Low Testosterone

@pesquallie
Yep, you do bring up an important issue, The older you get the less likely your testosterone will come back at all, Much less to normal level levels.

As mentioned by by Doctor Weber in his PCa commentary

The extent to which T is suppressed depends on a patient’s age and the duration of anti-
androgen exposure, and both those factors also influence the rate of T recovery after ADT is
ceased. At a T level of <230 ng/dL a man is said to be “hypogonadal” and symptoms from a
diminished T commence - to different degrees in different men. After 3 - 6 months duration of
Lupron or Relugolix treatment 65% of men will still be below <230 ng/dL at 12 months after
stopping.

If someone has a serious case of prostate cancer at 80+ It may make sense to use ADT, It depends on the person, their health and their mental attitude. You can always give testosterone injections after treatment is completed.

@brownsf Off the top of the head I think PSA returns on its own but, supplementation will fuel the fire once it does. I got up to 230 post adt and just dropped to 175 over the past 3 months. I will get retested in case it is a fluke. Have to say I am feeling run down with low energy and have to force myself to do anything. I was diagnosed Gleason 9 Grade 5. It is my understanding that those of us that do T therapy they test more frequently. At some point I would be willing to give it a try to see if it improves my quality of life. More research with doc's on my part needs to be done. One side of me thinks if it doesn't cause psa to return why not try it.

@jimgaudette
73 year old five years ago diagnosed with G9, had prostatectomy and then discovered a solitary met at T8 successfully treated with SBRT. Continued rise in PSA prompted triple therapy successful with PSA< 0.1 for 3 years. Only on Lupron for one year but T never got back above 40. Unlikely to return to normal at my age. A year a half ago my MO at Johns Hopkins put me on TRT. Complete reversal of all of the side effects of low T. Energy restored, muscle mass returned, no more hot flashes, mood improved, libido back (!) etc etc.

Complete ED after my surgery in 2021. Tried vacuum device and Trimix / Quadmix with diminishing efficacy. Had penile implant recently. I wish I had done it 5 years ago! Wonderful!

@mccannr
Absolutely incorrect. I am 73 with G9 and oligo metastatic disease. After aggressive triple therapy and radiation at Johns Hopkins, my T never recovered off all medication. My very experienced MO (>500 peer reviewed articles on prostate cancer diagnosis, treatment and cause; full Professor in 3 departments at JH; Director of the Brady Urologic Institute at JH; etc) actually recommended I go on TRT after almost 3 years undetectable PSA with T never recovered above 40. He said "you are a 70 year old man living in a 90 year old body".

There are many experienced, knowledgeable MOs that believe TRT in selected prostate cancer patients is beneficial. No doubt that quality of life is improved. There are serious detrimental health issues associated with long term T deprivation. Prolonged T reduction may hasten the development of more aggressive forms of prostate clones that do not need T to proliferate.

I'm in my early 60s and after six months of Orgovyx it took 18 months for my testosterone to return to normal. It's 100 points lower than it was pre-treatment but I'll take it. I *do* wish doctors had told me ahead of time that recovery can take that long. When he originally said "six months" I assumed six months, not a total of 24.

@retireddoc
I am 90 years and 9 months old with T level is 46, feels like living in much older body!
Can you please give me the name of the MO at JH? I want to ask him if my age and G9 cancer is a big factor in choosing TRT. My Oncologist Dr. Scholz encourages me to try TRT and says if cancer comes back, we will treat it. I didn't know there is also a risk in living with TRT other feeling lousy! I also consult with an oncologist at UCLA who says it is a personal decision.