ga73ds,
loss of testosterone with ADT is a notable cause of osteoporosis, comparable to the loss of estrogen in women. Some men take medication to prevent loss as soon as they start androgen deprivation therapy.
At-2.2 you are getting close, -2.5 being the cutoff to osteoporosis.
You can rebuild that bone there are some amazing medications, and the resumption of testosterone maintains it well. My short list in order of preference:
Forteo and Tymlos are anabolic medication that remodel bone. They remove damaged bone and replace it with bone that is integrated in the bone. I think it is the best bone, built the way our bodies renew bone throughout our lives.
All the bisphosphonates: Reclast, Zometa, Fosamax, Boniva Alendronate. The don't repair bone, but prevent older bone from being carried away. They increase your T score by collecting older bone. They have been the mainstay of fracture prevention until 2003 with the approval of Forteo.
The newest drugs are monoclonal antibodies. Evenity and Prolia. They add bone quickly. It isn't remodeled bone. They don't remove older or fissured bone, but provide quick bulk to your bones. Which can be extremely helpful if you are about to fracture, which, (by the way) you are not.
If your cancer leaves you at risk for bone cancern metastasis , consider Zometa or Prolia. If you've had somatic testing of the tumor, you'll have a better idea of your risk. If you haven't had Decipher or one of the other somatic tests, your biopsy material is still available for testing. You only have to request it though your doctor.
The doctor suggests Prolia because it is the best for preventing cancer metastasis initiation and advancement.
It is a medication I like least because of the possible side effects ( some people have no side effects) and because it can be devastating if you have to quit the medication. It is also the easiest medication to take--an injection every six months.
I like that your doctor is proactive and understand perfectly your reluctance to take Prolia.
I have a few scattered thoughts.
Sometimes testosterone resumes rapidly. If yours does, you will see the earliest effect in the spine where you need it the most.
You were on orgovyx--the best ADT for fastest recover of testosterone.
If you had radiation, some of your low number may be that there is some fat infiltration in the marrow which lowers scores. That can resolve on its own.
If you have lost height. I'd want an MRI of the spine, especially thoracic. Dexa doesn't measure thoracic because of the ribs. But the thoracic is almost always lower T score than the lumbar, and there may be changes there that could influence your decision.
If you have any questions, I'm happy to respond from my laypersons perspective.
Oh, but you are going to start feeling good again with the weight of cancer out of the way and the ADT out of your system. Congratulations.