This update brought to you by the letters D and T and by the number 208

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6068
   Posted 2/22/2018 12:41 PM (GMT -6)   
Those of you who -- inexplicably -- read my posts may remember a thread last month where I reported the failure of my plans to regain my pre-ADT baseline levels of Testosterone without exogenous supplementation. (see Still Hung Like a Hamster: and Update ) I decided to supplement and, after a struggle to find an affordable source, I finally managed to score some 10% T cream on 1/26 which I have been applying as directed every morning since. I just got back the results of blood work after 25 days of the treatment. I'm not sure what to think of the results.

Here are my previous seven total T levels, approx every three months, starting in April 2016 when my T recovery peaked then started to decline: 273, 206, 188, 199, 126, 185, 172. My lab suggests a "normal" range of 175-781 ng/dL and the midpoint of that range is 478. My pre-ADT baseline was around 700. During those 20 months I tried clomiphene and hCG to stimilate my natural production with disappointing results.

I had blood drawn earlier this week and the number is... drumroll... 208 ... rimshot, kazoo fanfare dribbles off...

So, OK, that's kinda disappointing. I was hoping for twice that.

But it's only been four weeks. Maybe I should be patient and see where I am in another three months. Does transdermal T supplementation take a while to reach a stable level? Or should I talk about boosting the dose? Whaddja think?

I am also thinking about boosting my daily vitamin D3 supplementation. I take sort of a lot (15,000 IU daily) but my tested levels (Vitamin D 25 Hydroxy) have been dropping: 39, 30, 29, 56, 54, 49, 49, 46. The normal range is 30-100, mid-range is 65. The jump from 29 to 56 was a response to increasing my daily D3 from 10,000 to 15,000 IU but it's been dropping off since. Maybe I'll try 20,000 IU and see what that does.

There have been a few studies that look at the relationship between Vitamin D levels and testosterone. They have a fairly high correlation but they both also correlate with obesity. Some researchers "control" for obesity and find that it explains most of the correlation but I'm not sure how much sense that makes. It's not at clear to me that weight is a free variable. It seems equally valid to consider the three to constitute a syndrome -- Low Vitamin D, Low T, and Low self-control in the lunch line seem to go along together.

Classical reference in title.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

Post Edited (PeterDisAbelard.) : 2/22/2018 10:46:25 AM (GMT-7)


InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 9369
   Posted 2/22/2018 1:07 PM (GMT -6)   
You just have to wonder how cookie Monster or Oscar would handle the situation.

and don't say 208 - you never know when the Count will popup.

just say'n...
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10645
   Posted 2/22/2018 1:49 PM (GMT -6)   
I think 208 is disappointing, but are you getting free testosterone levels checked as well? How about estradiol and DHT? Assuming that free T is low too, I have a couple of hypotheses:

(1) The T is getting in, but your body is over-controlling it. I think this is what is happening with your other supplemented steroid, Vitamin D, as well: even though you are supplementing high amounts, very little free vitamin D is showing up in your serum. Serum steroids levels are mediated by specific binding proteins. For T, there is a protein called "sex hormone binding globulin (SHBG)" that complexes "excess" and delivers it for metabolic waste removal as estrogen or DHT. So, it may be that you are overproducing SHBG - you can tell by measuring free T, and estrogen and DHT. If free T is low but estrogen or DHT is high, it's a good bet that this is going on.

Aromasin (exemestane) is a drug that prevents T from being metabolized to estrogen, and it reduces SHBG levels, so it boosts T on two fronts. It is too good at its job -- men actually want some estrogen - it contributes to proper sexual funcion, good skin, etc. But you can try it for a limited time to see if your free T increases. (Tamoxifen has the opposite effect - it increases SHBG and reduces serum T)

(2) The T isn't getting in. Some guys don't get adequate absorption transdermally. We all have different skin characteristics. if this is your dysfunction:
• you can try a higher dose - say, 20% T
• you can try a different base - like an alcohol gel
• you can give up on transdermal, and use shots or subcutaneous pellets instead
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6068
   Posted 2/22/2018 11:48 PM (GMT -6)   
Andrew,

The instructions for my T goo say to apply it to a part of the body where the skin is thin and there is no hair. Apparently, hair presents a particular problem with absorption. cookie Monster has never struck me as thin skinned and he's pretty hairy. He might need to inject.

And as for the count, perhaps I should have reported my T as 208.0 to suggest that the value is a real number (not an integer). Real numbers are uncountably infinite, unlike integers which are countably infinite.

Tall,

Thanks for the info.

I'll probably send a note to my MO suggesting we add free T, DHT, and estriadol to my blood work in three months. At the same time I may think about using a bit more of the T cream. It comes in a metered twist-click dispenser. Currently I am doing two clicks' worth. Maybe I'll try three clicks.If it works, great! And if it doesn't... maybe that next blood test will tell us why.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10645
   Posted 2/23/2018 3:38 AM (GMT -6)   
There should be good absorption through underarm skin (even with hair). The best absorption is through the scrotum - but your appliances may be in the way. The reason they tell you to avoid scrotal application is because a lot gets converted to DHT, which can cause balding and bad skin. It can also be made into a sub-bucal troche to be held under the tongue or between the gums and the cheeks. I don't know why they don't make a testosterone rectal suppository - I reckon that would be the best absorption rate.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 1103
   Posted 2/23/2018 8:18 AM (GMT -6)   
I see this has already been covered (thank you, TA), but to me it is quite clear that different patients react to the delivery system in different ways. I have been using Testim gel for about 6 years, with good to very good results. The problem is that the stuff stinks. Doc had me try Androgel, and it dropped my T level disastrously. For some reason, I didn't absorb it well at all.

The application instructions for Testim specifically instruct not to apply to the scrotum or genital areas. They recommend the upper chest/shoulder area, as long as that area is not too hairy. Not sure why they have to add that qualifier, as I'm going to guess that most of us who need this goop are not very hairy to begin with.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6068
   Posted 2/23/2018 9:09 AM (GMT -6)   
Paxton,

I am fairly hairy. Before my ADT the word furry might have applied. Currently I am smearing the goo on my upper chest between my collar bone and shoulder joint. For the first few days I also tried my inner thigh near the knee. I have noticed that the goop tends to clump onto any fine hair in the application area. So maybe that's the reason.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6068
   Posted 3/8/2018 3:35 PM (GMT -6)   
I've collected a bit more data which I am still trying to figure out. Hopefully the Tall One will wander by and point me at a clue.

Here is a table of my Total T, Free T, and DHT:

Date (T / free T / DHT)
3/2/2015 (106 / 2.3 / - )
6/24/2015 (198 / 4.6 / - )
10/1/2015 (239 / 5.7 / 229 )
4/11/2016 (273 / 5.15 / 254 )
7/11/2016 (206 / - /170 )
10/10/2016 (188 / - / 140 )
2/24/2017 (199 / - / 155 )
7/3/2017 (126 / - / 95 )
10/6/2017 (185 / - / 171 )
1/8/2018 (172 / - / 137 )
-------------------------------------*
2/21/2018 (208 / - / 645 )
2/28/2018 (320 / 7.04 / 780 )

* Start of T supplementation.

Reference ranges:
T: 240-950 ng/dL
Free T: 3.47-13.0 ng/dL
DHT: 112-955 pg/mL

Other values from latest tests:

ESTRADIOL, SERUM, MS 24 pg/mL
Reference Range:
Adult Males: 8.0 - 35
FREE ESTRADIOL, PERCENT 2.7 %
Reference Range:
Adult Males: 1.7 - 5.4
FREE ESTRADIOL, SERUM 0.65 pg/mL
Reference Range:
Adult Males: 0.2 - 1.5
SEX HORMONE BINDING GLOBULIN 43.4 nmol/L
Reference Range:
>49y: 19.3 - 76.4

To summarize: Since I started T supplementation my Total T has responded sluggishly, my Free T has responded moderately, and my DiHydroTestosterone has responded briskly. As of my last tests everything is in the normal ranges but Total T is still not where I want it to be.

My temptation is to try a higher concentration cream although that might drive my DHT through the roof. High DHT is mildly associated with some prostate cancer risks and it'd suit me better if I could crank up my total T without so much DHT.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

Post Edited (PeterDisAbelard.) : 3/8/2018 2:20:29 PM (GMT-7)


Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10645
   Posted 3/8/2018 4:58 PM (GMT -6)   
It appears that the T is being converted to DHT as fast as you rub it on. The solution is simple - block the enzyme (5-α-reductase) that converts T to DHT by taking Proscar or Avodart. The high DHT will only make your hair fall out and give you acne.

Fortunately, conversion to estrogen (the other main metabolic pathway) doesn't seem to be a problem. And you don't have elevated SHBG that might otherwise reduce your free T.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6068
   Posted 3/9/2018 12:11 PM (GMT -6)   
Thanks Tall One,

That's more or less what I thought was going on. I sent a note to my doctor asking for a scrip for finasteride.

Do keep us posted on your upcoming assimilation. As far as I know you will be our first member from the Borg Collective.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

White Bird
Regular Member


Date Joined Jan 2012
Total Posts : 204
   Posted 3/9/2018 1:17 PM (GMT -6)   
from my endocrinologist: "Get all your testing done first thing in the morning at the lab. That's when your hormones are at their highest. If not that, test every time at the same time of day for most uniform results."
New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, September 18, 2018 2:44 PM (GMT -6)
There are a total of 3,004,366 posts in 329,139 threads.
View Active Threads


Who's Online
This forum has 161738 registered members. Please welcome our newest member, Rosheen.
224 Guest(s), 8 Registered Member(s) are currently online.  Details
ANB, running wild, birthdaysuit, Minnesota, Rosheen, Awkenow, borborygmi, straydog