, & that many doctors are reluctant to treat it, & lack basic guidelines for accurately identifying it.

T is not included in the panel of blood tests performed during an annual medical.  A man has to pretty much self-diagnose hypogonadism before discussing with his doctor.  If the doctor is persuaded, a T test will be done, but a T prescription will be denied if the result isn't below the number that arbitrarily defines hypogonadism.  I know of one young man with T = 302 ng/dL who was denied a T prescription because T was higher than 300.  Needless to say, the doctor had no remedy for the man's hypogonadal symptoms.

& if T is lower than the cutoff (many doctors do use 350, rather than the old 300), treatment will often be withheld unless the patient reports a pattern of symptoms consistent with hypogonadism.  If a condition has no coherent symptoms, why treat it?

But there are adverse metabolic changes associated with low T.  A recent German paper [1] on T therapy for up to 10 years reported that:

"Waist circumference, body weight and mean BMI dropped progressively ... versus previous year for 7 years" 

"... fasting glucose displayed a significant decrease after the first year continuing to decrease thereafter." 

"A decline in HbA1c , from 6.4% to 5.6% (mean <6%), was observed from year 2 on, together with a decrease in the ratio of triglycerides:high-density lipoprotein (HDL), a surrogate marker of insulin resistance, with an increase in HDL levels." 

"The total cholesterol:HDL ratio and non-HDL cholesterol declined significantly." 

"A decrease was also observed in systolic and diastolic blood pressure," 

"with a decrease in levels of the inflammation marker C-reactive protein."

It seems that T can reverse the metabolic syndrome - & presumably lower CVD risk.

One annoying reaction to the T/CVD papers was from Public Citizen (Sidney M. Wolfe) [PC].  PC petitioned the FDA for a black box warning on T products.  PC “champions citizen interests before Congress, the executive branch agencies, and the courts”.  (Although citizens have no input.)  The FDA response:

“At this time, there is insufficient evidence of a causal link between testosterone therapy and adverse cardiovascular outcomes to support the regulatory actions requited in your petition."

The FDA also criticized the studies, claiming that they:

“have significant limitations that weaken their evidentiary value for confirming a causal relationship between testosterone and cardiovascular outcomes.”

Abraham Morgentaler had more to say on that [2]:

"methodological flaws and data errors invalidate both studies as credible evidence of risk. One showed reduced adverse events by half in T-treated men but reversed this result using an unproven statistical approach. The authors subsequently acknowledged serious data errors including nearly 10% contamination of the dataset by women. The second study mistakenly used the rate of T prescriptions written by healthcare providers to men with recent myocardial infarction (MI) as a proxy for the naturally occurring rate of MI."

Unfortunately, what people remember is the bad news.  Even my GP warned me against T on the basis of the two studies.

One of the side-effects of low T is near or actual anemia.  Dr Myers has complained about doctors who prescribe iron to his patients with anemia.  Normal T = normal red blood cell count [RBC] = normal hemoglobin = normal oxygen supply.  Without iron there is no hemoglobin, but iron will not normalize the RBC - only T can do that.

The worry about T supplementation is that red blood cells might continue to rise above normal.  My T has been as high as 1,200, with hematocrit remaining in the middle of the normal range.  However, my integrative medicine doctor says he has seen a couple of cases rise above normal.  I don't know why, or what it implies.         

-Patrick

[1]  ncbi.nlm.nih.gov/pubmed/267...

[2]  ncbi.nlm.nih.gov/pmc/articl...

[3]  jama.jamanetwork.com/articl...

[4]  journals.plos.org/plosone/a...

[ng27868168 in reply to pjoshea13]

Thanks for your response.  There IS a huge problem going on with younger men taking unprescribed  testosterone just for physical fitness and athletic improvement which will certainly come back to haunt and harm them as they get older.  Testosterone, like any other hormone can cause many serious side effects and a number of serious illnesses.  But in spite of that far too many younger men think they are 10 feet tall and bullet proof.    

[maack1]

You didn't provide your current testosterone level.  In any event, my considerations are explained here tinyurl.com/n9tzy82  

[Concavity]

I was treated for PCa in 2005 with EBRT with a PSA 9.8, Gleason 3+3 T1C stage II. Prior to EBRT I was given a Lupron shot as an androgen(Teststerone) suppressent to shrink any tumors before radiation. Afterwards Testosterone and PSA dropped to near zero. After Radiation there was a followup shot. Unfortunately, 6 months later, based on bad Urologist information, I took a third shot which was a mistake as after the second shot my Libido and sexual function had been slowly returning low to normal. After the third shot induced zero PSA and Testosterone levels, T and Libido only returned very slowly. Eventually my testosterone returned to  550 ng/dL with an eventual PSA baseline of 0.75. However, after about a year my T levels and Libido began to drop, eventually below 300 ng/dL and I began to develope Hypogonadism. 

 I asked my new Urologist if he would prescribe Testosterone since the drop was induced by the Lupron treatments. He agreed and indicated that there was no correlation between cancer returning and normal levels of T. That is PSA failures would occur or not occur based on my particular biology and the effectiveness of the EBRT.

I have been on 2-3 Androgen pumps a day for 10 years now with my PSA remaining stable at about 0.75 +/-0.2 and T levels of about 480ng/dL +/- 100ng/dL. However, external T treatments do result in continuing significant hypogonadism. For the most part my visual Libido never fully returned, but mental and physical Libido are good, as well as my erectile function with the aid of penis rings.  So I am very grateful for my overall status.

My urologist has warned that should my cancer returned its rate of growth would depend on T levels. So as long as your cancer is effectively under control Testosterone therapy is acceptable and has many other benefits as mentioned by other in these replies. 

At the same time I don't expect my PSA  to remain dormant as statistical studies indicate failures begin to accumulate after about 12 years with significant mortality beyond 15 years after EBRT treatment. Even so I would still highly recomend Testoreone treatment for anyone with dormant PCa and T levels below 300ng/dL.    

[BobSherm]

Keep in mind high prolactin can keep testosterone low adding T and not dealing with other hormone issues is another problem