Testosterone Replacement Therapy after 12months of Orgovyx and Radiati

Posted by ava11 @ava11, 6 days ago

By March 31st, 2026, it would be 12 months since I stopped Orgovyx and RT. My total Testosterone is 65 now and it was 87 few weeks ago.
My oncologist recommends TRT. But I am reluctant because of the cancer recurrence. He says the risk is same if my T goes up naturally or with TRT, based on new studies.
My main issues are occasional fatigue bouts lasts few seconds and prolonged exercise tolerance and changes in biomarkers.
Any of you have undergone TRT after ADT? What is your experience/
What happened when you stopped TRT. Did your T levels go down?

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Profile picture for seasuite @seasuite

I completed 4 months of Orgovyx two years ago. I still had/have nasty side effects, including hot flashes, visceral fat, weakness and mild ED. I started TRT about 8 months ago, on advice of several Urologists and ROs. My T level rose from 250 to over 400, but, the side effects never stopped. I've been tapering off TGel and now only take 1 pump every other day since it doesn't cure my issues with this AWFUL drug that has seemingly rewired my hormonal system. My urologist also said that taking TGel will reduce my ability to produce it naturally. I've exhausted all the urologist paths having seen 3 from two different institutions. I have an appointment with endocrinology next to see if they can shed some light on the mystery. The Orgovyx side effects have been far worse than those from RT.

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@seasuite I gather than four months is very much on the short side of duration usually involved with Orgovyx, so your report is doubly interesting. I am curious about TRT especially when natural recovery is not seen.

Might I ask your approximate age?

I gather there aren't any other preexisting medical issues that might also be involved?

Thanks.

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No worries Bro, I'll be 74 at the end of April. I eat a mediterranean diet and exercise daily. I ran a 5K while I was just starting Orgovyx. I haven't been able to run, even a 12 minute mile, since the 'crap' took over my system...as you can tell, I'm not happy with these life long side effects and would most likely not have taken the drug given my serious, but, highly speculative PCa diagnosis. 4 months is a very short prescription term.

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Profile picture for retireddoc @retireddoc

I was out on TRT when my T didn't recover 2 years after triple therapy for G9 oligometastatic cancer. Mt PSA was undetectable and remained so for a year after TRT. Last week it was 0.2. There is no way to know if my PSA would have gone up without TRT or not. I know my QOL was hugely improved with TRT.

I believe current research is showing that TRT does not cause PSA to rise in selected patients and is beneficial.

Here is the abstract from a recent review article:

Review Article
Open access
Published: 26 November 2025
Testosterone replacement therapy following definitive treatment for prostate cancer: a scoping review of safety and efficacy

John Gibson, Michael George, Peter Grice, Amar Mohee, Theodora Stasinou, Ian Pearce & Vaibhav Modgil on Behalf of Manchester Andrology Research Collaborative (MARC)
International Journal of Impotence Research (2025)Cite this article

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Abstract
Testosterone replacement therapy (TRT) remains controversial in men with a history of prostate cancer due to historical concerns regarding oncologic safety. This scoping review aimed to systematically map existing evidence on the safety and efficacy of TRT in men following definitive treatment for prostate cancer. A systematic search of PubMed, CENTRAL, and Embase identified 447 records, from which 12 studies met inclusion criteria. Most were retrospective cohort studies, with sample sizes ranging from 10 to 152 men. TRT was not associated with an increased risk of biochemical recurrence or cancer progression in any included study. Reported PSA kinetics remained within expected post-treatment parameters, and several studies showed lower recurrence rates in TRT groups compared to controls. TRT consistently increased total and/or free testosterone and improved hypogonadal symptoms.

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@retireddoc
Are there any studies for Gleason 9 biology, when it is safe to go on TRT? I am Gleason 9(4+5).
It appears most studies are on Gleason 7. It has been only 8 months since I stopped Orgovyx.
I want to be conservative and wait another 4 to 10 months before considering TRT.

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To the best of my knowledge, there are no specific studies regarding safety of TRT specific to Gleason score or even precise timeframe after cessation of treatment or length of undetectable PSA. For me, having a very experienced MO familiar with the literature/studies with his/her own database of treated patients can provide the best guidance. We (the patient) must weigh the QOL derived from TRT against the possibility that the testosterone will stimulate growth of any dormant prostate cancer cells. Tough call.

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Profile picture for retireddoc @retireddoc

To the best of my knowledge, there are no specific studies regarding safety of TRT specific to Gleason score or even precise timeframe after cessation of treatment or length of undetectable PSA. For me, having a very experienced MO familiar with the literature/studies with his/her own database of treated patients can provide the best guidance. We (the patient) must weigh the QOL derived from TRT against the possibility that the testosterone will stimulate growth of any dormant prostate cancer cells. Tough call.

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@retireddoc
In my case, it is even more confusing because of my age. I don't know how much of the low energy and fatigue is from low testosterone of 65 vs just getting older. I don't want to go through TRT and get very little or no improvement!
After I work out in the GYM for an hour with trainer with no problem and try to walk to a restaurant, it is a stop and go with low energy and fatigue. I am assuming that is from low testosterone not my age?

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I am 72 and have been very active my entire life. The 2 years I had testosterone near 0 I was very fatigued with little energy or enthusiasm. Hot flashes, muscle wasting, no libido (yes, that's still important to me), mental fog, mood swings and depression. I also wondered how much was age catching up to me vs. very low T.

The last year on TRT has been totally different. Hot flashes gone within a month, I have regained muscle and functional strength, my libido is back like it was years ago, my mood has brightened, the fog has lifted. My body hair has regrown and I have lost some fat around the middle and upper thighs. And this doesn't include the changes that I can't feel or identify. Like improved bone density and cardiovascular health. Like my MO at Hopkins told me right before putting me on TRT- "You are a 70 year old man living in a 90 year old body". And he was right.

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See article attached. As soon as I complete radiation, I will be back on TRT. There are numerous health risks of extremely low testosterone that in my non-medical opinion, far outweigh the risk of dying from prostate cancer that has been treated. See also the Protect T trials comparison of RP, radiation and doing nothing. You will be surprised by the findings. I'm a Gleason 4+3 and 3+4. If my decipher weren't .84 I would do nothing.

Shared files

Testo Replacement and PCa Article 4-29-25 (Testo-Replacement-and-PCa-Article-4-29-25.pdf)

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Profile picture for tk192 @tk192

See article attached. As soon as I complete radiation, I will be back on TRT. There are numerous health risks of extremely low testosterone that in my non-medical opinion, far outweigh the risk of dying from prostate cancer that has been treated. See also the Protect T trials comparison of RP, radiation and doing nothing. You will be surprised by the findings. I'm a Gleason 4+3 and 3+4. If my decipher weren't .84 I would do nothing.

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@tk192
Thank you for sharing the article. I am a patient of Mark Scholz. He is open for TRT for me. I am just hesitant since my symptoms are tolerable for me. He says if cancer comes back, we will treat it. Not so easy for me to accept that!
You say you will be back on TRT. Were you on TRT prior and you had cancer recurrence?

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