Hypogonadism, heat flushing, and testosterone replacement

[Smarks42]

Hi all,

It is almost a year since I had my external beam radiation for Gleason 7 (3+4) PCa (see my profile). So far so good: 4 PSA tests were reassuringly low. I am now almost 82 and I am hoping to deal with my strange heat-flushing problem, which I have had for several years. It predates my cancer diagnosis, so it has nothing to do with the bicalutamide I took during the radiation process, and I've never had any of the other ADT hormones that often cause heat flushing. My heat always lasts 24 to 36 hours followed by 24 to 36 hours without it, and this cycle keeps repeating. It seriously compromises the quality of my life. I have had every blood test my various doctors have come up with (including an endocrinologist), but I've gotten only negative results. Online, I finally found a connection between heat flushing and late onset hypogonadism, for which TRT seems to be the standard treatment. My new urologist thinks this approach is worth trying (he would closely monitor me to make certain TRT doesn't reactivate my cancer). His recommended strategy is to do pellet implants, which would be injected into me every 3 months.

I am a drug-sensitive guy, so I worry about the side effects of the pellets, plus the fact that I'm stuck with them for 3 months once they're injected. And a friend of mine has suggested a more "natural" approach. He has raised his T from the 250 level to 750 by taking 2 supplements daily: Nugenix Total-T, and Sculptnation Testbooth Max. Before I commit myself to the pellet option, I'm inclined to try these supplements. I would love to hear your reactions to all this, especially if you have had any experience with any of these or other treatment options. Thanks!

[Tall_Allen]

What is your testosterone level?

[Smarks42 in reply to Tall_Allen]

most recently, 237; the one before that, 218; and before that, 293–all within the past year.

[Tall_Allen in reply to Smarks42]

Lowish.

There can be some temporary depression of testosterone caused by radiation in some men (including me):

pubmed.ncbi.nlm.nih.gov/119...

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

TRT may interfere with your ability to use PSA to determine IMRT effectiveness this early.

[janebob99]

I, too, have hypogonadism. I agree with Tall_Allen that your T level is lowish. You should shoot for 500-700 ng/dl. You may want to consider supplemental T in the form of a cream or gel, rather than pellets. That way, if you PSA starts rising, you can quickly stop taking the supplemental T. Your PCP can write a prescription for compounded T from your local compounding pharmacy, who is used to doing this for men.

For stopping the hot flashes, you should consider taking supplemental low-dose transdermal estradiol, patches or gels. The correct dose for a patch is 0.1 mg Estradiol per 24 hr (one large patch per week) or 2 pumps per day of 0.06%-0.1% Estradiol concentration of gel (Divigel.com or Estrogel.com). This has been proven to be quite successful at eliminating hot flashes and is 100% natural.

Your estradiol is likely too low because your testosterone is low. (Estradiol is made from testosterone).

Bob in New Mexico

[Smarks42]

Thanks so much, JaneBob, this is excellent guidance, just what I was hoping to get from this network! Had you ever considered the natural pill approach, like the one my friend told me about?

[janebob99 in reply to Smarks42]

I'm curious, what "natural pill" are you referring to?

Estradiol supplementation is an all-natural therapy, whether by patch, gel, creme, spray or pellets. Estradiol pills are discouraged because of increased risk of blood clots.

[Mascouche in reply to janebob99]

Maybe Norwegian Kelp? That is what I use and so do my wife and sister, both menopausal. Very inexpensive and available on Amazon, so easy to find.

[Smarks42 in reply to janebob99]

My friend told me that he has raised his T from the 250 level to 750 by taking 2 supplements daily: Nugenix Total-T, and Sculptnation Testbooth Max. (I should mention, though, that he does weight training every day and just got his black belt in karate at age 79, so that might have something to do with his T rise!) Meanwhile, I told my new urologist that I'd rather try the cream or gel approach to raising T than make a 3-month commitment to the pellet implants, and he has ordered that for me. He wants to hold off on the estradiol supplement for hot flashes so we can isolate one approach at a time in order to know what drug is causing what effect. That makes sense to me. I'm hoping that a higher T level itself will do away with my heat problem.

[Don_1213]

I already posted this as a separate post, but this might be helpful (hopefully..): medpagetoday.com/meetingcov...

[Smarks42 in reply to Don_1213]

Thank you, Don. I wonder if this study can apply to me because my heat problem predated my taking ADT. All the men in the sample were apparently having hot flashes only after they were on ADT drugs,