This post may help someone researching cases of low-T, TRT, slowly rising uPSA, aromatase inhibitors (AI). Detailed lab results at bottom.
Btw, have never been a big poster here, but did get a lot of help over the years and helped other guys some, too, I guess. Have kinda reached end of road with what I can do on my own PCa situation (it’s stable), so may not be visiting as much. Until my uPSA starts shooting up (ha). But if I see a “new guy” in panic and asking for help, and nobody has answered, I will of course do what I can. We’ve all been there, and it’s scary. Many thanks to all who helped me, and to the mods, who have a thankless task.
Wanted to post results of recent meeting with an endocrinologist, my first and probably last.
Eight years post-RALP. Starting two years after that, with undetectable uPSA, my uro offered to put me on TRT. Back then, my T and symptoms were in worse shape than now. Had gels for 2014/15, then T-cyp injections 2016-18. Went off the shots for short periods when getting worrisome lab numbers. First time off was Feb. 2017 when I first noticed detectable uPSA. Was off six months, uPSA trended down. Got brave again, went back on TRT, but saw quite a rise in 2018. Early Dec 2018 my PSA was detectable even on uro’s standard PSA (also on my uPSA, ~ .050). At my annual visit then, we didn’t even discuss TRT (stay on or off)-- we talked about
possible useful scans way down the road, if PSA kept rising a lot higher. Week after that appt., made my own decision to go off TRT. In 2019 uPSAs mostly flatlined, .041 start of year, .041 each of last three monthly tests.
Occasional LabCorp tests on hormones showed free T quite low and E2 (estradiol) quite high (most recent was double the top of lab range). Made significant progress in strength training, aerobics, stress reduction in last year or so, but still had some nagging symptoms. Either age-related (70) or “low-T lite”, who knows (ha).
Made appt. for endocrinologist, taking 7 months to get in, and just went last week. Was hoping for someone that could talk me through everything together (PSA, TRT, AIs, etc.) and maybe give me a low dose AI to see if it could help residual symptoms some without forcing uPSA up. Some studies out there show this is a possible “back door TRT”.
Endo visit was pretty disappointing.
First, she said my labs looked pretty good. Yes, my free T kinda low and E2 high, but “she is a minimalist” about
meds. Said the aromatase inhibitors (AIs) are tricky to fine-tune, can cause bad SEs (oste
openia, depression) if push E2 too low. So she wouldn’t recommend AI right now – my labs/symptoms would have to be worse--she didn't say how much worse--I should have asked.
Second, she would never recommend TRT for a guy that’s had prostate cancer. Said T does not cause PCa, but “it can act like adding fuel to the fire” if any is present. I tried to explain Morgentaler’s saturation model to her—she wasn’t buying it. Totally opposite of my uro, who follows the saturation model (see bottom). She mentioned the “add fuel to fire” twice, and she’s young, so I guess that’s still what they teach in med schools. Strange.
Third, she said each field of medicine has its own studies and theories, sometimes ideas cross-pollinate, sometimes the fields just differ on things.
I knew pretty quickly it wasn’t going well. In back of my mind, I was also thinking it wouldn’t be good to be working with a doc that it takes that long to see, esp. if I had something urgent come up. So I cut it short.
She bid me a fond farewell, gave her a hearty “adios, amigo”, and left, pleased that my visit, allocated for forty minutes, went only twenty minutes, and knew I had put her way ahead on her daily schedule. A good deed done!
So, I am at end of road with ideas. Guess will just stay off TRT, not have any AI to try, keep pursuing diet (DIM tablets and anti-estrogenic foods) and exercise approach, get more sleep, etc. Wife has noticed some man-boobs starting, so will ramp up the overhead flys on incline bench. I am definitely better off now than five years ago, so not complaining. But was just trying to “optimize” for the long road. Oh, well, nice try.
Can now back off my monthly uPSAs. Was doing those to make sure I knew my “native trend”, so I could hopefully spot any rise (or fall) in uPSA related to treatments. Will probably test uPSA every two/three months, then go even longer stretches if still mostly flat-lining.
Have made contacts with a few other guys on other boards where we all kinda have same situation. None have come up with much to “put it all together”. Their endos about
as “non-helpful” as mine was last week. It’s a mystery to all. One guy’s endo actually asked him, “so what do you want from me?”
Posting at bottom personal lab summaries for anyone researching these topics. Maybe it will help somebody.
lab tests of T, etc.:https://imgur.com/apuor0w
Morgentaler's saturation model:http://www.ajandrology.com/article.asp?issn=1008-682x;year=2015;volume=17;issue=2;spage=206;epage=211;aulast=morgentaler