Anyone here after ADT undergone TRT

Your RO is considering the status of your disease to ensure there are no potential issues before considering TRT.
>?What was the status of your disease pre-treatment, and what is the status of your disease now?

Fatigue is my issue too after 6 months stoppage of ADT. Testosterone is 20 a week ago.

See the article attached. Perhaps share with your doctor. I'm in a similar boat, at 18, but no treatment yet. Can't wait to get back on TRT.

I was Gleason 9 PSA 13.6 cancer confined to the gland. Testosterone 328 age 88..
Now PSA 0.05 Testosterone 65.

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.)

One reason to wait a year is that once you start using TRT your body won't make it naturally, or will have a more difficult time making it naturally. I'm in that position now--it's been a year since six months of Orgovyx but my T has not recovered. The medical oncologist told me he's fine with me supplementing T at this point if I choose but my radiation oncologist advised against it so I have to decide. It's kind of a rock and a hard place--with hypogonadism I feel crappy and my bones are going to hell but I'm also terrified that starting T might reignite the cancer.

Yes I was doing resistance training with a personal trainer twice a week at LA Fitness for a year before I was diagnosed PC. After the radiation I am doing Resistance training with a trainer 3 times a week. I didn't lose any muscle mass.
My PCRI oncologist suggested to stop ADT after 9 months when my PSA was 0.05 but my RO at UCLA to stay on it it for 12 months.
My PSA later dropped to 0.02 and T was 8!

I waited a year after 4 months of Orgovyx, then started TRT (2 pumps 1.62) along with 10mg daily Cialis as my T levels had not fully recovered. After 3 months, my T levels were back to normal, no change to PSA and, of the big 4 side effects I track:
- Strength/Energy: noticeably improved
- Belly Fat (visceral): little to no change
- ED: slight improved 80% of normal
- Hot flashes: no change, they continue
I then reduced the T dose to one pump and daily Cialis to 5 mg. I noted little to no change in side effects.

My hope was to wean off all drugs, however, I'm going to stay with the current plan a while longer. Of course, my PSA and several other lab tests are done quarterly. It really ticks me off that I still get hot flashes going on two years after only 4 months of Orgovyx. That drug has a very nasty side to it.

I am in a clinical trial of no ADT, but I did have to cease TRT, leading to pretty low T, but not down to "castrate" level. I appreciate the article link above.

I had Gleason 9, but all other risk markers including DECIPHER were good. I had 70Gy 28 fraction proton radiation to the intact prostate and seminal vesicles.

But of course I wonder if I made the right decision - to join the trial. and thus avoid ADT And I do not eagerly await my first post radiation treatment checkup in a month. I have read that PSA trajectory after radiation of intact prostate can be way different than post RP.

I have most of the symptoms normally associated with ADT. My hot flashes seem to have faded, but night sweats are a real problem, ditto strength and energy, ED, etc.

I asked my RO at UCLA what if I don't go through ADT. He said ADT makes radiation more effective. He also said if don't go through the chances of cancer recurrence is 50%. He said ADT cuts it down by half. That is significant.