For a Gleason 9 (very high risk disease), the NCCN guidelines recommend 12-36 months of ADT. So, stopping ADT in just 12 months was on the short end. He’s probably concerned about that decision; you should ask him.
> did you have any additional risk factors identified in your MRI, biopsy, biomarker (genomic) test, or genetic (germline) test?

A PSA of 0.05 ng/mL after radiation is very good (lower than is usual after radiation); but, your testosterone is so low at this point, that it might be what’s causing your seemingly “too good” PSA level. And, since you had a Gleason 9, but stopped ADT on the short end, your RO apparently is being cautious and just wants to be sure of what’s going on. That’s not unreasonable in this confusing scenario.

You’ll have to personally weigh the short term benefit (relief from fatigue) against the longer-term benefit (and potential impact) of the TRT since you possibly stopped the ADT early.

As always, it’s your call…..

(Yes, fatigue can be an issue with ADT. Did you start the often recommended resistance-training exercising in advance of starting the ADT?)

Good luck!

(I had 28 sessions of proton radiation + 6 months of ADT for a Gleason 7=4+3. T levels dropped to 3.0 ng/dL, but rebounded once the Eligard left my system.)