T Nation

35 with Substantial Increases in PSA While on TRT


#1

Hello,

New but recent lurker. Been on TRT for 5 yrs and off and on last two years. After hitting 1200 Total T in 2013, while feeling great, I developed some urinary difficulties (frequency, dribbling) PSA at 1.2 so I abruptly stopped and, of course, crashed.

I remained off for 5 months in 2014 then resumed with androgel 7.5g daily and 500iu twice weekly HCG and felt better but urinary symptoms worsened. PSA climbed to 3.9 in Dec 14. So I abruptly stopped again and urinary symptoms decreased PSA dropped to low of 1.5, but felt horrible mentally and physically.

I eventually had prostate biopsy when PSA rose to 7.1 while on HCG mono in May 2015 and came up negative. Obviously my concern is I am too young for this urinary nonsense which seems to correlate rising androgens.

I should mention that I have a malignant hypothalamic tumor and had a recent bilateral varicocele repair as well.

Anyway, I will post blood work below and would really appreciate your input as some may have similar experience. Thanks.

Dec 2013
TT=1090 240 - 950 ng/dL
Free T=58 9 - 30 ng/dL
DHT=1550 112-955 pg/ml
PSA=1.2
E2=30
On 7.5 Androgel, 1000iu HCG twice weekly and 1/2 Arimidex once every 5 days

11/17/14
TT=423 240 - 950 ng/dL
Free T=16 9 - 30 ng/dL
PSA=3.9
E2=34
LH=<.5
After being off for 5 months these results are 6 months after starting again. Same regimen as in Dec.

4/16/15
TT=325 240 - 950 ng/dL
Free T= didn’t get 9 - 30 ng/dL
PSA=1.5
E2=<12
DHT=324 112-955 pg/ml
No TRT-Felt Horrible

5/27/15
TT=440 240 - 950 ng/dL
Free T= 12 9 - 30 ng/dL
PSA=7.1
E2=23
SHBG=33 10 - 57 nmol/L
HCG monotherapy 125iu daily: Felt pretty good

1/19/16
TT=369 240 - 950 ng/dL
Free T= 8.86 9 - 30 ng/dL
PSA=2
E2=<25
SHBG=34 10 - 57 nmol/L
LH=5.4
No TRT and bilateral varicocele repair a month prior

Sorry for horrible format but I’m a bit hurried tonight.


#2

We do know that E2 is more of a cause than T or DHT.

However, if there is a cancer, T and DHT make it more vigorous. Part of that perspective come from seeing that the prostate and any cancers are withered if T and DHT are eliminated. So it is a odd relationship that has made most doctors believe that T and DHT are causative and that is not true.

Key to any of this will be maintaining E2 around 2–22 pg/ml.

Do not do transdermal TRT as that has highest T–>E2.
Suggest self-injected T, 50mg twice a week with 0.5mg anastrozole at time of each injection.
You can try 250iu hCG EOD.
Reduce T dose as needed to get TT near 900.
You would then need to reduce anastrozole by the same factor to maintain current E2.

You need steadier T levels to allow anastrozole to work properly.
Get a prostate herbal based product. Try lef.com

Take vit-D3 5,000iu, natural source vit-E, high potency B complex multi-vit with trace elements including iodine+selenium, 1000iu Vit-C twice a day, fish oil. This may help with inflammation.

Post all of your lab work with ranges:
TT
FT
E2
prolactin
AST/ALT
TSH
fT3
fT4
CBC with hematocrit
PSA
CRP
homocysteine
AM cortisol
DHEA-S

Prostate biopsy: Did they culture for bacteria? Could be prostatitis.

List all medications; Rx and OTC.

Please follow these links in the 2nd post of the 1st forum topic:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc — if needed

Do not test PSA soon after ejaculation or a DRE.

Cialis/tadalafil can improve sexual function and help manage BPH.


#3

KSman, Gracias for the much appreciated information. I feel I’m pretty much on your recommended prostate regimen as I take D3 10,000iu daily, kelp tablet with 225mcg daily and 1000iu vitamin Csometimes more. I also have tinkered with saw palmetto, beta sisterol, stinging nettle and others for urinary difficulties without much success.

I am anxious to start a trt protocol around injections. Thinking of starting 75mg cypionate twice weekly, 250iu hcg twice weekly as well as your anastrozole recommendation. In the meantime I have started a dab of progesterone cream daily which has just made me sleep longer but more tired it seems. Would anyone recommend to keep doing this or does this do more harm than good?

I will post my most recent results for the labs you requested and maybe they can shed some more light on my situation.

TT=369 240 - 950 ng/dL (1/19/16)
FT=8.86 1.39 - 17.69 ng/dL (1/19/16)
E2=<25 8-43 pg/ml (1/19/16)
prolactin=10.2 4.0-15.2 ng/mL (9/23/15)
AST/ALT=29/30 <41 U/L (8/19/15)
TSH=.77 0.27-4.20 uIU/mL (9/18/15)
fT3=3.1 2.0-4.4 pg/mL (9/18/15)
fT4=1.21 0.90-1.70 ng/dL (9/18/15)
CBC with hematocrit all come within range with hematocrit and hemoglobin on low end of range
PSA=2 <4.0 ng/mL (1/19/16)
CRP=.7 0.0 - 0.8 mg/dL (3/5/14)
homocysteine never had done
AM cortisol haven’t had measured in years but was normal in 2011
DHEA-SULFATE=287 65 - 334 mcg/dL (1/19/16)

No it doesn’t appear a culture for bacteria was performed but have tried a short course of antibiotics without much success but it might not be a bad idea to revisit.

Current RX meds are Lamictal 300/mg daily to help mood disorder (been on for 4 years), cialis 5mg daily for bph and erectile issues (started beginning of 2015) and Abmien 12.5ER nightly (over a decade). I have crazy sleep issues possibly due to my tumor.

I hope this provides a bit more insight. I’m also thinking of starting Flomax, have a script, would you recommend or should I hold off? I’m thinking that TRT will worsen my urinary symptoms and this may be a preemptive attempt to discourage this.

Also, my PSA rose the highest with ED dosing of HCG at 125iu. Could the spacing of dosing be a factor? For instance, have you heard of dosing frequency affecting PSA positively or negatively?

All information is welcome. Even if its’ “you’re just screwed”. Thanks kids.