testosterone shots

ok Peter, I have no problem with the bph thread. Maybe Im reading it wrong, but I'm hearing, supplement t and it will somehow help your cancer or slow it down. I see in your statement there is some viability to that. So is the main stream medical system totally out of whack and instead of decreasing t we should be increasing it. thats what Im reading from his post and found it really off base. I personally think it sounds ridiculous, if what Im understanding was what he was trying to convey. O k thanks, off to see the Wizard

Random comments:

1. Gat and Goren does not recommend stopping ADT. On the contrary they claim that their treatment has an effective window for success at the early stage of Pca. If you past that this would not solve the problem. ( I read that from them, I do not have the link now Sorry.) Their procedure claims to normalize T level in prostate. ADT goes way beyond that.

2. They claim that all men with Pca or Bph have varicocele and this venous problem. It is self check to see whether you have varicocele. (if you report the result back I am interested.)

3. I have not seen either from them or anybody else to discuss testosterone supplementation in light of their theory. My post in the G.-G thread is likely the first, I am an ignorant patient and not a doctor. GG recommend their own procedure, which is much more effective if they are right than T supplementation. My amateurish speculation merely is that supplementation is better than nothing if they are right for early stage Pca.

4. Logoslidat: Among urologists the main proponent of T supplementation is Abraham Morgentaler a highly respected clinical associate professor urologist from Harvard. He has written a book about it that is available in abbreviated form on the internet. (I am sorry again. i do not have the link handy.) His claims include: Urologists believe that T supplementation increases the risk of Pca originates from a paper of a famous urologist who concluded this based on a single patient. When he started supplementation for his own liability protection he biopsied his first ~100 patient before TRT. about one third (an insanely high percentage) had Pca. Morgentaler concluded from this that low T does not protect from Pca. he and others had studies about t supplementations to early stage cancer patients before surgery and afterprostatectomy but no metastasis. All results consistently show some benefit of supplementation. They conservatively concluded from this that supplementation does not hurt. The hypothesis of Morgentaler for this that at a very low t level the prostate is already saturated, so above a certianl low level T does not make a difference. The claim that urological orthodxy is wacky comes from Morgentaler. My speculation merely that his and other's data support not merely his claim that T supplementation does not hurt, but it is good enough to make the claim that for nonmetastic Pca supplementation actually helps. And G.-G. gives a good hypothesis for the reason. I.e. negative correlation between serum and intraprostatic T level.


5. I believed also that TRT shuts down our own production. This does not seem to be true, as I was corrected in the G.-G. thread. Complete TRT replacement or even doping level extra t reduces LH to 30% of the original. As i read even ADT that moves LH close to 0 does not eliminate completely testicular t production either. Even worse prostate tumors at some point "learn' to produce their own T.

6. Is the main stream urology society out of whack? The answer unfortunately a definite yes. And that is just not unusual. I have infinite respect for medical society and medical research, but I have a healthy skepticism about the relation of the two. There are a lot of orthodoxy in medical practice that is based on unproven belief and have not been questioned sometimes even when medical science clearly shows that they are wrong. An example that is relevant to Pca as well. medical practice does not test (easy blood test) or treat insulin resistance syndrome, until it develops into a full blown type 2 diabetes in spite of the fact that probably more than half of Usa population over 40 has it, relatively easy to manage and its consequences are enormous. The major risk factor of it is stroke and heart attack, but it increases the incident of cancer, and decreases the chance of success of treatment.

Gat and Goren's work has several year history. As everybody they can be wrong, but they have impeccable scientific credentials. urologists when they do relevant work should comment some way whehter their results supports, disproves , modify G.-G. results. Urologists simply ignore the work. A likely explanation is that neither Gat or Goren are urologists. moreover their technique is a relatively complex interventional radiological procedure. For urologists accepting the result would either mean work with the knowledge that they do something that is very suboptimal to their patients or starting to refer their patients out to other field or to forget their built up expertise and expensive equipment and start to learn something radically new. It is so much easier to ignore.

7. I am just like everybody is here because i listen to what my doctor say, but I do not take it as the full and ultimate answer to all my question. I no longer accept without questioning anything either my doc or a medical research paper say. I came healingwell to read feedback from people who had the G G procedure. Interpreting feedback from people how undergone some procedure is tricky. people who are perfectly happy tend to disappear from the forums etc. Fortuantely results from GG develop during a period. So G and G veterans do not immediately disappear from the forum. The longish GG thread a conequently is is good confirmation that what GG report is mostly true. It might not work for everyone, but for the majority it is very helpful. We should take this very seriously.

Thank you Logoslidat,

I should add Dusame's additions to my speculations:
G and G claim that intraprostatic testosterone level can be over 100 times normal due to the backdoor diversion from the testes to the prostate. Our speculation that with added testosteron that can be reduced to 30 times normal. That would be an improvement unlikely to be a solution. GG procedure claims to normalize the level when it is successful (they claim 85%)
Dusame suggests the combination of and antiluteinizing hormone medication combined with testosterone might be a solution to normalize the level. As much as I know this might work, but I wish anybody good luck who wants to convince their doc to get this combo prescribed. I think attempts to get it might trigger a mental health referral.

Just another comment on the discussion:

The FDA is investigating the safety of testosterone supplementation in view of two recent reports of increased heart attacks in men starting on testosterone. Here is the FDA statement:

www.fda.gov/drugs/drugsafety/ucm383904.htm

Back on the original topic of supplementation...
In case you are not familiar with it, something that you can opt for that you require much more infrequently for T supplementation is called testopel - they are pellets that are implanted in the fatty muscle in your butt. The T in the pellets is slowly released over 4-6 months. You only need another dose then. I just had another dose implanted today. I much prefer this over the shots (which I have had before), just because the shots need to be given every 2 weeks to keep your levels up.

Info is here: www.testopel.com/
Jeff

I'm currently reading the book "Testosterone for Life" by Abraham Morgentaler recommended by another member.

Morgentaler has taken part in many studies and research that prove that testosterone levels do not increase the risk of prostate cancer. As he explains it the prostate has a saturation level that is met by even minimal amounts of testosterone.

My analogy, borrowing from one sited by PeterDisAbelard, would be putting a sponge on the beach at low tide. It doesn't matter if the tide is 4 inches or 4 feet the sponge still becomes saturated. So it would only be if you stopped the tide completely that the sponge would not become saturated.

It has been shown that stopping the tide completely (testosterone) works in men with advanced metastatic disease. But for those who already have testosterone it doesn't matter if the levels are raised.

In fact, Dr. Morgentaler is even seeing indications of a higher risk of prostate cancer in men with low testosterone. Why that would be is still theoretical but on one level it does make sense - prostate cancer rates coincide very closely with testosterone drops associated with aging.

As for the gel, apparently there is no danger of it being absorbed, by someone you are in contact with, 2 hours after the application.

Bobbiesan said...
I understand both sides of the debate but went with TRT. Two yrs undetectable psa. Couldn't find any real evidence that TRT above the saturation level was harmful, but did find some studies indicating it helpful. Uro said there is big shift amongst the uro community in thinking about this.

T-level was about 225, should be about 500 (give or take) for a 65 yr-old. Starting to feel a lot better on it than off.

In doing my research, I saw this interesting question posed to the hypothetical doctor who has a patient like me (Robert) and ten other similar post-ralp patients, but assume their T-levels are already at the normal 500.

Q: "Dr., you advise against raising Robert's T level"?

A: "Yes, correct"

Q: "Then, you are also actively working to lower your other ten patients' T-levels from 500 down to 225"?

A: "No, of course not"

Q: "And why is that"?

A: "Well, because, um, you see, um.. Hmmmm, I don't know..."


An interesting way to look at it.

Robert

Yes, well put and indeed a very interesting way of looking at it. If a T of 300 is friendlier to PC cells than a T of 200 or 100, and since it is quite likely most of us after whatever treatment still have a few PC cells hiding somewhere, wouldn't it make sense to try to drop every ones T lower? If you are very hesitant to raise it because of the dangers you believe are associated with that, then why not always try and lower it?

I'll be glad when we get some solid large number research on this. What does animal research show? Because wouldn't it be something to find out that having higher than low normal to below normal(but above castrate) levels of T not only did not hurt, but actually helped in the battle against PC? Right now I am not seeing any evidence that us guys with low normal or slightly below normal natural levels of T have any advantage in the PC risk, and maybe even just the opposite. Clearly having near zero is helpful. Not at all clear if raising your natural from 200 to 400 or 600 is harmful. There should be a ton of evidence for this, but I don't think there is. Any body got any evidence on the harm of higher T levels compared to low normal or some what below normal?

Here are some things that the members here might be able to supply info on:
1: For the ones here who have dared to step into the T therapy after PC world: how did your PSAs do, and for how long have you supplemented? If there was any rise at all, did it keep on rising over time, if you didn't stop immediately on the 1st rise?
2: For those who have blocked T production with drugs: what kind of time is involved in getting your T levels down to near zero, or does T drop quite rapidly? If there was a time in between the start of therapy and zero T, was there a time when your T dropped from say 400 to 200 and then 100? If so, what was happening with your PSAs along that journey? Were they dropping proportionately?
3: Are statistics available ( they darn well should be IMO) on large populations for T levels, and free T levels, vs PC diagnosis? If raising T from low normal levels to high normal levels increases the risk for PC or higher Gleason diagnoses, then it should show up in population studies.

These two studies actually show that T is lower in PC pts, particularly high grade PC, but their conclusion is that PC lowers T levels!
www.ncbi.nlm.nih.gov/pubmed/11304729 ( this one also showed a lower estradiol- estrogen- level with high Gleason PCs. I had both a low normal T and etradiol. They suggest it is the PC that is lowering both of these hormones)
www.ncbi.nlm.nih.gov/pubmed/12386917

Here is one that indicates higher FREE T increases risk for PC:
www.sciencedaily.com/releases/2004/05/040510012315.htm

Here is one indicating lower levels of total T are trouble, and higher levels are not:
www.ncbi.nlm.nih.gov/pubmed/17113983