How to know when to increase TRT

R

rrjames8

New member
Here are the questions I'm dealing with:
Do I increase my testosterone?
What is everyone's opinion about possible negative side effects? I don't want boobs. I purchased some for my wife and I'm happy with that set. Don't need another.
Is one product or modality (patch, gel or shot) better than another or are they all roughly the same?

Here's the rest of the story:

I don't know how long my testosterone was low. I do know that I had a prostatectomy a little over 2 years ago. I started testosterone replacement therapy (TRT) about 3 months ago. I was actually worried about keeping my job. I couldn't focus at all. I told my wife I was concerned so she recommended I get my T tested which was a good thing. I'm in my mid-40's and my first test came back with my Total T at 111. I'm not sure how low someone can go but I was obviously very low.

I began using Testim 50MG 1%. After the first month my Total was 243 and Free 8.2. At 3 months, which is recent, my results came back at Total 288 and Free at 7.7.

Ultimately, I'm much more focused. I couldn't even focus enough to write this effectively before I started TRT. I talked it over with my doctor. He is okay if I move up in dosage. I'm not sure how much more of my body I want to cover in Testim. I got use to the odor and stickiness. I don't mind it now but can't imagine doubling the amount I put on.

Appreciate your input.
 
For me the testim seemed to stop working after a few months despite going up In doses three times.
I was much happier with the injections. Watch your test levels including estrogen and of course go by how you feel too. I have little ones which was a fear for me with gel and how I got my primary to say yeah the shot would be better option. With the dosing he had me I became a giant yo yo with my T and estrogen levels. I was s an emotional wreck and still no concentration all but a few days things seemed less hazy. Switching the injections to twice a week and an Aromatase inhibitor (AI) is really starting to make a big diffence for me and I am surprised at how quickly too.
 
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Depends on how u feel, what ur test lvl is and how u and ur doctor what to treat it. I just went on Hormone Replacement Therapy (HRT) recently. 200mg every 2 weeks isn't gonna cut it. I still feel like shit. Most general practitioners aren't going to treat it aggressively. I'm only 35. I'd rather my test level b closer to 1200 than 200, which r the high and low ends of normal. If ur doc hasn't already, have him write a consult order for an endocrinologist that specializes in male hrt. Depending on what he finds, he/she may put u on hgh and cycle u on and off Human Chorionic Gonadotropin (HCG) and steroids. Good luck, low T is the worst feeling.
 
Appreciate the info. An endo won't touch me though. With prostate cancer there's the old school of thought and the new school of thought. The old school is that adding testosterone could be adding fuel to the cancer. The new theory is that you can treat low T but you need to monitor it. Urologists tend to handle the latter. I spoke with my endo and he politely refused. My urologist is very modern and open to whatever I want. What I want is to feel better without any nasty side effects.
 
rrjames8 said:
Appreciate the info. An endo won't touch me though. With prostate cancer there's the old school of thought and the new school of thought. The old school is that adding testosterone could be adding fuel to the cancer. The new theory is that you can treat low T but you need to monitor it. Urologists tend to handle the latter. I spoke with my endo and he politely refused. My urologist is very modern and open to whatever I want. What I want is to feel better without any nasty side effects.
Click to expand...

Some theorize that it is high estrogen levels in men that affects the prostate -- not testosterone.

As for protocol, most guys prefer inejections over creams/gels. And it is cheaper. And no risk of transfer to your wife/kids.

Test can aromatise into estrogen. So you need to check you estradiol levels frequently. You Total Test is still way too low. I am not doubting you feel a lot better considering where you started, but you can feel a lot better still. You need to get more test to get into the normal range for your age. Just watch your estradiol like I said before and take and Aromatase inhibitor (AI) if you require it.

Also watch you hematocrit. Donate blood if it starts getting too high.

God luck!
 
Megatron28 said:
Some theorize that it is high estrogen levels in men that affects the prostate -- not testosterone.

As for protocol, most guys prefer inejections over creams/gels. And it is cheaper. And no risk of transfer to your wife/kids.

Test can aromatise into estrogen. So you need to check you estradiol levels frequently. You Total Test is still way too low. I am not doubting you feel a lot better considering where you started, but you can feel a lot better still. You need to get more test to get into the normal range for your age. Just watch your estradiol like I said before and take and Aromatase inhibitor (AI) if you require it.

Also watch you hematocrit. Donate blood if it starts getting too high.

God luck!
Click to expand...
^ Pretty much this. The answer to your question is: NOW. You definitely sound like a guy that's not responding to the transdermal, so it might just be time to take that step into injections which (I'm biased) are a MILLION times better. You're still at very low levels and your estrogen/DHT will see a greater increase due to the manner in which testim works with your skin as it travels through your fatty subcutaneous layer on its way into your bloodstream - which is where you store your aromatase enzyme, which creates estrogen.

I'd suggest talking to your doctor about this and see what they say. Keep in mind that even though they have that MD, they may be quite clueless when it comes to male hormone therapy. I've literally had a doctor tell me that estrogen doesn't matter when it comes to men as we urinate out the excess so it can't build up in us. Needless to say, that doctor was not hired. ;)

If money is not an object, I would definitely suggest looking into the folks here at Increase My T as they most certainly appear to have both experience and knowledge when it comes to TRT. I've learned quite a bit from these guys, so I'd bet that they will be more than able to manage your care.

My .02c :)
 
I'm a cancer survivor also. Sucks ur endo won't touch u. C whoever and do whatever to get the help u need. My chemo killed my sack. I had some seriously rare and deadly cancer they there everything at. I survived. My nuts, not so much. As of writing this, I do not believe there is any documented link in any medical study between steroids and cancer let alone Hormone Replacement Therapy (HRT) and cancer, in men. Correct me if i'm wrong, I'd like to read the study. Uro, endo, gen, doesn't matter as long as u get treated. I don't believe a uro would b confident enough to go the hgh route though. Suffered massive depression the last 3 years. Just happy to get diagnosed and some help, finally. Hope u get the right help as well
 
Two tubes always, one shuts you down and your about where you started but from the supplemental test
Get the doc to bump you up, two will bring you to 600
 
halfwit said:
^ Pretty much this. The answer to your question is: NOW. You definitely sound like a guy that's not responding to the transdermal, so it might just be time to take that step into injections which (I'm biased) are a MILLION times better. You're still at very low levels and your estrogen/DHT will see a greater increase due to the manner in which testim works with your skin as it travels through your fatty subcutaneous layer on its way into your bloodstream - which is where you store your aromatase enzyme, which creates estrogen.

I'd suggest talking to your doctor about this and see what they say. Keep in mind that even though they have that MD, they may be quite clueless when it comes to male hormone therapy. I've literally had a doctor tell me that estrogen doesn't matter when it comes to men as we urinate out the excess so it can't build up in us. Needless to say, that doctor was not hired. ;)

If money is not an object, I would definitely suggest looking into the folks here at Increase My T as they most certainly appear to have both experience and knowledge when it comes to TRT. I've learned quite a bit from these guys, so I'd bet that they will be more than able to manage your care.

My .02c :)
Click to expand...

The folks here at "Increase My T"? Who is this group? I did a search but didn't find anything.
 
bigirishbstard said:
I'm a cancer survivor also. Sucks ur endo won't touch u. C whoever and do whatever to get the help u need. My chemo killed my sack. I had some seriously rare and deadly cancer they there everything at. I survived. My nuts, not so much. As of writing this, I do not believe there is any documented link in any medical study between steroids and cancer let alone Hormone Replacement Therapy (HRT) and cancer, in men. Correct me if i'm wrong, I'd like to read the study. Uro, endo, gen, doesn't matter as long as u get treated. I don't believe a uro would b confident enough to go the hgh route though. Suffered massive depression the last 3 years. Just happy to get diagnosed and some help, finally. Hope u get the right help as well
Click to expand...

There is a believed link to testosterone and prostate cancer. Over 2 years ago when I first got tested for low T, I was told I had to have my PSA checked. Its then that they discovered the cancer and they will not give you testosterone if you have prostate cancer. Its fuel to the fire. Interestingly though, someone else pointed to the idea that it could also be linked to higher estrogen. Either way, with prostate cancer you can't do TRT. The rule is that you then have to be cancer free for 2 years before they will consider TRT.
 
Just click on their link on the right. They will talk to you and give you ad idea of what they can offer in your situation. They have several peope on the forums you can pm too but at this point your post count isn't high enough to send pm's. I have talked to several places and IMT was the most helpful in terms of offering advice & help without doing the pay or we can't talk to you like many do. They were about the cheapest I've found too. It isn't cheap, but its a life changer and at least I am able to flex it, in my situation. I wish I had done it sooner. I am already feeling a big change.
 
rrjames8 said:
There is a believed link to testosterone and prostate cancer. Over 2 years ago when I first got tested for low T, I was told I had to have my PSA checked. Its then that they discovered the cancer and they will not give you testosterone if you have prostate cancer. Its fuel to the fire. Interestingly though, someone else pointed to the idea that it could also be linked to higher estrogen. Either way, with prostate cancer you can't do TRT. The rule is that you then have to be cancer free for 2 years before they will consider TRT.
Click to expand...

I'm a PCa survivor - 12 years. I dealt with low libido for years because of the PCa Testosterone linked. For a few years, my Uro told me it would not be a good idea to do TRT. However, through frustration I kept researching and eventually learned that Dr. Morgentaler (Harvard) and others have successuflly challenged this PCa - T link. I went back to my Uro in 2011 and learned he also knew about this change in theory. He had no problems whatsoever putting me on TRT. I did lots of research to ensure I was comfortable going forward, including PMing with doctors and even someone who had active PCa. Obvioulsy, I chose to go on testosterone replacement therapy (TRT) and have kept an eye on my PSA diligently without incident. I'm not saying go on testosterone replacement therapy (TRT), but make sure you know the latest facts and don't just take no for an answer for those medical "professionals" who are still misinformed. Google Morgentaler prostate cancer testosterone - that will get you started off very well in learning all the most current info on the PCa-T link.
 
Lindsay IMT Staff said:
Send me an email :) lindsay@increasemyt.com
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I don't know how he did a search and didn't find anything........... there are threads everywhere from us lol

BTW here is some reading for you sir.

A 52-year-old male with elevated serum prostate-specific antigen (PSA) level, moderate lower urinary tract symptoms (LUTS), and negative family history of prostate cancer is found to have adenocarcinoma of the prostate with negative bone scan. Following radical retropubic prostatectomy and satisfactory postoperative recovery, heretofore undetectable serum PSA level rose 35 months later. Digital rectal examination (DRE) and bone scan were negative. Adjuvant external beam radiation preceded by a 3-month injection of goserelin was initiated. Radiation was well tolerated, although the patient reported significant loss of libido, hot flashes, and depression warranting antidepressant medication. Failure to respond to this intervention led to initiation of supplemental testosterone; 1 month later, the patient reported significant relief of symptoms. The patient is currently successfully tapering use of supplemental testosterone in order to decrease andropause symptoms and to permit restoration of intrinsic testosterone.
Click to expand...

Testosterone Replacement Therapy for a Man with Prostate Cancer

Study suggests another look at testosterone-prostate cancer link

BOSTON The long-standing prohibition against testosterone therapy in men with untreated or low-risk prostate cancer merits reevaluation, according to a new study published in The Journal of Urology.

"For many decades it had been believed that a history of prostate cancer, even if treated and cured, was an absolute contraindication to testosterone therapy, due to the belief that testosterone activated prostate cancer growth, and could potentially cause dormant cancer cells to grow rapidly," says Abraham Morgentaler, MD of Men's Health Boston. "Generations of medical students and residents were taught that providing testosterone to a man with prostate cancer was like pouring gasoline on a fire."

This study, involving 13 symptomatic testosterone deficient men who also had untreated prostate cancer, suggests this traditional view is incorrect, and that testosterone treatment in men does not cause rapid growth of prostate cancer. It is the first to directly and rigorously assess changes in the prostate among men with prostate cancer who received testosterone therapy.

The men received testosterone therapy while undergoing active surveillance for prostate cancer for a median of 2.5 years. Median age was 58.8 years. The initial biopsy Gleason score was 6/10 for 12 of the men, 7/10 for the other (Gleason score grades the aggressiveness of prostate cancer by its microscopic appearance on a scale of 2-10. Gleason 6 is generally considered low to moderately aggressive, and Gleason 7 moderately aggressive).

Mean testosterone concentration increased from 238 to 664 ng/dl with treatment, yet neither prostate specific antigen (PSA) concentrations nor prostate volume showed any change. Follow-up biopsies of the prostate were performed in all men at approximately yearly intervals, and none developed cancer progression. In fact, 54 percent of the follow-up biopsies revealed no cancer at all.

Although the number of men in the study was small, and none had aggressive or advanced prostate cancer, Morgentaler observed, "These men were rigorously followed. The cancers in these men were typical of the prostate cancers for which men have undergone invasive treatment with surgery or radiation for 25 years. Clearly, the traditional belief that higher testosterone necessarily leads to rapid prostate cancer growth is incorrect."

In a Journal of Urology editorial comment, Martin M. Miner, MD, of the Miriam Hospital and Warren Alpert School of Medicine of Brown University notes the conclusions represent "a remarkable shift in thinking from only five years ago. If testosterone therapy was not associated with disease progression in men with untreated prostate cancer, how concerned must we be about testosterone therapy in men with treated prostate cancer?"

"An increasing number of newly diagnosed men with prostate cancer opting for active surveillance, and with many of them also desiring treatment for their signs and symptoms of testosterone deficiency, the results suggest a reevaluation of the long standing prohibition against offering testosterone therapy to men with prostate cancer," says Morgentaler.

Refraining from testosterone therapy due to unmerited prostate cancer fears may have adverse lifestyle and health consequences, since testosterone therapy in testosterone deficient men has been shown to improve symptoms of fatigue, decreased libido, and erectile dysfunction. Testosterone therapy may also improve mood, blood sugar control, increase muscle, decrease fat, and improve bone density. Four recent studies have shown that men with high testosterone levels appear to live longer than men with low levels, although it has not yet been shown that treating men with testosterone increases longevity.

Morgentaler commented on an Italian study that showed that low levels of testosterone were associated with aggressive prostate cancer. The risk of aggressive cancer was reduced for men with normal testosterone compared with men with low testosterone.

In an editorial in the journal Cancer, "Turning Conventional Wisdom Upside Down: Low Serum Testosterone and High-Risk Prostate Cancer Morgentaler wrote, "After seven decades of circumstantial evidence pointing us in the wrong direction, perhaps it is time to consider the once unthinkable ***8211; conducting a testosterone therapy trial of sufficient size and duration to determine whether normalization of serum testosterone in older men many reduce the risk of prostate cancer, particularly high-risk prostate cancer."
Click to expand...

Study suggests another look at testosterone-prostate cancer link

^^^ that is on men with untreated prostate cancer.

As far as I am aware, a casual relationship between testosterone and any type of cancer has never been proven.
 
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Very useful article. thanks for posting

IMT staff said:
I don't know how he did a search and didn't find anything........... there are threads everywhere from us lol

BTW here is some reading for you sir.



Testosterone Replacement Therapy for a Man with Prostate Cancer



Study suggests another look at testosterone-prostate cancer link

^^^ that is on men with untreated prostate cancer.

As far as I am aware, a casual relationship between testosterone and any type of cancer has never been proven.
Click to expand...
 
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