prostatectomy and testosterone level

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jeff angstadt
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Date Joined Feb 2012
Total Posts : 2
   Posted 2/2/2012 8:24 PM (GMT -7)   
scool  i have the same problem. my prostatectomy was 9/12/11 and im tired all the time and dont have any desire to do pretty much anything(including sex).

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8122
   Posted 2/3/2012 12:37 AM (GMT -7)   
From Jeff Angstadt it appears he hit a wrong button:

"my prostatectomy was9/12/11 and i have the same problems. tired and no desire for anything. i am 56 and my last psa was .009"

I moved this back for Jeff.

welcome to HealingWell. Just a couple pointers about how to use this forum. You see the three buttons on the bottom. One says "+Post New Topic". Only use that one if you want to start a new discussion. The button to best reply with is the "+Post Reply" button. You can also answer posts with the Quick Reply box on the very bottom of this page.

Now on to your cancer situation. As far as sexual activity within four months after radical prostatectomy it's not terribly uncommon for men to still be recovering from their surgeries. The fatigue part is a bit more concerning. Were you prescribed any hormone drugs? That could be a source of your fatigue. In any case you should let your doctor know about it so that he can note it and if necessary prescribe a treatment. One of the things I did after my surgery was walk. I managed to get about three miles a day in. I also had radiation and hormonal therapies and I believe that the walking helped immensely.

Again welcome. You'll get some more feedback soon enough so keep checking.

Advanced Prostate Cancer at age 44 (I am 49 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.


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Date Joined Feb 2011
Total Posts : 4093
   Posted 2/3/2012 5:40 AM (GMT -7)   
energy was something I had issues with after mine also. Mine was Jan 2011. It was somoene on this forum that suggested post traumatic stress could have a lot to do with that. I think that's spot on.

I think it's a combination of a lot of things. Depression setting in prior to surgery when they informed me (us) that we had cancer. That was exhausting mentally. Also, as a result, I stopped working out. Then you go through surgery which is major surgery and you're told to do nothing serious for 3 months. So trauma, depression, angst, physical inactivity, surgery... these all contribute to that feeling.

I still have far less energy now, 13 months later. Another thing to consider is that we're not getting any younger and a year like that will take it's toll.

Of course it can be turned around quickly but requires the right mindset.

As for sex after surgery. Ther eis firs tthat one month waiting period for the urethra to heal. After that, upon advice from my nurse, it was rehab time on a daily basis. Sure the mood was very different than prior to surgery. Doing it to make sure it works or to get the blood flowing (as advised) is different than wanting to do it. You may be experiencing that. Also, the first few months are typically very mechanical in that it takes work to get going. That requires an adjustment also.

In all probability things will change on a monthly basis for you.

Post Edited (davidg) : 2/3/2012 5:52:02 AM (GMT-7)

Regular Member

Date Joined Sep 2009
Total Posts : 460
   Posted 2/3/2012 7:33 AM (GMT -7)   
I am 60 and I had my robotic surgery 9/2007 and from that day to present, I have hardly no sex drive or energy to anything.  I have no ED issues from my surgery and can get rock solid erections without a problem, but I just don't have the drive or desires anymore.  Prior to my surgery I was thinking about sex constantly, now I have to force myself to think about it and do it. I had my testosterone checked a few years ago and it came out 370 which is in the normal range.  My uro tells me it is all in my head, but I still think it has something to do with the actual prostate being removed.

Regular Member

Date Joined Jan 2012
Total Posts : 336
   Posted 2/3/2012 8:21 AM (GMT -7)   
Jeff welcome to the best place to hang out for the worst thing in your life. It would also be helpful if you would go to your profile and add a signature that would tell us the journey you are on. Once you have that filled out and you've hit post reply, remember to scroll down below the dialogue box and click on the option box to "Include signature...).

I suggest you go to utube and search for a Dr. John Mulhall. Having no desire to have sex just four months post RP is not at all abnormal especially if you are dealing with incontinence. Plus, Dr. Mulhall tells you what you need to do to obtain peak sexuality within the 18-25 month window when you will reach your peak. You can probably check his book out of the local library.

Like TC-LasVegas said, get out and walk. Join the Aerobic Challenge:

I was walking 7 days post op, the day after the foley was out, and worked up to my usual 3 miles/morning. A lite exercise helps one's attitude and energy levels. Start slow and work you way up. Hang in there, we all have our fair share of bad days and better days. Yesterday I had zero continence again. I said to hell with it. Having zero alcohol for the last three day I said to myself if I'm going to leak I might as well drink so I drank a three ounce martini at around 5 pm. I sat back and watched so tv and felt my continence was better by 9 pm. This morning I confirmed that I was doing better while out for my walk when I stop at a semi secluded spot and was able to pee 4 or 5 oz despite completely voiding prior to leaving for the walk.

Read nonfiction stories of people that have been through a whole lot more than we ever have. The best book I've read while recovering was "In Harms Way" about the guys that had the USS Indianapolis torpedoed out from underneath them.
Age 59
9/8/2011 PSA 4.7 Free PSA 11%
Biopsy 9/15/2011 Gleason 3x3, 4 cores involved out of 12 cores within left hemisphere
Davinici performed on Jan 3rd 2012
Gleason 3x4 Approximately 7% of gland volume (all on left side)
Margins: Negative Pathologic Staging pT2a

Veteran Member

Date Joined Jan 2011
Total Posts : 735
   Posted 2/3/2012 2:40 PM (GMT -7)   
I am sure that the trauma of radical surgery impacts the energy level of patients.
Impotence and incontinence are early side effects that impact all of us that have undergone that surgery. Recovering takes time and exercise.

On the other hand, there are reports in the medical literature that the presence of PCa does affect the level of testosterone. This could be related to the fact that prostate cancer cells metabolize testosterone faster than normal prostate cells. In fact, several studies report an increase of testosterone after radical prostate surgery. The effect on reducing testosterone before surgery is more pronounced with more poorly differentiated disease.

"Iversen P, Rasmussen F, Christensen IJ. Serum testosterone as a prognostic factor in patients with advanced prostatic carcinoma. Department of Urology, Rigshospitalet, University of Copenhagen, Denmark.PMID: 7939452. Reported: correlations with symptomatology and other pretreatment parameters
suggest that low serum testosterone merely is a consequence of the advanced
malignancy rather than a causative factor in the pathogenesis of prostatic

The following studies report an increase in testosterone after radical prostatectomy:

1. Imamoto T, Suzuki H, Yano M, Kawamura K, Kamiya N, Araki K, Komiya A, Naya Y,
Shiraishi T, Ichikawa T. Does presence of prostate cancer affect serum
testosterone levels in clinically localized prostate cancer patients? Prostate
Cancer Prostatic Dis. 2009;12(1):78-82. Epub 2008 Jun 3. PubMed PMID: 18521100

Significant increases in serum T and LH levels were seen after RP, compared to preoperative levels in parallel. This study suggests that serum T levels are altered by the presence of PCa, supporting the possibility that PCa may inhibit serum T levels with negative feedback in the hypothalamic-pituitary axis.

J Urol. 1998 Aug;160(2):449-53.

Following radical prostatectomy there was a statistically significant increase in serum testosterone, free testosterone, estradiol, LH and FSH (p <0.0001), and statistically significant decrease in serum DHT (p <0.0001). No difference was noted in serum sex hormone binding globulin or prolactin levels.
hormone (FSH), sex hormone binding globulin and prolactin.

These data further suggest that the normal prostate and/or prostate neoplasm could secrete a substance or substances that give negative feedback control to pituitary gonadotropin secretion. Further investigation is warranted to identify this substance or substances.

3. Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadalhormone axis. Madersbacher S, Schatzl G, Bieglmayer C, Reiter WJ, Gassner C, Berger P, Zidek T, Marberger M. Department of Urology, University of Vienna, Vienna, Austria. PMID: 12429318

Patients with Gleason score 2 to 6 PCa had higher testosterone values (4.2 ng/mL) at baseline than did those with Gleason score 7 to 10 PCa (2.2 ng/mL, P < 0.05). Although 12 months after RP no changes in testosterone were observed in the low Gleason score group, the testosterone levels more than doubled in those with high-grade tumors.

Phoenix, Arizona
I am a prostate cancer survivor since 1992. The views or opinions expressed here are my own and are not endorsed nor supported by any agency or institution. Use your physician for medical advice.
DX at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA July, 0'11: <0.1

Veteran Member

Date Joined Jan 2012
Total Posts : 726
   Posted 2/3/2012 6:17 PM (GMT -7)   

My husband 53 is going through just having a RP in oct. 2011 with a rising PSA. First test was 1.2 in Dec 2011, then 1.8 Jan 2012 and now 3.5 Feb 2-2012.
We have seen an Oncologist who started him on casodex and luprone shot to follow when the PSA drops to undectable levels. Adjuvant radiation is sugessted.
We have had a bone scan,Ct scan and an MRI that showed nothing
What was your post-op PSA tests?



New Member

Date Joined Jan 2013
Total Posts : 14
   Posted 2/2/2013 7:31 AM (GMT -7)   
relevant article testorsteron replacement is safe post RP if no complication:

Testosteron level 370 is considered low by some. The 300 cutoff is arbitrary. You can google Morgenthaler + testosterone and you find plenty reference to show to your doc. TR might make you feel better or it might not. It might make sense to try.
It seems from Gat + Goren papers that the testosterone danger to prostate does not come from serum testosterone but from diverted testosterone coming directly from the testes due to varicocele that can cause levels 100+ times more than normal.
In fact anecdotal evidence that bodybuilders who elevate their testosterone level much higher than normal never get prostate cancer. (they might get testicular cancer (Lance Amstrong) but not prostate cancer.

Regular Member

Date Joined Jan 2011
Total Posts : 112
   Posted 2/3/2013 12:35 PM (GMT -7)   
My T level had been dropping rapidly during the past ~2 years, down to 389 (reference interval is ~ 350 - 1200). I saw no reason why my T level should be so low with my exercise, diet and supplements (including natural T boosters) regiment. I had the hardest time finding a doctor that would put me on TRT. Finally I found Dr. Bazzan at Jefferson Hospital in Phila. I like him because he stresses diet and exercise as part of the whole treatment. My T level went up 100 points in 3 weeks and in another few months, when the new pellets are to be inserted, we want to push it up a little higher. The biggest change I've noticed so far is that I'm sleeping better and my arthritic shoulders hurt less.
DOB: 01/61
PSA: 01/10 2.8
PSA: 11/10 4.2
DRE: 12/10 Normal
PSA: 01/11 4.1
Biopsy: 01/21/11 7/12 cores + Gleas.: 6(3+3) Stage: T1C
RALP 03/04/11 PA Hosp.
Prostate Size: 22 g Gleas.: 7(3+4)
Grade: T2C 10% of Tumor involved
EE: 0
Per. Inv.: 0
Sem. Vesicle/Lymph Nodes: Clear
Margins: +, invasive apical, post.
PSA: 04/22/11 - Present <0.1
No Ed or Incont. but urgency.
Started TRT (pellets) 12/14/12

Regular Member

Date Joined Dec 2008
Total Posts : 363
   Posted 2/3/2013 1:01 PM (GMT -7)   
Yup, TRT has started to make me feel better too. I found out by accident 2 years after robotic surgery that I had low T. I went through another year of 0 psas before approaching my internist about taking T (my level was 176, way below normal). He said no, once you have prostate cancer you can never have T he says. But my depression and brain fog kept getting worse, plus I had early osteoporosis so I wasn't satisfied with that. I went to my operating surgeon who said yes, then my local uro who said yes, and then the best endocrinologist who said you should do this for bones. So after fighting my insurance company over this it was finally approved. Prior to starting TRT again last month my total T was 189 (250-1100 normal range) and free T was 42.8 (35.0-155 normal range). Over a month later my total T is up to 299 and free T is up to 60. That may not see dramatic but my severe depression has lifted, the brain fog is totally gone, and I actually have some libidio again. Still 0 psa. So I'm sticking with T.......
My age= 52 at time of diagnosis
PSA went from 1.9 to 2.85 in one year, biopsy ordered,
2 cores positive, one 5%,one 25% G=6
Bilateral nerve sparing robotic surgery on 09/11/08, pathological stage T2A,
No signs of spread, organ confined,
all PSA'S 0 since surgery, diagnosed with low T, doing TRT now, still using trimix for ED

Veteran Member

Date Joined Dec 2012
Total Posts : 663
   Posted 4/4/2014 10:47 AM (GMT -7)   
I'm a tad over one year from prostatectomy. My sex drive is the same, if not stronger. My energy is about the same as before surgery. I don't have to use pads or shields of any kind since D day +1. My mind set is lower than before surgery probably because of 100% ED.
James - Age now 48 Diagnosed at 47
Biopsy 11-27-12 - PSA 12.7 | 7% Free PSA - 2/12 cores - 1 G6 3+3 5%, 1 G7 3+4 20%, Staged T1c
daVinci surgery March 22, 2013 PSA 16
Bilateral nerve sparing, 100% Continent, 100% ED
Final Path
G7 3+4, G4 <5%, 10% tumor in prostate, pT2c, pN0
Margins, Lymph nodes, Seminal Vesicles - Clear
5-24-13 <0.09
9-23-13 <0.04
1-6-14 <0.06

Regular Member

Date Joined Mar 2014
Total Posts : 96
   Posted 4/4/2014 2:29 PM (GMT -7)   
Ellard said...
could be because low libido i.e. sex desire i have done with my testosterone replacement therapy and now a happy person now ....<snip>

Adverising Troll idea

Yeah, I got him. Thanks -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 4/4/2014 9:47:26 PM (GMT-6)

New Member

Date Joined Jun 2014
Total Posts : 1
   Posted 6/2/2014 2:43 PM (GMT -7)   
Found this Topic in a search concerning myself having the same situation .. fatigue and semi depression issues. I'm currently 64
History.. 2009 age 59
12/09 ~ random blood test came up with a PSA of 14
01/10 ~ gleson 7
02/10 ~ biop... 4 of 12 core samples tested positive with one 100%
04/10 ~ Robotic..non sparing
06/10 ~ PSA .. 0.00
So now it's been 4 years post-op and the two biggest changes in my life are of coarse I can no longer get an erection, which was fully explained to me prior. But an even larger and daily looming issue, and not so discussed prior to the operation issue is .. I have no desire, nor it seems as though I have no energy to do just about anything. I did go back to work after 5 weeks of rehab, but unfortunately lost my job within 4 months after surgery. But that is just the tip of the problem.
Personally I'm still pretty put out about not being able to achieve an erection. I'm only 64 !! let me include a further history of me personally which includes that I got a vasectomy at a young age (23), but that had 0 effect on my sex drive or performance, and certainly none on my endurance, energy level, stamina, ect. But shortly after my prostate being removed I started noticing a real lack in energy..desire to get things done..motivation..and pretty much a.."I just don't give a krap and have no will" attitude. In fact, as I write this to you I have several things that I need to get going on and I just can't seem to muster up neither the motivation nor energy to go do them. I guess my question is this. What also left me with my prostate...and where can I pick some up? I seriously desire to have at least a semi-normal life. I've heard you can get injections to deal with the no-erection issue...but this listless, no energy life I've been left with is unacceptable for me. Since my operation I've moved from Virginia to Idaho, and have not located a Doctor to discuss any personal man issues with. In fact, this is the first attempt to reach outside my self and seek counsel concerning these issues. Truthfully, my wife doesn't even know that this is how I'm feeling..nor do I want to bother her with it. She has her own issues to deal with, and being the man, I'm here to help her with hers, not lay a bunch of my burden on her.
If you can suggest what might be the best direction for me to turn, I'd greatly appreciate it.

Regular Member

Date Joined Nov 2010
Total Posts : 259
   Posted 6/3/2014 8:53 AM (GMT -7)   
This is so strange. Years following RP my testosterone level bottomed out around 350. I consider this kind of low since I'm an avid weight lifter. My PSA began to rise from .01 to .035 back to current .031. Still not high but rising. My May 2014 testosterone test came back at 582. My Uro asked if I was taking T therapy. Of course, I'm not, nor will I.

I went on a cancer diet (no red meat, limited diary etc.) and lost 20 lbs. since my last appointment. I am a personal trainer and believe increased exercise combined with weight loss increased my T level naturally. I don't know, another explanation might be our meat supply contains steroids and my system adjusted by increasing my own T production since I was not receiving steroids in my red meat anymore. Far fetched but who knows.
60 years old
2009 PSA 2.2
2010 PSA 3.2
Biopsy 24 cores 3 positive
Gleason 3 plus 3 (pre and post surgery)
Robotic Surgery March 3, 2011
Cath removal 3/17/11
PT2a Stage
Oct. 2011 PSA 0.03
Oct 2012 PSA 0.01
May 2013 PSA 0.021
Oct 2013 PSA 0.025
Dec 2013 PSA 0.028
March 2014 PSA 0.035
May 2014 PSA 0.031 (first time it's gone down a little)

Regular Member

Date Joined Nov 2013
Total Posts : 103
   Posted 6/3/2014 3:15 PM (GMT -7)   
I ditto the post that suggests Andrew Morgantaler's "Testosterone for Life".A great book, that dispels old school thinking about T and prostate cancer. At two years out my T was 585. I've been doing bioidentical HRT for over 3 years and my T levels stay over 1000. My PSA is always<.01.I still cannot get an erection without a VED, but my energy is great,my libido is strong and my mood and attitude is that of a much younger man. Regards Inkhorn
Age 62-dx pc 11/09- Gleason score 6-1 core positive with 4 others suspicious- RP on 1/10-Path report indicated the tumor was present in 6 slides both right and left- stage t-2-After 1 year 98% continent-after 4 years still have ED- PSA remains <.01-other side effects,epididymitis, peyronies disease
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