62 y.o. High PSA, TRT?

[Artyi]

Hi guys!

As I'm on testosterone replacement therapy (TRT) myself, my dad did some blood work on his own, to check is he OK while being 62 years old. He is training a lot, found a new girlfriend who is a little bit younger and wants to make gains and feel more young.

So his results were these:

LH - 2.43 mIU/ml
FSH - 1.86 mIU/ml
E2 - 114 pmol/l
Testo Serum - 13.1 nmol/l
SHBG - 29.8 nmol/l

But the PSA is terrible and I'm worried a lot - 4.42 ng/ml

As I understand he is not good to go with testosterone replacement therapy (TRT) with such PSA result.
But if PSA was OK, he has a high E2 and low Testo where he could obviously do some light TRT.
I thought that he can take same Aromatase inhibitor (AI) - 0.5mg E7D and see what happens. Which will raise some testo and lower e2, but what about his PSA?

I would really appreciate your answer, until he will talk to his urologist. But the problem is that in our country (Lithuania), nobody cares about testosterone replacement therapy (TRT) as possibility to live better life.

Thank you in advance.

 

[theguy9129]

Prostate-Specific Antigen (PSA) Test - National Cancer Institute

thers a link for you. But I would look into that farther. But as far as your father whats his goals and ambitions. I mean afterall he is 62 not 40 anymore. Im sure he would get a boost, but if he has high PSA this may make it worse.

 

[RedLang]

His E2 is good mate (114pmol = 31pg/ml). If he takes an Aromatase inhibitor (AI) he will tank it.

Best to wait and see what the uro wants to do. They should do a follow up blood test, then a digital probe, then maybe a biopsy to check for PC.

Prostatitis and infections can increase the PSA.

 

[THE-DET-OAK]

Hi guys!

As I'm on testosterone replacement therapy (TRT) myself, my dad did some blood work on his own, to check is he OK while being 62 years old. He is training a lot, found a new girlfriend who is a little bit younger and wants to make gains and feel more young.

So his results were these:

LH - 2.43 mIU/ml
FSH - 1.86 mIU/ml
E2 - 114 pmol/l
Testo Serum - 13.1 nmol/l
SHBG - 29.8 nmol/l

But the PSA is terrible and I'm worried a lot - 4.42 ng/ml

As I understand he is not good to go with testosterone replacement therapy (TRT) with such PSA result.
But if PSA was OK, he has a high E2 and low Testo where he could obviously do some light TRT.
I thought that he can take same Aromatase inhibitor (AI) - 0.5mg E7D and see what happens. Which will raise some testo and lower e2, but what about his PSA?

I would really appreciate your answer, until he will talk to his urologist. But the problem is that in our country (Lithuania), nobody cares about testosterone replacement therapy (TRT) as possibility to live better life.

Thank you in advance.

Keep in mind high PSA just means he needs to get a biopsy, this does not necessarily mean he has cancer. Once he has done that and there is no cancer some studies have actually shown that healthy physiological levels of testosterone may actually reduce his risk.

He will need to be monitored closely during the first 6 months of his treatment.

Dr. Morgentaler: Well, the question, if I hear you right, is if the man has PIN and the PSA rises, what do you do? And I would say that the answer is the same whether the man has PIN or not and whether the man is on testosterone or not. If a man has a rising PSA, it is a reason to do biopsy period for every man on testosterone or not. And of course we have to be careful, but remember that the PSA change that we see with testosterone replacement therapy happens very early within a couple of months and it gets the level of eugonadal men and no more and then the changes that we see, we saw some of the Nebido® study before and some of the other ones, there is very little rise in PSA after the initial six months. Let***8217;s remember: we worried about prostate cancer. PSA for us is just a reason to do a biopsy. So once you do the biopsy and there is no cancer, all you can do is follow him and that is his new base line and I do that for my patients who are not receiving testosterone therapy, too.

Choosing the right patient for testosterone replacement therapy

 

[THE-DET-OAK]

Abstract

OBJECTIVE:
To assess prostate-specific antigen (PSA) levels in hypogonadal men after testosterone replacement by three different methods and attempt to determine any possible relationship between hypogonadism and prostate cancer in this study population.
METHODS:
A total of 90 consecutive men who had erectile dysfunction and were found to have hypogonadism were monitored with digital rectal examination (DRE) and measurement of PSA levels before and after testosterone replacement therapy. The patients were treated with one of three options: (1) testosterone enanthate by intramuscular injections, 200 or 300 mg every 2 or 3 weeks (N = 25); (2) testosterone nonscrotal patches, 5 mg daily (N = 16); or (3) clomiphene citrate, 50 mg orally three times a week, in patients with functional secondary hypogonadism (N = 49). Treatment was continued for 2 to 3 months, after which PSA levels were reassessed. Patients with suspicious results on DRE and increased PSA levels before or after treatment with testosterone underwent prostate biopsy. For statistical analysis, patients were categorized into two age-groups--40 to 60 years old and 61 to 80 years old.
RESULTS:
With all methods of testosterone replacement, PSA levels increased in both age-groups. Endogenous testosterone elevation from clomiphene stimulation raised PSA levels the highest, and testosterone patches yielded the least PSA response. Ten men underwent biopsy of the prostate. In one patient, a nodule was found on DRE; the other nine men underwent biopsy because of suspicious PSA levels. Of these patients, two were found to have adenocarcinoma, and a third man who underwent rebiopsy was also found to have cancer. Therefore, 3 of the 90 patients (3.3%) had prostate cancer.
CONCLUSIONS:
PSA levels increased in response to all types of testosterone replacement, regardless of whether the testosterone level was raised endogenously or exogenously. PSA levels are inappropriately low in hypogonadal men and may mask an underlying cancer. Determining PSA levels before and after testosterone treatment is recommended. Elevated PSA levels before or after testosterone therapy should prompt performance of a urologic evaluation for possible prostate biopsy.

Testosterone treatment in hypogonadal m... [Endocr Pract. 2000 Mar-Apr] - PubMed - NCBI

 

[2rude4u]

Hi guys!

As I'm on testosterone replacement therapy (TRT) myself, my dad did some blood work on his own, to check is he OK while being 62 years old. He is training a lot, found a new girlfriend who is a little bit younger and wants to make gains and feel more young.

So his results were these:

LH - 2.43 mIU/ml
FSH - 1.86 mIU/ml
E2 - 114 pmol/l
Testo Serum - 13.1 nmol/l
SHBG - 29.8 nmol/l

But the PSA is terrible and I'm worried a lot - 4.42 ng/ml

As I understand he is not good to go with testosterone replacement therapy (TRT) with such PSA result.
But if PSA was OK, he has a high E2 and low Testo where he could obviously do some light TRT.
I thought that he can take same Aromatase inhibitor (AI) - 0.5mg E7D and see what happens. Which will raise some testo and lower e2, but what about his PSA?

I would really appreciate your answer, until he will talk to his urologist. But the problem is that in our country (Lithuania), nobody cares about testosterone replacement therapy (TRT) as possibility to live better life.

Thank you in advance.

PSA testing is quickly losing the confidence of the medical community. It has been proven inaccurate and unreliable in many, many cases. If you are one of those that swears by PSA levels his is not over by much and PSA levels fluctuate by more than a pt.

NEVER ALLOW A BIOPSY BASED ON 1 PSA TEST. There should be a series of at least 3 PSA tests over the course of 60-90 days. If they continue to increase without explanation such as BPH then he may want to consider a biopy, but he needs to understand fully the riskd associated with it.

 

[Artyi]

His E2 is good mate (114pmol = 31pg/ml). If he takes an Aromatase inhibitor (AI) he will tank it.

Best to wait and see what the uro wants to do. They should do a follow up blood test, then a digital probe, then maybe a biopsy to check for PC.

Prostatitis and infections can increase the PSA.

I see. And what is the normal level of E2? Because mine is pretty high - 177 pmol/l. I started taking AI: 0.5mg E7D. How low should I go with it?

PSA testing is quickly losing the confidence of the medical community. It has been proven inaccurate and unreliable in many, many cases. If you are one of those that swears by PSA levels his is not over by much and PSA levels fluctuate by more than a pt.

NEVER ALLOW A BIOPSY BASED ON 1 PSA TEST. There should be a series of at least 3 PSA tests over the course of 60-90 days. If they continue to increase without explanation such as BPH then he may want to consider a biopy, but he needs to understand fully the riskd associated with it.

Yes, that what I told my dad and he is really scared with a biopsy, so he is not going to do that right away. We already talked with him about PSA results and planned next 4 blood tests every 30 days. Also, he made an appointment with a urologist.

I hope he will be fine and we will start a light testosterone replacement therapy (TRT) for him.

 

[theguy9129]

I see. And what is the normal level of E2? Because mine is pretty high - 177 pmol/l. I started taking AI: 0.5mg E7D. How low should I go with it?



Yes, that what I told my dad and he is really scared with a biopsy, so he is not going to do that right away. We already talked with him about PSA results and planned next 4 blood tests every 30 days. Also, he made an appointment with a urologist.

I hope he will be fine and we will start a light testosterone replacement therapy (TRT) for him.

Like said i would et multiple test. But I wouldnt be scared of a biopsy because if there is a problem, better to find it now then later

 

[Juice.Monkey]

I see. And what is the normal level of E2? Because mine is pretty high - 177 pmol/l. I started taking AI: 0.5mg E7D. How low should I go with it?

What is the Aromatase inhibitor (AI) and why E7D? What was your Testosterone level at the time of the Test?

Also, I've read the its a combo of both elevated DHT and E2 levels that are needed to cause elevated PSA results and/or enlarged prostate.

Lower E2 levels and it may improve prostate health.

It also wouldnt hurt to take some Saw Palemetto or some other prostate OTC supplement. Its been awhile since I've researched exactly how it works but if I remember correctly Saw palmetto blocks DHT from attaching to receptors at the prostate.

Det-oak can probably elaborate further.