When can use Testosterone Replacement Therapy

[Victor615]

I was on TRT prior to my diagnosis. When my PSA was over 4, my doctor took me off of TRT. That was in March 2023. I experienced and continue to experience the typical side effects of low T. My Gleason Score was 4+3 and the cancer was localized and confirmed by a PSA- PET scan. My PSA never exceeded 5.7.

I had SBRT in February/March 2024. My testosterone level was recently 7.65 and PSA was < .01? I’ve read that when patients begin using TRT again after having prostate cancer that there is no discernible difference between those using TRT and those who don’t.

I would like to begin TRT again, but my RO appears hesitant. My urologist said he would put me back on TRT immediately. Does anyone have experience with TRT after SBRT?

Thank you!

[Xavier10]

When did you finish ADT? That is a relevant question. Some say TRT 18 months after ending that is normal but that is a long time for someone that already had low T to begin with. Plus there are some new theories that low testosterone actually encourages PCa. Or at least that is how I read a recent post about a study. Something about low T leaves an androgen receptor by itself, whereas higher T the receptors couple and ward off cancer. or something like that. But 7 is super low. That is close to zero. So probably wouldn't apply to that. But it makes it appear you are still on ADT.

healthunlocked.com/advanced...

[Tall_Allen]

You have to wait a couple of years, so you can know if increase in PSA is due to biochemical failure or a normal increase.

[Victor615 in reply to Tall_Allen]

Don’t most men’s testosterone levels rise naturally after SBRT? How is this different than taking TRT?

[Tall_Allen in reply to Victor615]

Actually, after radiation, testosterone levels may decrease temporarily:

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

They monitor your PSA as your testosterone rises. If it reaches a nadir of < 0.5 and stays there despite your testosterone increase, you can feel safe taking TRT. Otherwise, how will you know if your SBRT was effective or not?

[Tall_Allen in reply to Tall_Allen]

Thinking about your situation, your RO may be willing to give you the minimal transdermal TRT to keep your T in the 250-350 range until he is sure that you don't have a recurrence.

[janebob99]

Like you, I had hypogonadism before prostate cancer. I've completed 6 months of Orgovyx and SBRT. My PSA is now 0.02. My plan is to start TRT very soon (~ 1 month). Of course, I will monitor my PSA on a frequent basis, and adjust T levels as needed.

[Victor615 in reply to janebob99]

I hope you have success! Thanks for sharing your plan. I hope you continue to post your experience.

[Fozzworth]

I, too, was on TRT prior to all of this. I start SBRT at UCLA next week and they want me on ADT. Did you even take ADT? ADT after TRT seems like a double whammy to the system!

[janebob99 in reply to Fozzworth]

I had 5 sessions of SBRT about 8 months ago, and just completed 6 months of Orgovyx. I have a complicated history of microadenoma on my pituitary gland that caused my hypogonadism. A recent MRI showed that the pituitary tumor has disappeared, so I'm wondering if my T will now recover naturally to normal levels without doing TRT. Stay tuned...

I consulted with Dr. Kishan at UCLA....he was great ! You're in good hands at UCLA!!

You may want to ask Dr. Kishan about using low-medium dose estradiol patches to alleviate the symptoms of hot flashes and osteoporosis from traditional ADT treatments (Lupron, Orgovyx). Recent Phase-III results from the PATCH trial reported that you can replace traditional ADT with estradiol patch ADT safely and effectively.

Contact me for more info at [e-mail].

Bob in New Mexico

[Still_in_shock in reply to janebob99]

What does Kishan think about low dose estradiol?

[janebob99 in reply to Still_in_shock]

I haven't talked to him about that. But, he's a very sharp guy and may be aware of it's use.

[Victor615 in reply to Fozzworth]

I had two months of bicalutamide. I’m getting increasingly concerned that my testosterone level isn’t going to increase. It’s gone from 63 to 33 to 7.65.

[JWS13 in reply to Fozzworth]

I was G7 4-3 , imrt 20 sessions ,took orgo 4 months T never returned ..new study says there is no biochemical life ext. value w adt. for g-7's even if only 4 mos.. No libido for 2 years until I started TRT.

[Fozzworth in reply to JWS13]

I finished radiation therapy last week and I have a bottle of Orgovyx ADT therapy sitting on my kitchen counter which I have not opened and I don't know if I can bring myself to it.

[Miko710]

Following. I'm 73. I had Gleason 4+3, some 8. T2A. No mets. (PMSA PET scan), Cribriform. SBRT in summer 2023. Finished 18 months of Eligard in November 2024. . PSA is .01. It's early, but I'm hoping that my T will rise naturally. My RO doesn't want TRT for me. I went through all the normal ADT SE: some belly fat (I exercise), hot flashes, mood changes, fatigue. It's bearable. Hand specialist says that I now have advanced arthritis in my right pinky finger, but I think the jury is still out of that. It came on suddenly. Other threads here say it will vanish now that I'm off ADT. Maybe. What they never tell you. But I'm interested in TRT. I'll keep asking my RO

[Victor615 in reply to Miko710]

I hope your T level increases naturally as well. The effects of Low T are pretty awful.

[Xavier10]

ROs won't do it. Especially the older ones. That's just been my experience. That's just what they're taught. They don't wanna see their handiwork screwed up by feeding the cancer that may still actually be there or in the supposed process of dying but hasn't yet. Probably in a year you'll have an idea if T is coming back on its own. And also whether your treatment was successful. There are many variations, but research is finding that it's taking a lot longer than the old rule of thumb to come back and sometimes it doesn't come back at all. You may have to get it from your PA, or a Urologist. Or one of those Men's Centers. It's becoming pretty common for former prostate cancer patients to take TRT.

[Victor615 in reply to Xavier10]

Thank you very much!

[janebob99 in reply to Xavier10]

Excellent comment.

The good news is that when doing TRT, you can simply monitor your PSA and adjust the T level to have a constant PSA. But, it takes frequent monitoring and "smart" adjustments.

Many men do this now, and have a substantially constant PSA.

Note, however, that there is a lag time between when there is a step increase in T and a subsequent increase in PSA (or, visa-versa).

[Don_1213]

I'll find out in about a week - I'm about 2.5 months into weekly T shots (one today actually).

See my bio for details, but after continually dropping PSA reads, my T recovered after Radiation/ADT, only to sink again on it's own to below 200.

My GP suggested TRT, my medical oncologist and I had a talk and discussed risks vs benefits, and he found an endocrinologist/urologist specializing in sexual health treatments to prescribe the T. My RO wasn't consulted since I didn't think he would even venture an opinion - not in his wheelhouse so to speak...

Right now - we're technically doing 3-month PSA/T reads, but I managed to squeeze it to about 6 week reads by having my GP also prescribe reads between the medical-oncologists scheduled ones. Our goal is - no increase in PSA and have a normal T level for an old guy.

So far - so good. First read found PSA had dropped, and T had moved into almost normal level. Energy levels are up, and generally I can more easily ignore all the pains and aches that come with being 78...

Will be doing the 2nd read since TRT was started next week, and will see what the numbers tell us.