Testosterone Replacement Therapy

[EdinBmore]

Testosterone level seems to have plateaued at 250 post 2018-19 IMRT, ADT and brachyboost; was never more than 270 pre-treatment. Criteria for starting/stopping TRT? What are its pros and cons? Responses to it from men here?

Many thanks,

EdinBaltimore

[nacinla]

Normal range, according to the bar graph on my testosterone test results, shows 200 – 1,000. Other guys here may have better information. I started TRT a couple of years ago after waiting five or six years after my SBRT treatment in 2014. Prior to TRT, my PSA nadir was 0.11; it rose to 0.30 after TRT start and currently it's at 0.21, which they tell me is nothing to worry about given I'm on TRT. I have found that the half-life of the testosterone gel is pretty short. I skipped my morning application (4 actuations) before a test, thinking that applying the gel would skew the results, and it turns out it did skew the results — the other way: my level dropped to 42 from over 670 in the last test. I have more energy, and I'm getting more upper body muscle at the gym. I can't say that I'm rabidly horny all the time, but I am masturbating more frequently than before. When I was much younger I used the Androgel patch (the one you applied to your shaved balls) and the effect on libido and ... short temper ... was more noticeable. Not having the latter now.

[MikeCaron]

hi Eden, as you can imagine, opinion among urologists is all over the place on this issue since historically, the thought has been that adding testosterone to the mix, even in those who have had a radical prostatectomy with no evidence of prostate cancer afterwards, is like throwing gasoline on a fire.

However, All studies to date suggest that men who appear cancer free (undetectable PSA) after radical prostatectomy benefit from TRT. All of the studies show that, after RP, men on TRT are no more likely to progress to prostate cancer than men who are not on TRT, and in some studies TRT appears to be protective of progressing to prostate cancer compared to those not on it. In Boston, where I live, there is a health center called Men’s Health Boston that will provide TRT to many men who have prostate cancer without evidence of active metastatic cancer. The center was started by a Harvard urologist named Morgentaler, who has published probably more research on this subject than anyone. I had an RP in late 2021. I began TRT through this health center in May or June 2022. My PSA is tested every three months and has remained undetectable each time. I feel more energetic, I’ve returned to lifting weights, I have a stronger libido, and ED, though not back to normal, has greatly improved.

The cancer center where I received my treatment, Dana Farber Cancer Center, where the urologist and endocrinologist denied me the opportunity to go onto TRT, is now doing its own studies on TRT post radical prostatectomy.

Edin , your situation is different from mine so I can’t speak directly to it. One difference is that I self-inject in my thigh 50 ml of testosterone each week—I don’t mind the needle, but some guys feel differently. I’ve done the gel on the past and I feel that the injections are better. I’ve also done the slow Release pellets injected into the butt (not self-injection) every three months or so to be better than the gel (in terms of energy, libido, etc) but IMO it’s more of a roller coaster and the injections each week keep it more even.

Good luck and hope it all works for the best.

Mike

[EdinBmore in reply to MikeCaron]

I really appreciate your taking the time to respond. Yes, the jury certainly seems to be "out" on best practice re TRT. On which side of the argument does one err? Take it and risk - maybe - throwing gasoline on the fire? Or, don't take it and have a less than "full" life of energy, libido and mood? Sigh. Still in consultation with docs. Just don't know.

Thanks again,

EdinBaltimore

[MikeCaron in reply to EdinBmore]

Edin here’s an interview w the Harvard guy I was mentioning.

a4m.com/podcast-episode-72-...

”Dr. Morgentaler is now credited with shattering the decades-old belief that testosterone therapy is risky for prostate cancer, and pioneering the modern use of testosterone in men.”