Why can't you do TRT if you control DHT & Estrogen?
TRT & prostate cancer: Why can't you do... - Prostate Cancer N...
TRT & prostate cancer
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ocman
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Because you probably won't find a doctor to participate in such treatments. Unless in a clinical trial.
ocman• in reply to
If you could, would it work and would it be safe...
• in reply toocman
I think not and that is why probably most doctor's wouldn't even consider it outside of a clinical trial...you are putting gas on a fire, with the hope by adding fire retardants you will will prevent a conflagration. Unwise in my non-medical opinion.
Have you asked your Urologist and/or Medical Oncologist about this? If so, what did they respond with?
ocman• in reply to
Yes, the MO said should wait 1 year after HDR Brachytherapy (monotherapy) and the RO said wait 2 years, and the Urologist was willing to do it now...
• in reply toocman
I don't think my MO or Urologist would sign off on TRT given my pathology...you must be in a low risk group...I am not.
ocman• in reply to
My info is in my profile...4+3...
• in reply toocman
You might be able to pull it off....you are not stage 4 like I am.
Good luck...would like to know your results.
ocman• in reply to
My RO really wants me to wait 2 years past treatment, I just passed 1 year this month...I will certainly post info if I proceed. Looking for more opinions as well...
addicted2cycling• in reply to
Got my biweekly "T" (Cypionate) shot yesterday. January 2016 was the 1st injection beginning 8 months after the right half Hemi Cryoablation needed for my 5+5 Gleason 10 that would not be categorized as LOW RISK.
p.s. -- since I began my PCa trip with castration in April 2015, the "T" surely helps me continue my bicycling endeavors. Today's ride was 50.05 miles and looking to ride another double my age plus 1 mile for my 71st birthday in 1 month from today on July 10.
Seems to me you have gotten pretty close to it already. Whats a few more miles? You got this ! Are you all healed up yet from your endo ?
" ...Are you all healed up yet from your endo ?"
Had my first sneeze earlier tonight since the ENDO that did not hurt in my right pectoral. Guess I'm getting closer to being healed up. Other issues have been popping up and maybe have to go for a 7:11:00 on bike ride for BIRTHDAY.
I hope you didn't have allergies. 7:11 would be pretty close to 142 at you regular pace., assuming you can keep it up that long. Way out of my league. You could start with that and if feeling good go back to plan A.
Thankfully, NO ALLERGIES but wife HAS BECOME pollen sensitive.
Will just have to wait and see how I feel. It was 2 years ago I began riding on beater bike shortly after midnight during a rain storm, even had some lightning. 12:01 AM on 7/10 is "Go Time" with ABBA's - Gimme! Gimme! Gimme! (A Man After Midnight) playing on my iPod.
youtube.com/watch?v=XEjLoHd...
Good distance/time test coming with next FULL MOON: Jun 24, 2021
• in reply toocman
I'm high risk. In 2019 I had RP and the doctors at Mayo gave me two months before the aggressive return of cancer. I did 6 months of estrogen patches (a form of ADT). After that, I started high testosterone (400 mg weekly of cypionate). My testosterone measures 2100 - >3000 (lab cutoff).
My free test is almost 100. Bio-available runs 500-600.
So far I have no evidence of cancer. I'm sure it's still there though.
At first, my MO was very against the use of testosterone. I did it anyway. As of 6 months ago, she told me to "keep doing what you're doing because it's working".
So, obviously works for some of us. I control estrogen (keep estradiol or E2 around 20). I used to use DHT blockers but for the last few months, I've been letting DHT float up. An experiment of sorts. NIH research shows that DHT is even more powerful than testosterone to kill the cancer. A possible mechanism is calcium ion influx through voltage-gated calcium channels (VGCC). Another is double-strand DNA breaks.
A nice side effect is that I've gained 30 lbs of muscle and 0 lbs of fat (so fat percentage decreased and now it is single digits). I eat like a horse and can chow down like I did in my 20's.
Lot's of studies too. NIH, Johns Hopkins, etc.
treedown• in reply to
I don't feel a need to eat like a horse but building up some lean muscle would be nice. Hopefully things will remain the same and get me some time off ADT soon.
Because it would mask a recurrence.
Just curious how would it mask recurrence?
Because you wouldn't know if PSA is rising because T is feeding the cancer or because T is causing benign PSA increases.
Hypothetically, if you were going to go on TRT it would be better to not take Finasteride to block DHT?
I can't deal with hypotheticals. What is your situation exactly?
My Testosterone level is 344 (264-916) and I want to go back on TRT in the least way harmful. Not sure if that would be straight TRT with no ancillaries or try and block DHT & E2 etc.
It's not that it's harmful, it's just that it can interfere with determining if you are experiencing a recurrence. Do you feel comfortable enough only a year after therapy that you will never be recurrent?
So, for example, let's say you use TRT, and your PSA goes up to 2.0 - what would you do about it, if anything? Do you understand the problem? Your concerns about DHT and estrogen are irrelevant.
If my PSA got to 2.0 that would be a problem.
Well, if I was never recurrent it wouldn't be a problem. I'm not 100% comfortable after 1 year, that's why I'm asking all of these questions. I was planning on waiting for 2 years, then I talked to 2 Urologists and they both offered to put me on TRT.
It's not a urologist you should be talking to - it's the RO who did your brachytherapy. Yes, if your PSA didn't rise, there is probably no problem - but it is likely to rise. And then what will you do? It could be rising because the extra T is causing BPH. Or it could be rising because the extra T is feeding some cancer that was untreated. How will you know which?
BTW - I am very sympathetic. I am on TRT myself. But I waited several years for a very stable PSA (0.1) so I would be sure that the cancer is gone.
I was talking to the RO, he originally told me 1 year, but after 6 months he said 2 years before TRT.
Good advice.
Yes, I know it's good advice, thanks for all your good advice!
Start on Avodart (Dutasteride). I read that after it gets to the steady state, some 1.5 to 2 months after start, it raises T by 25%. In my case this translates to minimum 25% as I saw a 1500 when my baseline was 830. Our bodies function in a feedback loop. When lesser DHT is detected the body tries to bring it back to normal by producing more T. It takes some time for the body to realise that there has been some tampering within the feedback loop. After 1.5 year on Avodart my body settled for 1150 .
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Horm Mol Biol Clin Investig
. 2017 Jun 21;30(3):/j/hmbci.2017.30.issue-3/hmbci-2017-0015/hmbci-2017-0015.xml.
doi: 10.1515/hmbci-2017-0015.
Long-term dutasteride therapy in men with benign prostatic hyperplasia alters glucose and lipid profiles and increases severity of erectile dysfunction
Abdulmaged Traish 1 , Karim Sultan Haider 1 , Gheorghe Doros 1 , Ahmad Haider 1
Affiliations
PMID: 28632494 DOI: 10.1515/hmbci-2017-0015
Abstract
Background Dutasteride has been successfully used in treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, dutasteride inhibits 5α-reductase type 1 and type 2 enzymes and may compromises glucocorticoids and androgen metabolism and alters metabolic function resulting in undesirable metabolic and sexual adverse side effects. Aim The aim of this study was to investigate the long-term adverse effects of dutasteride therapy in men with BPH on: i) blood glucose, ii) glycated hemoglobin (HbA1c), iii) low density lipoprotein-cholesterol (LDL-C); high density lipoprotein-cholesterol (HDL-C) and total cholesterol (TC), iv) testosterone (T), v) liver alanine and aspartate aminotransferases (ALT and AST) and vi) erectile dysfunction (ED). Methods A retrospective registry study, with a cohort of 230 men aged between 47 and 68 years (mean 57.78 ± 4.81) were treated with dutasteride (0.5 mg/day) for LUTS, secondary to BPH. A second cohort of 230 men aged between 52 and 72 years (mean 62.62 ± 4.65) were treated with tamsulosin (0.4 mg). All men were followed up for 36-42 months. At intervals of 3-6 months, and at each visit, plasma glucose, HbA1c, TC, LDL-cholesterol, T levels and liver alanine amino transferase (ALT) and aspartate aminotransferase (AST) were determined. Further patient assessment was made by the International Index of Erectile Function (IIEF-EF) questionnaire, the Aging Male Symptom (AMS) and International Prostate Symptom Scores (IPSS). Results Long-term treatment with dutasteride therapy is associated with significant improvements in LUTS, as assessed by reduction in prostate volume, IPSS and prostate specific antigen (PSA). Long-term dutasteride therapy, however, resulted in increased blood glucose, HbA1c, TC and LDL levels, ALT and AST activities, AMS Score and reduced T levels and worsened ED as assessed by the IIEF-EF scores. No worsening of ED, glucose, HbA1c, ALT, AST, AMS were observed in men treated with tamsulosin. Most importantly, long-term dutasteride therapy resulted in reduction in total T levels, contributing to a state of hypogonadism. Conclusion Our findings suggest that long-term dutasteride therapy produces worsening of ED, reduced T levels and increased glucose, HbA1c and alters lipid profiles, suggesting induced imbalance in metabolic function. We strongly recommend that physicians discuss with their patients these potential serious adverse effects of long-term dutasteride therapy prior to instituting this form of treatment.
Started Avodart on October 2019, so 20 months taking it. Will have to keep an eye during the coming years. For the moment, total T stubbornly stays over 1100. Berberine probably takes care of my blood glucose and Europen milk thistle of the liver indices. Both of them are in the lowest levels starting 1983 that I have blood analysis data.
Just curious about the berberine usage: I read somewhere that research showed it can lower blood sugar, improve cholesterol and triglyceride levels, and reduce testosterone levels; you were wanting to increase T?; and sub-chronic toxicity of berberine has been said to damage lung, and liver by increasing (ALT) and (AST), significantly; and is not intended for long-term use...if it works for you then that's a good thing
No, on the contrary I am trying to get T a bit lower, although it is a good hormone for mental matters. The trouble with me is that I have familial hypercholisterolemia of the first kind*. That is, my baseline total Cholesterolol (tC) under no medication hovers around 350. Cholesterol is the predecessor hormone of Testosterone, mechanism that explains why my tT beats that of 20 y.o. youngsters.
AST = 18 iu/l (5-50), ALT = 16 iu/l (5-50) and Glucose 88 mg/dl (70-107)
(*) Hypercholesterolemia of the second kind, i.e. tC 500-600 is quite rare but if one has it, a heart episode before 50 years of age is the norm.
How would you control estrogen and DHT when using TRT? I would like to boost T but other factors are already too high.
Arimidex for Estrogen and Finasteride for DHT
• in reply toocman
I started with Arimidex. I bloated up. I switched to Anastrazole. Same thing. Letrozole works like a charm, fortunately.I used Finasteride and also Dutasteride.
If it masks it, that doesn't completely explain why my last scans were perfectly clean. Before I had them my MO was 100% positive that they would be negative.
PSA fluctuates between <.01 and 0.06. No cancer signs. Nada. I have two doctors today and they both think my prognosis is great based on my metrics and lack of signs or progression.
ocman• in reply to
Who's your MO?
• in reply toocman
Dr. Amber Flaherty.
• in reply toocman
I don't get the testosterone from her. I get it legally from another doctor. I hesitate to give his name out on this site because of some very biased people who might think it is their moral "duty" to report him (or her or it).
Check out Dr Denmeade and his work on Bipolar Androgen Therapy (BAT) I have a PDF of his work if you cannot find him on the net
lancer
• in reply tolancer82801
Dr. Denmeade is doing some much-needed work in this area. It looks like I am a hyper responder but it would be great for others if there was a way we could determine who might respond and who probably won't.
lancer82801• in reply to
Yes that would be nice. I had 400mg Testosterone Jan 04,21 with a PSA of 0.04 and Testosterone of 8. On 02-03-21 my PSA was 0.12 and Testosterone was 329 This all in the face of Estradiol patches maintaining my estrogen level at around 150Will test again this week to see
• in reply tolancer82801
It took approximately 5 weeks for the estrogen patches to kick in.
How many patches and what dose/freq are you using?
lancer82801• in reply to
I started with 4 0.1mg Dottie Estradiol patches twice weekly. 6 weeks later i went to 2 of same patches twice weekly PSA has maintained at 0.04 for last 5 months
• in reply tolancer82801
And then it just bumped up to 0.12?
And you've been on the estrogen for how long?
The patches are biweekly?
I used weekly patches. I targeted my T to be 0. Took between 0.2 and 0.4 mg a day. I used weekly patches (each one providing 0.1 mg a day).
I don't think this played a part but is important to mention,: my doc put me on zytiga. The reason I don't think that the zytiga was responsible was that I started one day before my blood test that showed T was 0. I think zytiga takes a week or so to take effect. But I can't prove that the zytiga didn't help. I wish I would have waited a day before starting it...
lancer82801• in reply to
Estradiol since Sept 2020 again biweekly 0.1mg 2 patches changed on Tues and Friday The PSA popped up after the 400mg Testosterone cypionate IM No other treatment
• in reply tolancer82801
Were you doing cyp with the estrogen?
I try to hold my estradiol (E2) down to 20-25 pg/ml when I do cyp (last 17 months).
Some guys use DHT blockers when they do high T. I did for a while but now I'm letting the DHT go high (going very high since 5-10% of T is converted to DHT).
I was on bi weekly patches and switched to weekly simply for convenience. Is there a reason you choose to change them twice a week?
I started it and just Followed the Patch trial protocol which was biweekly. Also, I have read that the patches don't always deliver a consistent metered dose as advertised, so thought the bi-weekly would give a more consistent dose of Estradiol
I met with my urologist today. We decided to test again in 3 weeks ( a month after I dropped from 3 to 2 patches) to see the effect of dropping from 3 to 2 .1 mg patches weekly. I’ve had neuropathy of feet which I believe could be from hormone imbalance. So I’m trying to lower E2 and increase T ( but still at castrate level) by reducing patch dosage. My psa has been .2 ( up from nil) for six months. If I can keep it at that level or at least not increasing quickly I’ll be satisfied. When I was on Lupron it doubled in two months when I stopped. Maybe estradiol will be better. I’ve been on it for 2 1/2 years . A hell of a lot better than Lupron by far!
You are further along this road than I am. I started the Estradiol patches last August and it took my T to castrate levels in about 6 weeks. Decreased the E patches to 2 0.1mg twice weekly. Then by Dec or so PSA was stable in 0.05 range. and T less than 10. I wanted some T back and My Doc agreed to give me T cypionate one injection 400mg brought the T up to 800 or so and now 4 months later my T is STILL about 300 and DHT is 120. PSA is 0.15Doc does not have an answer only says check back in a month
What is cyp?
= Testosterone Cyprionate, one of the two usual forms of TRT. The other is enanthate.
Thanks got it. I just had one injection of 400mg Testosterone cypionate. and am maintaining estradiol patches (2) 0.1mg patches changed twice weekly
I’m seeing my urologist today and will ask him about TRT. I was on it for ten years due to hypogonadism prior to dx with Pca. I started with shots but broke out in acne so switched to androgel. I sure would like to get my T back!
rba092075 wrote >>> " ... I sure would like to get my T back!"
I am pleased for those men who express that "I FEEL LIKE A TEENAGER AGAIN" after receiving their "T." As for me, it does nothing to boost mental or physical state but instead simply provides an added avenue for recovery (not all the time more recently) from exercise.
Good luck at the urologist. 👍 👍
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