prostatectomy and testosterone level

From Jeff Angstadt it appears he hit a wrong button:

"my prostatectomy was9/12/11 and i have the same problems. tired and no desire for anything. i am 56 and my last psa was .009"

I moved this back for Jeff.

Jeff,
welcome to HealingWell. Just a couple pointers about how to use this forum. You see the three buttons on the bottom. One says "+Post New Topic". Only use that one if you want to start a new discussion. The button to best reply with is the "+Post Reply" button. You can also answer posts with the Quick Reply box on the very bottom of this page.

Now on to your cancer situation. As far as sexual activity within four months after radical prostatectomy it's not terribly uncommon for men to still be recovering from their surgeries. The fatigue part is a bit more concerning. Were you prescribed any hormone drugs? That could be a source of your fatigue. In any case you should let your doctor know about it so that he can note it and if necessary prescribe a treatment. One of the things I did after my surgery was walk. I managed to get about three miles a day in. I also had radiation and hormonal therapies and I believe that the walking helped immensely.

Again welcome. You'll get some more feedback soon enough so keep checking.

Tony

I am 60 and I had my robotic surgery 9/2007 and from that day to present, I have hardly no sex drive or energy to anything.  I have no ED issues from my surgery and can get rock solid erections without a problem, but I just don't have the drive or desires anymore.  Prior to my surgery I was thinking about sex constantly, now I have to force myself to think about it and do it. I had my testosterone checked a few years ago and it came out 370 which is in the normal range.  My uro tells me it is all in my head, but I still think it has something to do with the actual prostate being removed.

I am sure that the trauma of radical surgery impacts the energy level of patients.
Impotence and incontinence are early side effects that impact all of us that have undergone that surgery. Recovering takes time and exercise.

On the other hand, there are reports in the medical literature that the presence of PCa does affect the level of testosterone. This could be related to the fact that prostate cancer cells metabolize testosterone faster than normal prostate cells. In fact, several studies report an increase of testosterone after radical prostate surgery. The effect on reducing testosterone before surgery is more pronounced with more poorly differentiated disease.

"Iversen P, Rasmussen F, Christensen IJ. Serum testosterone as a prognostic factor in patients with advanced prostatic carcinoma. Department of Urology, Rigshospitalet, University of Copenhagen, Denmark.PMID: 7939452. Reported: correlations with symptomatology and other pretreatment parameters
suggest that low serum testosterone merely is a consequence of the advanced
malignancy rather than a causative factor in the pathogenesis of prostatic
cancer."

The following studies report an increase in testosterone after radical prostatectomy:

1. Imamoto T, Suzuki H, Yano M, Kawamura K, Kamiya N, Araki K, Komiya A, Naya Y,
Shiraishi T, Ichikawa T. Does presence of prostate cancer affect serum
testosterone levels in clinically localized prostate cancer patients? Prostate
Cancer Prostatic Dis. 2009;12(1):78-82. Epub 2008 Jun 3. PubMed PMID: 18521100

Significant increases in serum T and LH levels were seen after RP, compared to preoperative levels in parallel. This study suggests that serum T levels are altered by the presence of PCa, supporting the possibility that PCa may inhibit serum T levels with negative feedback in the hypothalamic-pituitary axis.


2. INFLUENCE OF RADICAL PROSTATECTOMY ON SERUM HORMONE LEVELS
LESLIE R. MILLERa, ALAN W. PARTINa, DANIEL W. CHANa, DEBRA J. BRUZEKa, ADRIAN S. DOBSa, JONATHAN I. EPSTEINa and PATRICK C. WALSH
J Urol. 1998 Aug;160(2):449-53.

Following radical prostatectomy there was a statistically significant increase in serum testosterone, free testosterone, estradiol, LH and FSH (p <0.0001), and statistically significant decrease in serum DHT (p <0.0001). No difference was noted in serum sex hormone binding globulin or prolactin levels.
hormone (FSH), sex hormone binding globulin and prolactin.

These data further suggest that the normal prostate and/or prostate neoplasm could secrete a substance or substances that give negative feedback control to pituitary gonadotropin secretion. Further investigation is warranted to identify this substance or substances.

3. Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadalhormone axis. Madersbacher S, Schatzl G, Bieglmayer C, Reiter WJ, Gassner C, Berger P, Zidek T, Marberger M. Department of Urology, University of Vienna, Vienna, Austria. PMID: 12429318

Patients with Gleason score 2 to 6 PCa had higher testosterone values (4.2 ng/mL) at baseline than did those with Gleason score 7 to 10 PCa (2.2 ng/mL, P < 0.05). Although 12 months after RP no changes in testosterone were observed in the low Gleason score group, the testosterone levels more than doubled in those with high-grade tumors.

RalphV

relevant article testorsteron replacement is safe post RP if no complication:
http://www.ncbi.nlm.nih.gov/pubmed/19207277

Testosteron level 370 is considered low by some. The 300 cutoff is arbitrary. You can google Morgenthaler + testosterone and you find plenty reference to show to your doc. TR might make you feel better or it might not. It might make sense to try.
It seems from Gat + Goren papers that the testosterone danger to prostate does not come from serum testosterone but from diverted testosterone coming directly from the testes due to varicocele that can cause levels 100+ times more than normal.
In fact anecdotal evidence that bodybuilders who elevate their testosterone level much higher than normal never get prostate cancer. (they might get testicular cancer (Lance Amstrong) but not prostate cancer.

Yup, TRT has started to make me feel better too. I found out by accident 2 years after robotic surgery that I had low T. I went through another year of 0 psas before approaching my internist about taking T (my level was 176, way below normal). He said no, once you have prostate cancer you can never have T he says. But my depression and brain fog kept getting worse, plus I had early osteoporosis so I wasn't satisfied with that. I went to my operating surgeon who said yes, then my local uro who said yes, and then the best endocrinologist who said you should do this for bones. So after fighting my insurance company over this it was finally approved. Prior to starting TRT again last month my total T was 189 (250-1100 normal range) and free T was 42.8 (35.0-155 normal range). Over a month later my total T is up to 299 and free T is up to 60. That may not see dramatic but my severe depression has lifted, the brain fog is totally gone, and I actually have some libidio again. Still 0 psa. So I'm sticking with T.......

Ellard said...
could be because low libido i.e. sex desire i have done with my testosterone replacement therapy and now a happy person now ....<snip>

Adverising Troll

Yeah, I got him. Thanks -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 4/4/2014 9:47:26 PM (GMT-6)

This is so strange. Years following RP my testosterone level bottomed out around 350. I consider this kind of low since I'm an avid weight lifter. My PSA began to rise from .01 to .035 back to current .031. Still not high but rising. My May 2014 testosterone test came back at 582. My Uro asked if I was taking T therapy. Of course, I'm not, nor will I.

I went on a cancer diet (no red meat, limited diary etc.) and lost 20 lbs. since my last appointment. I am a personal trainer and believe increased exercise combined with weight loss increased my T level naturally. I don't know, another explanation might be our meat supply contains steroids and my system adjusted by increasing my own T production since I was not receiving steroids in my red meat anymore. Far fetched but who knows.