(I am) Starting testosterone replacement therapy

@oldgreenpaint MARC SHOLZ -MD/ ONCOLOGIST USC LA- prostate cancer expert.

@oldgreenpaint Orgovyx recovery is typically 2-3 months but can be shorter. It is an antagonist, not an agonist like Lupron. Firmagon is an injectable antagonist and has quicker recovery than Lupron but not quite as quick as Orgovyx since as an injection it works for a full month vs. the 24 hours for Orgovyx. With a 36-hour half-life Orgovyx is effectively out of you within a week of stopping.

Scholz statement from September 2025 on TRT. Is beneficial in some cases for overall health as well as quality of life. Needs to be monitored carefully. Recommends waiting 2+ years after treatment since the risk of recurrence at that point is low.
https://www.verywellhealth.com/can-prostate-cancer-patients-take-testosterone-4135428

@jim18 good info. My understanding is that Firmagon has a half life of 55 days, although the AI came up with 53 days. Saying that it takes 4-5 half lives to get it to a level that it is ineffective. A time frame of 265 days calculated. Last one for me was Feb 2026. So I am at 8+months…..240+days. Meanwhile….all the other negative side effects of low T continue to raise my risks of heart disease, dementia, osteoporosis.

Screen shot of AI…

@oldgreenpaint

Oh , they do take that in consideration !
Recovery from Orgovyx is faster but not immediate either. When we were considering adjuvant RO suggested "4 mos of ADT" with Lupron, but when my husband asked for Orgovyx he said "Oh, in that case you will need ADT for 6 mos " . So there you go ; ).
They know that men hate ADT and try to make is sound "less" than what it is which is ridiculous - that just causes confusion and later a mistrust with the whole protocol !
I am sure 100% that men would NOT refuse cancer treatment if they knew all the facts and IF some refuse that is their right to do so - as simple as that.

"I was small quantity Gleason 8" means you are Gleason 8 .

@jim18 I don’t think that’s quite right. RT does not “fry” the complete prostate. (Many, many decades ago however, yes that was the case.)

What RT does is to damage the DNA in prostate cells. Healthy cells can usually repair the damage (though some do not); cancer cells usually cannot repair the damage, so they all (hopefully!) eventually die.

Regarding dry (or reduced) ejaculation following RT - this happens because the radiation often damages the seminal vesicles, which produce the vast majority of seminal fluid.

There is no expectation of undetectable PSA coming off RT + ADT (nor from RT alone). Unlike with a prostatectomy where the entire prostate is impacted (and undetectable PSA must absolutely happen), following RT a healthy (but about 35% smaller) prostate remains, still fully functional and producing PSA, though at a lower “new normal.” The goal following RT+ADT is to hit a nadir <0.20, and then to rise slightly from there until it stabilizes at that “new normal.” A PSA of >0.50 many years after completing RT is not unusual (and not a concern). If it exceeds >1.0, then might start looking at what’s going on well before it approaches 2.0. The expectations for PSA following RT are vastly different than following surgery.

The Phoenix Criteria is what defined that nadir+2.0 threshold for biochemical recurrence (BCR). However, since that Criteria was defined in 2005 (over 20 years ago), advancements - like PSMA PET scans - now allow for detection of BCR long before that nadir+2.0 threshold is reached.

The purpose of RT is to kill the cancer cells and leave behind a healthy, fully functioning (as much as possible) prostate gland. If done well, it works.

@surftohealth88 That may be true in some places. My brother that followed in my footsteps was told…6 months ADT, And it didn’t matter which drug he chose. I advised him to take the Orgovyx and no adjustment was made in duration.

@jamesjjc You are stating the obvious, and I could be quite snarky in my reply, but my goal isn’t to debate or justify what I am doing, it is to provoke thought and present information that men can use to make informed decisions. You do realize that cancer size (quantity) and location are used to Stage the cancer, right? I am T1C or T2A. For me, I was one of the groundbreakers in going long term Active Surveillance with G7 cancer the entire time. 15 years, when there were no MRI fusion guided biopsies, that now provide highly accurate information. For me, it was targeted perfectly 14 months ago, G8. But the quantity of tumor was one half of a cc. Literally less than 2% of my prostate volume. If the needle had missed the spot by a few millimeters it could well have been G7 like it has always been.

I have visited the same prostate cancer oncologist for 15 years. He understands that a one size fits all approach to all things relating to PC is a recipe for disaster. I can’t begin to tell you how many men I know that opted for early aggressive treatment that had their lives ruined. My doc looked at a psa of 6, small quantity of Gleason 8 and advised 4 months ADT along with beam radiation. I had this done at a COE, and took 5 doses of ADT. My treatment is finished. With last dose of Firmagon in Feb 2026. If I had recovered testosterone naturally, what would be your advise? I have not, so TRT was advised by my oncologist, that I have trusted for 15 years.

@ecurb If you are a believer in Mark Scholz, as I am, then you should watch this PCRI video, starting at the 10 minute point. Watch for two minutes and you will learn his take on TRT after completing ADT treatment. You will learn that he does not differentiate between natural restoration of testosterone after ADT and TRT after ADT. he does not mention any waiting period of 2-5 years. How absurd!

@jim18

I read that article. It is important to note that it was co-authored or at least edited by the publisher, who was not Mark Scholz. Some of the info contained in article directly conflicts with the PCRI video by Dr.Mark that I posted above. Watch starting at the 10 minute point. What I like about this man is that he isn’t part of the group-think guideline following institutions. Every man with PC has his own unique situation, and strictly following guidelines can lead to very bad outcomes. The urologist that diagnosed me 16 years ago would have had me on the operating table a week later, had I freaked out and told him…
Get the Cancer out. I know men that did just that, and it was disastrous.