Testosterone Replacement Therapy

I have both a family doctor and my urologist who both will prescribe injectable T for me.
At my last PSA, it did rise some, but I can't stand living the way I felt with low T.

I am probably an outlier, but I have been on TRT (gel) before diagnosis, during treatment, and all along since treatment for G3+4=7 PCa. Before TRT, my T was in the 200's, and I was significantly symptomatic. Through a series of consultations, I was put in contact with Dr. Abraham Morgentaler in Boston (he is affiliated with Harvard Med.). He has spent his last 20-25 years researching all things having to do with T and PCa. Why not consider consulting him? (You can also search his publications and practice summary online.)

With Dr. Morgentaler's advice, my uro and RO were more than willing to manage both my PCa care and my TRT. We keep my T level in the second quartile of the range, and with the gel it averages in the 400-600 range, with my most recent PSA reading (66 months after treatment) being my nadir of 0.47. In my case, it all seems to work OK.

Paxton said...
Sailor - I would hesitate to call a T level of 181 "borderline low." Every lab T test I've ever had (starting about 20 years ago) showed its "normal" range something like 300-1100. If 300 is the bottom of the range, I'd call 181 definitely low, and would expect the patient to be evaluated for symptoms. Some men do perfectly fine at levels like 150-200 while others need 300, 400, or even higher to function properly. Doctors who specialize in T issues call it "treating the patient, not the numbers."

I had a doctor who treated the numbers for many years before the present team was formed. It was horrible.

I confess that I was a bit sloppy; just using my memory, rather than looking up the normal range for T. Little doubt though that T tends to go down with age and may drop below the 'normal' range.
https://www.webmd.com/men/features/keep-testosterone-in-balance

Post Edited (Sr Sailor) : 8/9/2022 8:13:10 PM (GMT-7)

My testosterone levels are very low like 25 or less due to long term opiate use.
I've been on TRT since and only stopped for several months and I was miserable so I started up again.
My oncologist knows but accepts that I'll not stop. So far since SBRT my PSA is dropping.

Glen

Yes, Prato, that is the gist of the Saturation Theory. Morgenthaler found that as long as T levels were above castrate levels (which he defines as 50 or higher), the PCa activity is the same. More T does not equate to more cancer, nor does it increase the chance of developing PCa. There is a growing body of research that supports this.

Saturation Theory is the only research that I am aware of (but I am most definitely NOT an expert in this area) that was published since the Huggins study of 1947, which posited that giving T to a PCa patient was like pouring gasoline onto a fire. Medical schools taught this "rule" to students for decades. The problem was that of study structure. IIRC, this study started out with a sample size of only 3. Of these 3, one died, one withdrew from the study, and the study proceeded and drew its well-known conclusions from a final sample size of ONE. Around here, we call that an anecdote, not a research study.

OK, I will step down from my soapbox. I will, however, say that I believe that TRT among PCa patients is or at least should be an open consideration. The answer will not be the same for all patients, nor is there any "rule" to follow. One must consider the many variables of the individual patient's case, both PCa and T. The patient and their care team must make the best judgement they can, with the information available to them. We can compare notes on our own cases, but there will almost certainly be differences that make it necessary to consult the relevant professionals before making a final choice. (And, of course, these professionals are the same ones who will need to prescribe and manage any TRT to be administered.)

In my case I had long-standing, highly symptomatic hypogonadism. Decades long. Documented and treated for years prior to PCa diagnosis. Many philosophical and real battles with doctors until I linked up with my current uro about 20-some years ago. I also had favorable-risk intermediate level PCa, with only one biopsy core having any G4 cells, and this one being a very low percentage of such cells. Very low calculated total tumor load as well. For me, with these characteristics, we felt it worth the risk to try continuation of my TRT. To-date, that seems to have been a reasonable choice, as my PSA continues to decline, with current nadir of 0.47 at 66 months after SBRT treatment. I wouldn't try to advise anyone else as to whether they should pursue TRT after PCa treatment. I can only speak of my own experience. I would, however, advise them to look into it with their care team (or with Dr. Morgentaler himself, as I did.)