TESTOSTERONE SUPPLEMENTATION AFTER RADIATION AND FIRMAGON

Once we are in the club our decisions exist within certain boxes, we can never be exactly as we were. We can live satisfying and good lives but with new limits and considerations. Every treatment that we decide to take has a risk profile, something is given up for the perceived benefit of the treatment, it is not free. The choice is not perfect. You are the only one that knows what is most important to you. Once you are presented with the options only you and your family will know what decision is the best fit. I hear, "that cancer must come out I can't live with any cancer inside me"! Others prefer watchful waiting, leave it alone if a low level threat. Same cancer, 2 different families.

ADT by its design pushes the cancer back by depriving the growth mechanism of testosterone. For most men this works for a period of time and then it slowly stops working so complete blockaid is added for the residual androgens elsewhere and then on to other things. Your doctor may know the answer to this because I don't - is there any data on cancer that is completely undetctable but now back in an environment flooded with testosterone, its main fuel. On paper, there is certainly a risk of starting everything back up. only you know what the biggest motivator is for you - getting back to baseline while risking recurrance or optimizing the possibility of remission and putting up with the side effects. Play both movies forward to the conclusion in a thought experiment and see which one feels right to you.

If it were me and I was in remission with the possibility of decades ahead I don't think I would risk it. If I was closer to the end I might want one last shot at my old self. It also depends on your surroundings - job, wife, kids. I just lost my wife, kids all moved away. My calculation might be very different than yours.

Half the battle is getting our heads right and making adjustments after acceptance. Don't give up fighting but don't let the bandit as its called here take evrything from you.

George

Artie

Exactly how I see it.

George

Hi,

I wonder if TRT would be that bad in your case. I think that you could try it under periodical vigilance, because of the long period in remission. However, you could also try to find the reason behind your lack of testosterone and start by treating it (if any).

As we age, our body changes the way it uses hormones.  That Michelin tire created arround our waist is made up of estrogens that, by itself, have been produced from testosterone, reducing the stuff. . The most evidence of its existence is when we lose our six packs and see it being replaced by a menopause belly. The estrogens storage depot is the tummy.

You can try increasing testosterone with a diet proper to counter the production of estrogens, accompanied with a series of physical exercises. Vitamin B5, B6 and B12 seem to be influential in the production of testosterone. You may aquire them naturally by changing your diet. https://www.medicalnewstoday.com/articles/323224

https://universityhealthnews.com/daily/aging-independence/8-surprising-high-estrogen-symptoms-in-men/

https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056

Hope this helps in your regaining of quality of life.

Best

VG

Jeremy,

Firstly I want to congratulate you for the remission status your cyberknife treatment managed to accomplish. The long period it took to lower the PSA is typical in PCa radiation therapies. One could also think that the low testosterone helped in lowering the PSA but I believe that it’s all due to the CK's good work. I don’t think that CK is associated with the low testosterone (T) or low thyroxine (T4).

I wonder if you have an endocrine system disorder. The testosterone produced by the testis and the T4 produced by the thyroid are regulated by the good function of the pituitary in delivering the LH (FSH) and TSH to these organs respectively. To have both decreasing makes me think that the pituitary is the problem. Can you tell us if CK was combined with hormonal treatment (ADT)?

The fact is that ADT causes havoc at the hypothalamus/pituitary and some guys do not recover from the it's side-effects which are related to a pituitary disorder. That could also be behind your experiencing brain fog. Even if you had no ADT, I would recommend you to check the levels of LH and TSH, including the thyroid’s triiodothyronine (T3) which controls the rate at which the body uses energy. All the symptoms you describe above seems to interweave the same problem. 

Testosterone is produced from cholesterol and the estrogens (behind fatty belly) are produced from testosterone decreasing the amount in circulation. You need to include these proteins in your next blood test. Another aspect in your health history as described in your post, is the calcium deposits and high BP that could deteriorate the kidneys function. Get it checked too.

You may be interested in reading our comments in this link;

https://csn.cancer.org/node/323832

Welcome to the board.

Best wishes,

VGama 

Artie,

I am not a doctor to provide you sound advice in regards to your issue with low testosterone. I believe that low T is caused by several factors that go from the age of the individual,  diets, life style, other health issues and particularly the medication he/she is taking. You need to do your own researches  and follow your instincts. In my case I am taking Zocor (simvastatin 20 mg) daily but in intermittent periods of 3-months on/off.

20mg is the lowest dose available and, together with my life style, diet and other medications, it managed to be enough to control and keep the cholesterol close to 165 mg/dL.

In my researches I found that statins can be good but also bad. Though the effects of statins differ among them, one should verify each characteristics and side-effects in detail so that we choose the best to our cases, changing medication if required. Simvastatin lowers both, the cholesterol and the testosterone. It increases creatinine and causes muscle cramps. For certain extent it also leads to low libido and other typical effects of hypogonadism like fatigue. At one time I thought in changing it to Crestor (very expensive rosuvastatin recommended by Dr. Myers) as it helps in avoiding some of the typical statin effects but after one box of pills I returned to simvastatin. 

I recall back in 2003 (third year post RP) when the GP recommended me Adalat 30 medication for blood pressure. I was taking at the time daily 100mg aspirin together with a supplement of selenium. In 2009 another GP recommended me adding a statin pill which was thought to fight PCa. This was at the third year after RT when the PSA started to increase indicating treatment failure. 

I knew that I was going to start ADT so it took me to deeply research on drugs effects and interactions. After discussing with the uro-oncologist treating my PCa he decided to have ADT without statins. I started simvastatin much later by the end of 2013 when the cholesterol  increased to 240ng/dL. Meanwhile, kidney function deteriorated reaching the level of stage 3. The  nephrologist's opinion was that ADT and BP were to blame. Though Adalat kept BP within the normal parameters, he changed this medication with the combi Valsartan 80mg + Hydrochlorothiazide 12.5mg. He wasn’t worried with the simvastatin effects on the creatinine levels.

My opinion is that the statin is decreasing my testosterone (now at 342 ng/dL) which may have some influence on the PSA level too. I would recommend you to check any influence caused by the statin you are taking, if any. You may try changing it to verify if the situation improves. 

Best,

VGama