testosterone replacement for PC Gleason 9'er and radiation at LL

My PSA after 3 years is doing quite well 0.2. Thank you Dr Jabolla (LL). My Testosterone is not so good at 187. and all the side effects, lethergy, hot flashes, insomnia, body aches, back aches, groin pain etc. LL says that after 5 years if the PSA stays low they MIGHT consider a mild T replacement. I saw Dr Jabolla at a 2 year checkup and he indicated I didn't need to come all the way to see him from Arkansas. He said my Urologist here is just fine(Arkansas). So Yes I am alive after a pretty scary 8 core all positive Gleason 9 , PSA 10 trip. My white cells is still a low 2.5. T replacement seems very controversial.

thanks Allen for the newsy info. I'll trust my docs right now, and tuff it out for a while. I do worry about side effects like heart failure? It is a muscle. But then T replacement seems to cause heart problems too. I'll keep tracking!

ProtonT - I wonder if your doc meant that TRT is somehow "less good" for you due to the specific fact that you had Proton therapy. I think (and I've been wrong before) that his opinion may be that having any radiation therapy somehow makes TRT less advisable. If that is the case, I think TA addressed the only real issue - that of the potential for "noise" in future PSA readings, making ongoing case management somehow less precise.

Personally, I don't buy that opinion. If your present T level is above castrate level, the act of increasing your T level will not magically create new PCa, nor will it cause any remaining PCa to somehow become more active or more aggressive. I have it on the authority of a nationally (internationally?) known specialist/researcher in the intersect of TRT and PCa, that your body cannot tell the difference between the T that it manufactures intrinsically and that which you purchase at the pharmacy. It is the same stuff. If you begin TRT, then monitor PSA to establish a new baseline, you should be good to continue. That is only my own opinion, formed after consultation with Dr. Morgentaler (in Boston), prior to the start of my CyberKnife treatment last year. I had been using TRT for about 5 years prior to diagnosis. I continued all through treatment and remain on TRT now, a full year after treatment. In my case, it made sense to do this. I was aware of the uncertainty of PSA stability, but my pathology in the favorable intermediate risk category made it seem reasonable to me.

Berdoo - One more thing to consider carefully. You state that your T is now at 180. Your doc is entertaining the thought of a "mild" supplement. I don't believe that this will work. Once you introduce extrinsic T (supplement from outside the body), the natural T production within your body will decline and approach zero. The body is built to read its internal T level and if it is too low, it tries to make more (which your body apparently cannot do); if the reading is high enough, your body will dial back or shut down its internal production to keep T from getting too high. This is why many men who start out with TRT find that their T levels spike, then drop heavily. One must work through this spike/valley to get to find out what their level will be.

In other words, there really is no such thing as T supplements. Only T replacement. We can replace whatever amount of T our bodies can make with replacement T from outside, but it is ultimately a REPLACEMENT (hence TRT), not a supplement.

If your doc asserts that he can supplement T over the long term, I would recommend you consult with a doc who specializes in TRT and T management.

Paxton said...
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In other words, there really is no such thing as T supplements. Only T replacement. We can replace whatever amount of T our bodies can make with replacement T from outside, but it is ultimately a REPLACEMENT (hence TRT), not a supplement....

One thought though, if the body is shooting for say, 400, but only makes it to 187, would it really scale back production if you add 200 or so via supplementation? It seems the throttling process would happen if the real issue is the feedback loop being too sensitive, like it has for some reason decided it only want to make 187. So supplementation could work if the manufacturing plant doesn't have enough capacity, vs. the control system shutting it down too soon.

Could that be an alternate interpretation?

I spoke with Dr Morgentaler at Men’s Health Boston about TRT while on ADT. He has a few patients who want it due to poor Quality of life regardless of the impact on PCa free survival. Given that my QOL is good on ADT3 and my Psa is undetectable he said he wouldn’t recommend TRT. Why fix what ain’t broke?
Bob