Low Testosterone

@retireddoc
Is it true once you start TRT and if you stop, there is no chance natural production of Testosterone? In other words I need to be on TRT rest of my life to feel good unless cancer comes back.

@ava11
From what I understand, yes, that is true. When you go on TRT your testicles stop production. My MO told me once I got on TRT it would be for life. I would assume there is a cancer scenario down the road when my MO would stop the TRT.

Some guys like to know every future step and contingency. I don't. I am trying to live my life for now. I leave the future treatments up to my MO and I'll deal with it when it comes. I just follow instructions. He knows my risk tolerance, that I want to live as long as possible etc, etc. Right now, thankfully, I am feeling no SE from my cancer or any treatments (other than having a penile implant due to surgical/ ADT induced ED-BUT, wow I love the implant so far!).

Well

With a GS of 9, having your PSA stay stable for 15 months after stopping ADT with a modest T recovery to the 40-90 range and age 90, well, not bad.

One of the questions might be, have the side effects of systemic therapy, hot flashes, fatigue, muscle dnd joint stiffness...subsided with the cessation of systemic therapy...?

How do you separate out symptoms of aging versus symptoms from "low T?"

Good question, I had mine checked this week as part of my Medicare annual wellness consult, 455, Free T 79.

My PCM in response to my comment that I felt fatigued still, you're 70...was his response.

I go to the gym most every day, 45-60 minutes on the bike, resistance training, swim 500-100 meters, hot and cold tub.

Other days I ride my bike outside 30-45 miles. Vacations often involve hiking, skiing...

This year I've ridden my bike in two vets, one was 55 miles, the other 50.

So, am I tired because of what I do, my age, or combination of both...? Probably the latter. Would boosting my T to say 700-1000 fix the "tiredness?" My PCM thinks not, age is the dominant factor from his experience.

My PCM asked if I take naps, yep, most afternoons!

Recovery of T is a function of age, baseline T, which agent, how long the systemic therapy was...

We generally know the older you are, the longer you are on systemic therapy and the agent, Orgovyx vs say, Lupron, impacts recover, that recovery may be slow and minimal.

What's normal, well, I've seen 300-100 tossed around as @jeffmarc has said.

What about TRT? Keep in mind there is a school of thought that says any T is fire for the fire and any T is bad...

As I say, caution about statements that say any, all...if that were the case, why have I enjoyed treatment vacations of 5 and 2+ years after de-intensification? My T recovered in both cases to 400+ in the first year.

You could discuss TRT with your medical team, would it solve your concerns you mention, maybe, would it be fuel for the fire, maybe?

If the latter, you may have treatment options such as estradiol, ARI monotherapy, MDT only that don't involve castration.

You may still experience some of the side effects.

What would I do were I you?

Tell to my medical team about TRT. If they support doing so then have discussion about non-castration treatment options should you have recurrence. Also, discuss what constitutes recurrence, will you image, if so , at what PSA, with what?

Manage my health through moderation, diet, exercise, stress...

Take the damn nap...

Kevin

@kujhawk1978
Thank you for your reply. you are a young 70! I guess there are no 85+ year old people here undergoing TRT for me to learn from their experience.

@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!

@ava11

Just to be around at 85+ may be an "uncommon" thing and for folks with PCa...even less so!

Kevin

@kujhawk1978
After saying to my Primary Care Physician " I've been dealing with Prostate cancer for over 31 years (i'll be 80 next month) ". He said he's never had a patient deal with PCa for that long and he's been practicing for over 50 years.

@denkea

I'm sure somewhere there are statistics but if I had to take a SWAG and use a Bell Curve, I would guess 60-70 would be the baseline, 50 would be one standard deviation to the left, fourty would be two...

To the right, 70 would be one, eighty would be two and ninety, well, three!

Kevin