T Nation

Rising PSA and TRT


#1

I have read the sticky on Advice for New Guys by KSman and I hope I am following the correct procedures here.
Problem: I have been on an HRT program since 2008 with very good results, however over the last year, my PSA level has raised drastically and I am looking for some feedback.

My Protocol I started in 2008 was T,AL,HCG,HGH,DHEA (more of an HRT than TRT program). I have a progressive thinking doc and over the years my dosing and method of application have matured to what I am doing now as follows:

T Enanthate= 84MG Weekly in EOD SQ Injections (24 mg per dose)
HCG= 220iu SQ injections EOD
Anastrozole= .25 MG EOD,1 (112.5 MG weekly)
DHEA= 25 MG daily, Timed release capsules, compounded
HGH= 1iu daily SQ 6 days per week (6iu weekly)

I have had to make adjustments from time to time, mainly on the AL, but mostly the above gives me a smooth ride. Any day of the week I draw blood, my levels look relatively the same at optimal levels, so I have gotten beyond up and down spikes. The only one that seems to bounce around some is the E2, but I check my blood work through labcorp every 6 months, so I have been able to jump on it quickly whenever something gets out of line. My Libido is strong, I work out 5 to 6 days a week, I run several Half marathons annually; feel strong, feel great!!

My last lab results were in March 2014 and pretty typical of what I have been getting:

DHEA=306.5 (48.9-344.2)
IGF1=130 (49-188)
Test=1129 (348-1197)
Free Test=36.4 (6.60 to 18.10)
SHBG=30.7 (19.3-76.4)
Progesterone=1.1 (.2-1.4)
Pregnenolone=<10 (<151)
E2=14.2 (7.6-42.6) (usually this is a little higher, closer to 20, the test before this one showed the E2 at over 30 so I may have jumped on this a little too hard with the AL dosage)
Dihydrotestosterone=101 (30-85) (Usually this was more around 80 so this was higher than normal)

Per the Sticky on advice for new guys, here is data on me:

-age ; 61 years old
-height; 5'9"
-waist ; 31
-weight ; 155 lbs, body fat about 12%
-describe body and facial hair ; normal hair on body (more hairy than not), good facial hair (I could grow a great beard if I wanted), bald headed (I now shave the skull)
-describe where you carry fat and how changed ; always around my waist and boobs if I get over weight
-health conditions, symptoms [history] ; great health, however, (1) have had BPH since my 30s, never caused me any problems, psa levels always ok. (2) Before starting HRT, I had a bad 10 years of drinking, smoking and gaining weight (my spouse passed away, kind of gave up for awhile). Since starting HRT and getting a new doc in 2008, lost 30 pounds, workout 6 days a week, don�?�¢??t smoke, I do drink some, I have a great sex life. Feel Great, no issues except my prostate.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever ; RX, Xanax as needed daytime work anxiety, Restoril as needed night time sleep aid, Take 15 mg remeron nightly (helps sleep, anxiety and feels great). I tried a round of Proscar for 30 days once, it dropped my DHT real low as well as my E2, so I quite right away. Libido never suffered, do not have any lingering effects from it, just did not like what I read about it.
-lab results with ranges ; See above data, I can provide tons more; I have kept great records for many years.
-describe diet [some create substantial damage with starvation diets] ; Mainly a Paleo type diet, however, do not skip much on fruits or dairly products. Very disciplined diet, try to keep my protein/carbs/fat and overall calories in check with my bodies usage.
-describe training: Boxing and Running. Do not box in competition, only cardio workouts on bags and in the ring with mit and glove training. Do not take hits to my head, but I have a great cardio. Run 3 times a week, box 3 times a week, have fun and do nothing 1 or 2 days a week.
-testes ache, ever, with a fever? ; Never
-how have morning wood and nocturnal erections changed; been strong since I started HRT and working out. My Libido is good and strong without the use of any aids.

With all the above in mind, my Prostate Problem has suddenly come up on the scene. So, here is the problem:

My PSA has always been a pretty steady 1.0 to 1.5 with the free results always over 50%. My last good test was in August of 2012 and was 1.5 (0.0 to 4.0) with the Free being 52%.

Next test was May of 2013 which showed and increased PSA level;
PSA; 2.9
Free; 27%

Re-Test June 2013, results are worse
PSA; 5.2
Free; 20%

At this point, my urologist put me on levaquin for 30 days (suspecting an infection). 2 weeks later a retest:

Re-Test August 2013, improvement shows up after levaquin
PSA; 2.4
Free PSA; 32.5%

The improvement after the levaquin caused us to believe that we were dealing with an infection, so we waited 6 months for another DRE exam and blood test.

Re-Test 2/1/2014, going back downhill
PSA; 5.9
Free PSA 16.1%
DRE by Doctor felt clean/healthy organ

At this point, we ran one more test called a PCA3 which scored me at a 43 (the higher the numbers the worse; anything over 25 is considered to go along with a strong likelihood of a positive biopsy result).
So, after all of the above, I finally took my urologist advice and went for a biopsy (which btw is totally painful and ruins your sex life for weeks).

Received back the results from a 12 point biopsy, all showed Benign except for one sample which showed a small focus of high-grade Pin, considered benign, suggest future biopsy, Biopsy was taken in March 2014.

So, after all that, here I am waiting for my next DRE urology exam and blood testing which will be in August. Feeling great physically, but wondering about my poor prostate and if I am proceeding correctly;

My urologist advises me to stay on my TRT Routine, but is not sure about the HGH. My Wellness Doctor (for lack of a better term), feels that I should keep my current routine just as it is, including the HGH; he is pretty high on keeping my immune system up and going.

I have done a ton of reading on the www and through LEF (many long nights) on subjects like me. Of course you get all the guys who want to chemically castrate you, but the majority of the intelligent reading I come across tells me that I should remain steady on the TRT, but nothing tells me about;

  1. What levels; I have all mine at the upper end of optimal.
  2. HGH; Hard to find anything on this subject and prostate problems.

I would really appreciate some intelligent thoughts on this matter. I feel I am blazing new trails here that even my Doctors are blazing alongside me (actually, right behind me). I am an Engineer by trade, so I am used to blazing trails to a certain extent. However, this is a little different.

I would really appreciate input from KSman. What would be your next move?

Thanks


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#2

I say keep your levels at the upper end of optimal for now. From what i understand prostate cancer is a very slow growing cancer and the majority of men eventually die of other causes. You might look into Metformin and supplements recommend on LEF first. If that doesn’t work to bring down and stabilize your psa you may have to resort to drugs like dutasteride. I don’t know what happen to KSman he hasn’t posted in awhile. Maybe he’s on vacation. :slight_smile:

Metformin

Here is one study on Growth hormone replacement and serum prostate-specific antigen.

Effect of growth hormone (GH) and/or testosterone replacement on the prostate in GH-deficient adult patients.


#3

Thank you jb13! Couple of those write ups you posted I had not seen; good stuff. My plan is to stay the course on my HRT, much the same as your thoughts.

Funny enough, I had already started metformin just 2 weeks ago. I will be interested to see how if affects my overall blood results. I will post them when I get them. Let me know if you find anything else.

I am sure there are some others out there with my same problem, might be helpful to them also.


#4

My only general advice would be to keep E2 low as that can cause prostate problems. But your E2 is now well managed so nothing to do there.

I also recall some things that you can review here: https://www.google.com/search?q=serm+toremifine+prostate !!!

I have been on TRT for 8 years and GH for 2. My PSA has slowly decreased over time and was relatively low all along. So that is one data point. I think that I can say that urine flow is stronger since starting GH.

Your IFG-1 response to hGH is low. My multi-dose IGF-1 232 per iu/day, 7iu/week, very linear. IGF-1 is produced in the liver. Any liver related lab issues?

If you see doc and get a DRE, then get PSA labs done after that, PSA will be exaggerated.

“”"PSA levels can be also increased by prostatitis, irritation, benign prostatic hyperplasia (BPH), and recent ejaculation,[29][30] producing a false positive result. Digital rectal examination (DRE) has been shown in several studies[31] to produce an increase in PSA. However, the effect is clinically insignificant, since DRE causes the most substantial increases in patients with PSA levels already elevated over 4.0 ng/mL.

It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.[13]

In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen.[44] Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.[45]

Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.[46]
"""

Any form of inflammation in or near the prostate can increases PSA. Try antiinflammatory supplements or perhaps drugs [meloxicam 15mg/day]. EFA’s, larger amounts of Vit-C, vitamins. Review issues re CoQ10, Ubiquinol and supplements that improve mitochondrial function. Review your Rx drugs for effects on GH/IGF-1, liver or kidneys[PSA increase].

As long as PSA seems abnormal and DRE seems clear, we may be dealing with something odd. Perhaps they way that your body processes DHEA is not normal. You could drop dose, see if PSA changes. If it goes down, later add DHEA back in and see if PSA responds to that.

http://joe.endocrinology-journals.org/content/204/3/311.full.pdf

You can see that DHEA is transformed inside the prostate to product various hormones. Perhaps you are processing DHEA in this fashion abnormally. So something has changed. If stopping DHEA improves PSA, you would then have some idea about what is going on even though you may never know why.

http://healthblog.dallasnews.com/2013/11/13-factors-that-might-affect-your-psa-levels.html/

Also focus on what might be creating local or systemic inflammation. Lab work for C reactive protein is a general inflammatory marker. Homocysteine is cardio specific. Your PSA levels may be a symptom of a process that is inflammatory and the effects on the prostate are but one effect. A healthy prostate will release more PSA if subjected to internal or external sources of inflammation. Your antibiotic that reduced PSA my have reduced inflammation caused by a problem that was in inside the prostate, which could be systemic or a near by source of inflammation. I would review levels and changes to serum anti-body levels, looking for changes that fix the time frame of the PSA increase. You are sexually active. You cannot ignore the possibility of a STD that is causing inflammation. The effect of the antibiotic would tend to indicate bacterial infection, not viral. You have to consider many things. You could trial an anti-viral and look for PSA response. STD screening is simple to get done and would at the very lease tend to rule out a lot of possibilities. If something is found, you know what to treat and how.

A sample of what you might come across: http://www.ncbi.nlm.nih.gov/pubmed/18765120

So that is a lot of ground to cover, but needs to be done.


#5

My only general advice would be to keep E2 low as that can cause prostate problems. But your E2 is now well managed so nothing to do there.

I also recall some things that you can review here: https://www.google.com/search?q=serm+toremifine+prostate !!!

I have been on TRT for 8 years and GH for 2. My PSA has slowly decreased over time and was relatively low all along. So that is one data point. I think that I can say that urine flow is stronger since starting GH.

Your IFG-1 response to hGH is low. My multi-dose IGF-1 232 per iu/day, 7iu/week, very linear. IGF-1 is produced in the liver. Any liver related lab issues?

If you see doc and get a DRE, then get PSA labs done after that, PSA will be exaggerated.

“”"PSA levels can be also increased by prostatitis, irritation, benign prostatic hyperplasia (BPH), and recent ejaculation,[29][30] producing a false positive result. Digital rectal examination (DRE) has been shown in several studies[31] to produce an increase in PSA. However, the effect is clinically insignificant, since DRE causes the most substantial increases in patients with PSA levels already elevated over 4.0 ng/mL.

It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.[13]

In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen.[44] Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.[45]

Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.[46]
"""

Any form of inflammation in or near the prostate can increases PSA. Try antiinflammatory supplements or perhaps drugs [meloxicam 15mg/day]. EFA’s, larger amounts of Vit-C, vitamins. Review issues re CoQ10, Ubiquinol and supplements that improve mitochondrial function. Review your Rx drugs for effects on GH/IGF-1, liver or kidneys[PSA increase].

As long as PSA seems abnormal and DRE seems clear, we may be dealing with something odd. Perhaps they way that your body processes DHEA is not normal. You could drop dose, see if PSA changes. If it goes down, later add DHEA back in and see if PSA responds to that.

http://joe.endocrinology-journals.org/content/204/3/311.full.pdf

You can see that DHEA is transformed inside the prostate to product various hormones. Perhaps you are processing DHEA in this fashion abnormally. So something has changed. If stopping DHEA improves PSA, you would then have some idea about what is going on even though you may never know why.

http://healthblog.dallasnews.com/2013/11/13-factors-that-might-affect-your-psa-levels.html/

Also focus on what might be creating local or systemic inflammation. Lab work for C reactive protein is a general inflammatory marker. Homocysteine is cardio specific. Your PSA levels may be a symptom of a process that is inflammatory and the effects on the prostate are but one effect. A healthy prostate will release more PSA if subjected to internal or external sources of inflammation. Your antibiotic that reduced PSA my have reduced inflammation caused by a problem that was in inside the prostate, which could be systemic or a near by source of inflammation. I would review levels and changes to serum anti-body levels, looking for changes that fix the time frame of the PSA increase. You are sexually active. You cannot ignore the possibility of a STD that is causing inflammation. The effect of the antibiotic would tend to indicate bacterial infection, not viral. You have to consider many things. You could trial an anti-viral and look for PSA response. STD screening is simple to get done and would at the very lease tend to rule out a lot of possibilities. If something is found, you know what to treat and how.

A sample of what you might come across: http://www.ncbi.nlm.nih.gov/pubmed/18765120

So that is a lot of ground to cover, but needs to be done. It will be an effort to grasp the number of things that I have addressed above.


#6

KSman: Thank you for your input here. Of all the considerations you bring to mind: Something I have not taken into account is the fact that I began taking a form of DHEA in the S form (sustained release); and the timing has been relevant to the change in my situation. I am going to make some adjustments and will let you know if anything relevant turns out. Your time and thoughts are very much appreciated. Thanks again


#7

KSman; in reference to your thoughts and suggestions to my situation noted above; I Did not want u to think I was just latching onto the one DHEA thought in my initial response and overlooking all the other data you point towards. It just struck me as a significant item. While it will be one of my starting points, I am taking into account all you have suggested. It’s a lot of data to research, however, I enjoy the challenge and very much appreciate your time. Thanks again,


#8

KSman; I noticed you reference my IGF-1 response to HGH seems low and then you make the following quote;

“My multi-dose IGF-1 232 per iu/day, 7iu/week”

I am not sure I understand that correctly. Are you saying your IGF-1 levels are at 232 by injecting 1 iu each evening 7 days per week?


#9

Yes, my level would be 232 with 1iu per day, 7 days a week. I have a plot of IGF-1 VS dose, with different doses and lab dates and the result is a straight line. And when that happens, one is confident that the potency of the hGH must be correct. [I guess that I am also concerned that your hGH might be suspect.]


#10

Test results, hormones and CBC about 2 weeks after dropping dhea suppliments completely and starting HGH 1iu nightly 7days per week NIGHTLY

I have now reduced my AL from 25 mg eod to 25 mg twice a week.

Will be running my e2 again and PSA F/T next few weeks.


#11

Test results, hormones and CBC about 2 weeks after dropping dhea suppliments completely and starting HGH 1iu nightly 7days per week NIGHTLY

I have now reduced my AL from 25 mg eod to 25 mg twice a week.

Will be running my e2 again and PSA F/T next few weeks.


#12

Test results, hormones and CBC about 2 weeks after dropping dhea suppliments completely and starting HGH 1iu nightly 7days per week NIGHTLY

I have now reduced my AL from 25 mg eod to 25 mg twice a week.

Will be running my e2 again and PSA F/T next few weeks.


#13

Do not understand: "I have now reduced my AL from 25 mg eod to ?.?25 mg twice a week. " AI?AL aromatase inhibitor

Reduce anastrozole by factor of 8.9/22 = .4

You need DHEA, DHEA-S lab result low!!! Should be 25mg, not .25

It takes 6 weeks to really know what hGH will do for you.


#14

PSA level is dropping as my DHEA level decreases. Was 6.1/16% before i stopped DHEA. Plan on testing again in 30 days, if it continues back towards normal will try bit at a time increasing the DHEA (non SR).


#15

[quote]KSman wrote:
Do not understand: "I have now reduced my AL from 25 mg eod to ?.?25 mg twice a week. " AI?AL aromatase inhibitor

Reduce anastrozole by factor of 8.9/22 = .4

You need DHEA, DHEA-S lab result low!!! Should be 25mg, not .25

It takes 6 weeks to really know what hGH will do for you.

KSman: thank you for your continued review and response.

  1. Anastrozole: My E2 was too low, therefore I have began reducing my intake from 87.5 mg weekly (25 mg eod) to 50 mg weekly (25mg 2 per week). Using the formula 8.9/22, I am basically reducing my intake from 87.5 by 40%. Therefore, 60% of 87.5=52…Am I doing this correctly? BTW; I have no idea why my E2 suddenly began to drop over the last 6 months. I have been on the same dosage of 87.5 weekly for a long time and my E2 has always been in the 20 area (15 to 25). I have not changed my T dosage, and you can see it is in a good spot. Also, my DHT has remained relatively stable in the 80 area. The only thing I noticed was a slight rise in my Free PSA and a slight drop in my SHBG. In any case, I just started this new routine in the last few weeks and I see a slight rise in my E2 (8.9 to 9.2). More time necessary I guess. BTW, even though the E2 is moving around, I have continued to feel great, I assume that is good but that I should continue to try and get it in the 20 area again??

  2. DHEA: 25mg is correct, the .25 was a typo-------I had began dropping of the DHEA as you had suggested previously to see if that would have an effect on my rising PSA problem. I just posted my new PSA results and it would appear that you were on to something there. PSA dropped from 6.1 (a number that had been continually rising over the last year) to 2.7 in about a little less than a month. I was going to go one more month without the DHEA to confirm a continued decline in PSA. If that works, I was then going to began back on the DHEA and see if it did anything to the PSA. I had previously been on a standard DHEA supplement of 25 mg per day for years without any Prostate issues. However, I believe that my PSA problems may have began about the same time that I switched my DHEA supplement from standard to the SR formula (sustained/time release).

  3. HGH: I changed up my routine about about 3 weeks ago to taking it at night and increasing from 6 iu to 7 iu per week. This was based on learning of your routine. While I have not felt any difference yet, I went ahead and did a blood check and you can see that my IGF-1 levels have began to rise (150 to 200 so far). So, I guess I will keep monitoring and see what effects I may feel and see in another month.

Thank you again

[/quote]


#16

There are good reasons to want to keep E2 lower for prostate health. So keep that in mind. I hope that a botched E2 lab result does not have you chasing your tail. [My PSA has been dropping from low to very low over 6+ years of TRT and my T levels are high.]


#17

Nrreit52, Once again KSman comes through with some good information and man I’d like to know where your doctor is at to put you on that protocol because I need to move. You can’t even get Drs to run needed test around here.


#18

[quote]KSman wrote:
There are good reasons to want to keep E2 lower for prostate health. So keep that in mind. I hope that a botched E2 lab result does not have you chasing your tail. [My PSA has been dropping from low to very low over 6+ years of TRT and my T levels are high.][/quote]

KSman; Should I consider keeping my E2 as low as it is now? (Less than10). I was aiming for the 22 mark, but apparently my body has no problem with staying much lower with relatively small amounts of Anastrozole (50 to 75 mg per week in multiple doses), and I have not had any negative side effects that I know of. Also, I have taken 3 separate E2 blood tests over the last 3 months, (results were <5.1, 8.6, and 9.7, relatively), maybe the first number was a botch. Your thoughts?


#19

[quote]ironman4850 wrote:
Nrreit52, Once again KSman comes through with some good information and man I’d like to know where your doctor is at to put you on that protocol because I need to move. You can’t even get Drs to run needed test around here.[/quote]

Ironman4850: I run my own tests through life extension and LabCorp. I have a Doc who sees me and is up on the TRT which is a blessing, but honestly, I do my own testing to stay fine tuned. Also, since I have been keeping track of all KSman’s stickies and posts, I have learned more than i ever did from my doctors, even the specialists. The guy is a wealth of information!

If you have a TRT doc, I would just plan on doing some of your own testing also, just saying…


#20

What does this mean? "small amounts of Anastrozole (50 to 75 mg per week in multiple doses"
Is that 0.5 - 0.75 mg per week or .5 - .7 ml of a 1mg/ml solution?

All of those E2 levels are way to low. E2 is essential for proper brain function. Those three E2 labs indicate that you are NOT been misguided by a botched lab. Suggest that you cut anastrozole dose by 50%