Testosterone replacement therapy

Hi guys, i haven't posted in a long time although i do check in from time to time. I need advise. My psa has been in the .35 range for 4 years or so, slowly declining every year. My oncologist comments on my weight gain and the amount of belly fat i have. He always recommends exercise and low carb. I tell him i am a very healthy eater but i may eat too much. I told him with what i eat and really hardly drink at all, i ahould not be this fat. He ordered a testosterone test. I was shocked when it came back at 68 total t.
I had explaibed low energy, not being sharp mentally, poor sleep, etc. When oncology doc called back, he said conti ue to watch my diet and continue exercising. He did not wabt me to do trt because of the cancer. I have appointment with urologist recommended by oncologist who uses testosterone. Im looking for advise. One doctor said it was "normal" to have very low t levels after lupron. I don't agree. What do you guys think?
Thanks, Mike. Ps., still hung like a bull hamster!

Some guys here said that T Meds changed their lives for the better. Other guys like me tried it for a few years and never noticed any difference.

My URO and I even tested it a couple of times where I stopped using the T Meds and then went back on a couple of months later. Didn't notice a thing.

When diagnosed with Pca I had to stop my trt because my primary doctor stopped my prescription.
My T went down to 25 and most likely lower and I suffered from horrible anxiety fears and depression. Extremely irritated for no reason and felt crappy.
I found my old TRT clinic and didn't give my PCA history.
I've been on TRT throughout and while sorry I had to hide facts, would not change a thing.
SBRT over two years ago and PSA dropping.

My body and mind and I made the choice.
It ought to be up to the patient but that choice was removed unless of course I had to be untruthful.

Glen

Leuprolide chemotherapy pretty much killed off my testicles, last T read was 126, 3 years ago. Will get retested next month but expect the same.

Considering what I have been through to try and get rid of the PCa, I consider the loss of my sex drive pretty appropriate for my surgically - induced total ED and have become comfortable with being the "A" in LGBTQA+. There is simply no way I will chance a recurrence of the cancer if I can avoid that. My team assures me that testosterone is to the cancer what gasoline is to a fire, so T replacement is off the table as far as I am concerned. The wife says she is done too, but our relationship is more than just sex.

That said, it is just not a big deal to me any more. I have lost the 20 pound leuprolide/enzalutamide treatment weight gain by continuing my exercise program, seriously modifying my diet and taking up 'intermittent fasting' 2 days a week. That took the 3 years since ending those chems.

As my body hair has grown back and my nails have quit splitting so much I have hope that my pituitary is back online somewhat and I will eventually regain some muscle as well. As for the other stuff, I am 73 so I don't expect to be the same as I was 50 years ago anyways....

Thank you everyone for your detailed responses. My psa is currently about .34. It has been pretty consistent for about 5 years. When looking at my testosterone test from 7 years ago to now on a chart, it looks like as my testosterone numbers decreased, so did my psa. I kept asking my oncologust why he thought my psa was slowly decreasing or said another way, why he thought it wasnt increasing. I wondered (hoped) that maybe prostate tissue left behind might be the culprit rather than cancerous prostate tissue. Of course, he didnt know. My weight and the visceral fat around my belly slowly increased. No, i did not work out. For most of that time, i worked and it was pretty physical. I kept telling my doctors that i was a very healthy eater and i could not explain why i could not lose weight. I assumed my cognitive issues and lack of energy was because i was an old man. At my last visit with my oncologist, after i explained i just dont have the energy or motivation to consistently exercuse ir work on projects around the house. I am the guy that never hires a contractor. I would look around the house and marvel with my wife, how did we ever do all this stuff 3 or 4 years ago. I was now overwelmed with the idea of painting a room let alone remodelling a bathroom.

I am trying to weigh the risk/benefit of trt. I am not looking to recapture my youth or become an underwear model. I am now working out and bike riding. Based on what i have read, even if i was able to lose substantial weight, my t probably won't increase back to "normal" levels. At this point, i am as concerned about dying from a heat attack or stroke as i am from prostate cancer. Clearly to me anyway, my lack of testosterone is masking what my true psa might be. My decreasing psa was because my testosterone was very low. My testicles have shrunk tremendously since my cancer journey. I believe i am very symptomatic. I did look into Dr. Morgentaler and feel i got a aha moment. I read through one of his research papers and will include a link here. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650486/

I was struct by the lack of "proof" that trt for cancer patients is akin to throwing gasoline onto the fire. I walked away with quite the opposite feeling. Clearly, anyone who considers trt has to be very vigilant and work with your urologist very closely. I am meeting with urologist recommended by oncologist who does use trt for prostate cancer patients.
I am not going into appointment thinking i am going to do trt, rather i want his opinion. I believe doctors today do not have or take the time to keep up with the most current studies or research. I am hopeful the doctor i am going to see is one of the doctors who is on top of the most current research.

I will let you all kbow what happens at that meeting. Thank you again for all the time you have given me. I believe thr information from this site is more helpful that the amount of information that can be gleaned from many doctirs rushed appointments. Obviously, it is much more important and personal to us prostate cancer folks.

Thanks, Mike

PS,
I forgot to add that I just wish that BAT (Bipolar Androgen Therapy) was developed to point of being a routine therapy for castrate sensitive patients. Wouldn't it be a hoot to get supraphysiologiical doses of T part of the time.😀

Mike,
My post was really meant to support you (and anyone else) to at least have the chance to try it. If the TRT causes things to head in the wrong direction, the doctor could always revoke it. It's too bad doctors must constantly think about getting sued or disciplined.

I hope you get a chance to try it out.

Good morning Mattam, I did not interpret your post as anything other than caring and supportive. We are all here for the same reason. It is because of people like you that this forum is the go to place for information and support! Thank you PeterDisAbleard for your explanation. It is exactly what I was trying to express but you are able to say it far better than me. I am going to meet with urologist with open mind. I definitely have not decidef what i am going to do. I hac blood work this morning for psa and t so I can see if my t of 68 is a fluke or not. Thanks again everyone on this forum, Mike

Jim,
This abstract is probably a good place to start. There's a link to the full text (free) and links in the references and citations lead to other papers published before (references) and after (citations) this one.
Testosterone Therapy in Men With Prostate Cancer
I followed some of the citations of citations and found this more recent study.
Oncologic Outcomes of Testosterone Therapy for Men on Active Surveillance for Prostate Cancer: A Population-based Analysis
There is also this: Questioning the evidence behind the Saturation Model for testosterone replacement therapy in prostate cancer and a response Letter to the editor: Questioning the evidence behind the Saturation Model for testosterone replacement therapy in prostate cancer

Here's my take, and I won't enter the fray between the doctors and researchers, but will offer my opinions based upon my own discussion with Dr. Morgentaler.

I cannot comment on PCa cases in which the patient was given ADT. These cases are beyond the severity of my own, and I did not really pay much attention to these situations.

My PCa diagnosis was rated G3+4, with very small tumor load and very low grade 4 content.

In my own case, I was diagnosed hypogonadal for many years prior to PCa diagnosis. I have received TRT before, during and since my SBRT treatment. My doctors and I feel that it is completely appropriate to supplement my T, up to a NORMAL level. The reasoning being that if I, as a patient, would not have been castrated (either physically or chemically) in the treatment of my particular PCa, then I should not be forced to live as a castrati due to the physiological shortcomings of my particular body. Dr. Morgentaler and I were not joking when we concluded that my body cannot discern between the T that a normally functioning body would produce and that which I purchased at the pharmacy. That's the gist of my logic that TRT is right for me. It may or may not be good for others.

I do not know if TRT makes sense for all, but I do recommend that those with low-risk PCa diagnoses discuss this with trusted doctors. In my case, this team includes Dr. Morgentaler, my uro and my RO.

I am now 7 1/2 years out from the last of my SBRT treatments. My PSA has steadily declined from 5.69 pre-treatment to its present 0.18. Over this time I have continued TRT, and maintain T levels around the midpoint of the "normal" range.

I used to be a "gym rat" but not any more -- too old. I am still a very active 76 year-old, doing moderate home exercise (weights, push-ups, crunches, etc.) and moderate cardio exercise at a club 5 days a week. I am small - about 5'5" and 150 lbs. No monster . . . at least not since my days in the military.

Sorry to be so long-winded, but I wanted to make the point that TRT "may" be right for "some" PCa patients, but it needs careful research and discernment among the team.

I've been on TRT for quite a few years and when I was diagnosed with Gleason 6, my Uro suggested that I stop it.

I did and immediately my libido crashed, and I felt like I aged 10 years.
I refused to live life that way and resumed the T. My wife said she thought my penile implant had stopped working.
Doc wasn't judgmental and suggested more active vigilance.

I had enlarged prostate leading to urine backing up into my kidneys and damaging them.
I was at stage 4 kidney disease and started getting my affairs in order.

I finally got to see a nephrologist and they did an ultrasound and sent me to my Urologist.
He performed TURP surgery reversed the symptoms and possibly saved me.

Recently, my T level has spiked, and my doc wants me to cut back which I am doing.
The TURP has also reduced my PSA from around 5.5 to 1.6.
I don't know what scale they use, but Uro wasn't surprised.

I still tire more easily than I should from the kidney issue, but I hope to improve, and am content to live life as normally as possible from now on.

That's exactly what I told my uro, Glen. He was very agreeable.
My T level just spiked, and my PCP wants me to cut back on it. I will as long as it doesn't affect me negatively.

Tom - How high did your T level spike? Mine has occasionally gone up to near the top of the lab's "normal" range, and my uro and I have decided that we will not react to one single reading. Since we test twice a year, we watch trends rather than unique readings. I've had readings from 350 to over 900 and just stayed the course with treatment. I might flinch and adjust if my reading went way over the range, but it hasn't.

A single "spike" reading could be something as simple as getting some of your gel (if you use gel) ground into the skin where the blood draw is taken. Of course, if you use injectibles that doesn't apply.

As we learn again and again, the human body is a wonderful but complex machine. Unless something is life-threatening, I try to manage from the trends.

So far, so good.