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What is a normal T-level?

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Purgatory
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Posted 2/5/2011 6:48 PM (GMT -8)
I hear a lot here about reducing T-levels, especially in controlling advanced PC, but just what is a normal T-level in a man?

I am sure it varies, like everything else, and I assume (guessing) that perhaps it naturally decreases with age.

Is it a hard fact that "T" does indeed directly feed cancer, prostate cancer in particular?

If a man had a much higher natural level of "T", would it or could it worsen the aggressiveness of his cancer?

I have never had mine tested, but never had a reason or never had it suggested.  Just curious.

David

 

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John T
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Posted 2/5/2011 7:33 PM (GMT -8)
Normal T is 300. T does feed prostate cancer that's why HT works as it reduces the T that the tumors feed on. In some cases the PC cells mutate and learn to live with very small amount of T. The vast majority of PC react very well to drugs that reduce T to very low levels. When on HT it is very important to monitor T levels often to insure that the proper levels are obtained. Many doctors just give a lupron shot and sent you on your way without knowing if it really reduced the T levels to a point where PC cells can't grow. According to Dr Strum that level is <20 ng/dl.
There is tons of evidence that T levels affect PC growth. Lupron by itself causes T flair for a short period of time and increased agressiveness can be seen on scans and felt as bone mets expand rapidly with the increase in T levels. Conversely lack of T shows tumor regression.

JT
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Arnie
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Posted 2/5/2011 7:47 PM (GMT -8)
David..you've probably read in my posts about supplementing "T" after I reached 2 yrs. post treatment with a PSA of <0.1.........my levels have been in the mid-300's since after my surgery. I had no reference point pre-surgery--mainly becasue I, like you, didn't have any complaints. ( in retrospect, though, I was probably declining and didn't really focus on that until I had a more precipitous decline 3 months after surgery).  I've immersed myself in researching the pros and cons of this as you can imagine........what I've learned is that most of us start experiencing a slow and steady decrease around the age of 40 at a 1-2% pace per year. Most, not all..........and what's "normal" for one man at any age, is not necessarily normal for another man at that age. Similarly, identical levels in one man won't produce the same symptoms (or lack of) in another. What was considered gospel up until recently (that  T automatically feeds cancer) has been turned on its head. There are now studies that indicate that having higher T levels protects not only against cancer, but against a host of other things as well (cardiovascular disease, etc.).......as T levels decline, incidences of PCa and other diseases increase as we age.

In answering your questons, I'll use me as an example---I've had no BCR in 2 years. My levels have fluctuated from 321-496 in that span. My uro has refrained from supplementing until now, aguing that raising T "might" feed any cancer cells. But the other side of that coin is at 350 or whatever, I've got enough T for cells to latch on to, and if that was true, why wasn't the uro lowering me to castration levels?-------no answer. Or if I had a level of 600, hypothetically, and had a BCR, we wouldn't be talking about lowering my levles to 350, we'd be talking about <50.

Will a higher level of natural T worsen PCa?--------I have a friend my age who had open prostatectomy 10 years ago. He's been undetectable since, but has T levels around 800. No complaints, and no attempts by his uro to lower his T-------I also realize that a man's pre & post treatment stats have to be considered as well.

I'm at day 15 of supplementation at .5 mg/ml of bioidentical testosterone. It's a very conservative dose, and I haven't experienced any sexual rushes, or surges of strength, and probably won't for a while as it takes time to build up endocrine levels. I think I do feel a little more clear-headed and a little less tired........also, it's really the free "T" levels that matter, and they can be affected by a bunch of other markers such as aromatase, SHBG, etc.--------I'll save getting into the weeds on that discussion for a more pointed thread. Just wanted to throw my two cents your way in answer to your questions.

Arnie in DE

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Skate
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Posted 2/5/2011 7:57 PM (GMT -8)

Very interesting information gentlemen.  Looking forward to reading more on the subject from yourselves and others.

Jack

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Purgatory
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Posted 2/5/2011 8:48 PM (GMT -8)
I also don't understand what the "flare" is all about? Is that a good or bad thing? Heard it mentioned here and was never sure.
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Fairwind
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Posted 2/5/2011 8:54 PM (GMT -8)
"Depending on the lab your doctor uses, male testosterone levels typically range between 250ng/dl and 850 ng/dl." Those are the low and high limits of "normal"..

The very first effective effective PC treatment was castration which lowered "T" levels to almost zero..Castration is STILL the most effective ADT as it generally achieves the lowest testosterone count. Lupron et.al. produce the same effect by preventing the testes from producing testosterone. However in some men (7%) they fail to work as desired and the "T" level never falls below 20 which is considered "good enough" for treatment purposes. I'll post a link in a minute..

www.prostate-cancer.com/hormone-therapy/side-effects/hormonal-side-effects-orchiectomy.html

Post Edited (Fairwind) : 2/5/2011 10:24:27 PM (GMT-7)

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biker90
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Posted 2/5/2011 9:48 PM (GMT -8)
Hey Purg,

I have to second what Arnie said. It is not at all clear that T causes recurrence after PCa treatment. I was on T replacement therapy for years before cancer. My level during that time was 500 - 650. After RRP my uro took me off T altogether as he was of that opinion that it would cause recurrence. My level dropped to 48 in a couple of months and I had severe depression, hot flashes and all the other signs of hypogonadism. I changed uros and got back on therapy and have been fine every since. That was in April 2007 and my PSAs have all been zero since surgery.

I did a lot of research on the web about the subject and found that, like every thing else with this disease, nothing is carved in stone. I take testosterone cypionate (200 mg once every 2 weeks) I was on twice that dosage but cut back last year to see if I could live with a lower level (now 375) The difference that I notice is less libido than with the higher dose.

Every patient is different and every doctor is different and there are many conflicting opinions about almost every aspect of PCa. Everybody MUST take charge of their recovery and find the stuff that works for them.

Good luck in your long struggle. You are hope for us guys that have had it a lot easier than you.

Jim
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Fairwind
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Posted 2/5/2011 10:04 PM (GMT -8)
If your surgery truly cures your cancer then boosting your "T" level would be harmless. But if the cancer is merely in remission boosting testosterone would be very risky business...
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zufus
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Posted 2/6/2011 3:41 AM (GMT -8)
Purg remember I pointed out from Strum's book about a real person who's know it all doc didn't prevent the flare thing, he died from complications to uters and then heart failure.
So, I hope that answers your question. Plenty of docs don't use casodex prior, perhaps we need another death to prove a point to them.   My uro-doc didn't give me casodex nor never mentioned it, I then added it on to ADT3, but with my high stats I could have been put at real risks for the flare thing.  I fired him later anyway, he had like 3 strike errors against him, I would have never known the reasons for strikes had I not  been proactive.  :-)

This started my question everything and all the time theory...which seems to work very well in PCa issues.

Post Edited (zufus) : 2/6/2011 4:50:03 AM (GMT-7)

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JNF
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Posted 2/6/2011 5:13 AM (GMT -8)
Once on is on ADT using the LHRH drugs like Lupron and Eligard, doe the flare recur with each dose? I have another 6 month injection of Eligard coming up in April. Should Cassodex be administered in advance to offset any flare, or does the flare only occur with the first injection? I am also on daily Jalyn.
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Skate
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Posted 2/6/2011 5:22 AM (GMT -8)
My doctor administered casodex two weeks prior to my first injection of Zoladex and two weeks after.  It is meant to prevent the T flare that occurs when the first injection occurs.  The body would suddenly produce vast amounts of T at the invasion of a substance that would stop it's production like Lupron or Zoladex. Casodex sets up a blockade to prevent the high rising T from feeding the PC.  It would be sort of like a feast for PC.  I won't need casodex again (I hope) as the Zoladex is doing it's job and I guess you would say the Zoladex settled in now.  That's what my DR. told me prior to starting HT.

 

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dkob131
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Posted 2/6/2011 5:49 AM (GMT -8)
 I did a fair amount of investigating the flair and here is what I found:  If the average T level  is 300 then after adminstering an inital shot of Lupron the T level spikes 65% on average plus whatever your normal reading is so if your leve was 300 to begin with then it will spike to around 505 over the next 6-7 days at that point it begins to drop back reaching whatever your baseline was at about 14 days.  From there it continues down in most guys to whatever your nadir is at the 30-35 day mark.

As you can see the flair could be really dangerous for someone with mets already.  If the Lupron is truly doing its job then the second injection shouldn't in theory cause a spike because your T level is so low to begin with.

As some of you know there is a new drug on the market that can be delivered without causing the flair, the issue as always is cost.  It immediately starts to drop your T level and has no spike affect.  The drug is called Dreglaulix or something close to that spelling.

David

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Skate
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Posted 2/6/2011 8:51 AM (GMT -8)

David

I believe that is commonly known as Firmagon as well (Degarelix)

Jack

 

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Purgatory
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Joined : Oct 2008
Posts : 25448
Posted 2/6/2011 9:13 AM (GMT -8)
Guys, a lot of well thought out answers. Sounds like having a flare is a high risk factor to me, like pouring gas onto a bonfire, perhaps I read too much into it.

Arne, you gave a lot of good info too, have to let some of that digest into my head. Zufus - your illustration was a good example too, I believe.

Just want to make sure that all you HT guys, I respect your own journey and your own courage to continue that way. We each fight out own battles in this terrible war called PC. Most of my ordeals the past 2 years were more physical in nature, and I am hoping I have ended that phase with this last surgery. Getting use to a perm. stoma, though, is till hard on my mind, I keep thinking one that that I can be reveresed, like some that have colostomies, but with a urostomy, its a one way ticket.

The only sex related issue I ever had pre PC, if it is really a problem, was I would have periods where I would be unable to complete and climax. Wood was never, ever an issue, but sometimes, despite a lot of fun trying, just not able to complete the act and have to walk away not finished so to speak. I use to joke about a wire in my head coming loose. I still have that issue on rare occassion post surgery, but definitely not as often.

I wonder if I should have a T level test, just as a bench mark. Does anyone think this makes anysense? None of my doctors have ever mentioned or brought up the subject.

David in SC
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Mitch128
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Posts : 83
Posted 2/6/2011 11:14 AM (GMT -8)
< I wonder if I should have a T level test, just as a bench mark. Does anyone think this makes anysense? None of my doctors have ever mentioned or brought up the subject>

David,

Last Thursday, while reviewing my latest blood panel results with Dr. Bill Koch (Powdersville Family Practice), my primary care physician, said my next test (in four months) should include a Testosterone level reading.

 

Following Orchiectomy on March 15, 2010, all my blood panel results, including the latest PSA of 0.02, fall in the normal range. Recognizing that, at some point, my PCa will reach the refractory stage, Dr. Koch thinks a "benchmark"  or "baseline" should be established for future reference. At that point I will again be under the care of medical oncologist Dr. Gary Spitzer, whom you know by reputation.

 

While the testosterone level test seems to be aimed primarily at those who have been surgically or chemically castrated, I personally think this test falls in the category of the more you know, the better decisions you can make regarding your own health care.

 

Hope this helps,

Mitch in SC

 

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compiler
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Posts : 7699
Posted 2/6/2011 11:51 AM (GMT -8)
This is all very interesting.

I'm a bit confused as I always understood that T feeds PC. That's why lupron can initially yield fabulous results.

Now some of you are saying not true?

Also, what is the difference between lupron and zoladex?

Mel

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John T
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Posted 2/6/2011 12:43 PM (GMT -8)
Lupron feeds PC through T flair for only a short period of time during the initial start up of the drug. Using Casodex for 14 days prior to starting Lupron prevents this flair.
It's such a simple step to take and it baffels me that many doctors giving Lupron don't do this.
JT
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Fairwind
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Posted 2/6/2011 2:43 PM (GMT -8)
Maybe this is why not all patients are pretreated with Casodex..

" Back, pelvic, stomach, or general body pain; constipation; decreased sexual ability; diarrhea; dizziness; frequent urination, especially at night; gas; headache; hot flashes; nausea; stomach upset; sweating; trouble sleeping; weakness.

Seek medical attention right away if any of these SEVERE side effects occur when using Casodex:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; difficulty swallowing; unusual hoarseness); black or bloody stools; blurred vision or other vision changes; bone pain; breast growth or pain; changes in the amount of urine produced; chest pain; dark or bloody urine; fainting; fever, chills, or persistent sore throat; flu-like symptoms; increased hunger, thirst, or urination; joint pain, stiffness, or swelling; loss of appetite; mental or mood changes (eg, anxiety, depression); muscle aches or weakness; numbness or tingling of the skin; pale stools; severe or persistent cough; severe or persistent dizziness, drowsiness, or headache; severe or persistent nausea or stomach pain; shortness of breath; swelling of the ankles, legs, or feet; unusual bruising or bleeding; unusual tiredness or weakness; vomiting; weight change; yellowing of the skin or eyes.
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compiler
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Posted 2/6/2011 2:46 PM (GMT -8)
Darned if you do, darned if you don't (RE: Casodex).

Mel

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John T
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Posted 2/6/2011 4:03 PM (GMT -8)
Fairwind,
Ever read the warning lables on Viagra or any other drugs. The lawyers have to think of every possible thing.
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compiler
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Posted 2/6/2011 4:39 PM (GMT -8)
John:  99% of those warnings never occur with most of us.

Why do I have the feeling that many of those warnings DO happen with Casodex.

Mostly I've heard of breast pain/growth

Mel

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John T
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Posted 2/6/2011 6:49 PM (GMT -8)
Mel,
I took Casodex for 7 months. The side affects are about 20% of those of Lupron. Breast growth is an issue and can be easily stopped with Femera. Hot flashes are there, but not too bad, maybe twice a day lasting for 5 min. Loss of Libido is definately an issue, but goes away in a couple of months after stopping.
The other issues mentioned are rare and warnings are standard lawyer stuff.
For side affects it probably has the least of any of the HT drugs. A lot of patients use Casodex only as a mono therapy. Andrew (Ohio State) was the best example: he was given three months to live and had severe PC throughout his bladder and a permanent catheter. In two months his catheter fell out on its own and a year later has an undetectable psa and is leading a normal life. In some cases like Andrew's the drug works exceptionally well.
JT
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Purgatory
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Posted 2/6/2011 7:12 PM (GMT -8)
When I have my next doctors appt and PSA at the end of the month, I will see what my dr. thinks about me getting a T reading as a base line. Wont hurt to ask.
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Putt
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Posted 2/7/2011 11:12 AM (GMT -8)

Flair?  Speaking about Casodex.  Here is a direct quote from page 140 in the book "A Primer on Prostate Cancer, The Empowered Patient's Guide", written by Dr. Stephen B. Strum and Donna Pogliano.  I'm sure they won't mind me posting it.

"The up-front use of the anti-androgen prevents both biochemical and clinical flare by saturating the docking sites (androgen receptors) for androgens within PC cells as well as benign prostate cells.  This prevents testosterone and its potent metabolite DHT, (dihy-drotestosterone) from stimulating PC and benign prostate cell growth."

He further states "the patient is spared as much as two weeks of tumor growth by starting an anti-androgen seven days prior to LHRH agonist administration."

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