It is a VERY tough decision. As I think I posted elsewhere, Dr. Scholz's point is that if we start HT BEFORE the PC goes to the bones (and in my case it probably has not yet metasticized to the bones), THEN he claims there is a MEDIAN of 10 years before we have to do something else. He also believes in IADT (ie: intermittant) and the latest thinking seems to be 8 months.
But, of course, this is dependent on my having an excellent response to the HT. So far, like you, my response history has been dismal.
If I knew that I would respond perfectly and be off the HT after 8 months, it would be a no brainer.
Look, David, if the HT is just a bullet that might work for a short time whenever you employed it, then your argument makes perfect sense. Why use it now and impair your QOL? I wish there was more agreement among the experts. If I buy into Scholz/Meyers/Liebowitz and others, then I should be starting HT PDQ. If I buy into Hussain and your doctors and others, then I would wait. Actually, at the rate things are going, I will be over 10 (PSA) in 9 months. But, to paraphrase what you say, medicine is an art and we like to treat the patient, not just a number.
But part of treating the patient is to present that facts, as well as taking into consideration the patient's current status. I suspect HT will weaken the bones and muscles and cause additional aches and pains. You are already suffering greatly in that area. Your priority should be to try and ascertain and correct the cause of your pain. I am not in the same situation. Different patients, so maybe different treatments.
Maybe Scholz will also say there is no rush. I doubt it. When I saw him, he did say that when the PSA hits 1, we had better seriously consider HT.
I am on a few mailing lists, and plenty of patients are in our boat!
This is not easy!