Long Term HRT, DHT, PSA

Pharma TRT
1

A bit of background - I’ll turn 60 this month, I’ve been on transdermal HRT for almost 15 years - I was always Low T - azospermic - and started HRT to help combat cluster headaches. I never had a problem with libido, ED or anything else that one would associate with Low T (around 250 ng/dl).

I’ve been able to keep good fat free muscle mass, and feel pretty good generally. Over the past 5 years, I’ve been dealing with some prostate issues, and a slow rise in PSA from about 1.8 to my last, recent level of 5.0. Last year at this time it was 3.4.

My urologist now wants to do a biopsy, I’m getting a consult for a 3TmpMRI before getting poked, maybe to discount the presence of any lesions. I’m hoping that my recent foray into cycling has driven up my PSA - I’m going to get another test done after laying off the bike for 2 weeks.

My peak levels about 3 hrs post dose are as follows:
Serum Testosterone 1166 ng/dl
% F+W Bound 30.7%
Testosterone F+W Bound 358 ng/dl
DHT 234 ng/dl
% Free DHT 1.7%
Free DHT 39.78 pg/dl
DHEA Sulfate 34.7 ug/dl
Estradiol 32.1 pg/dl

My D3 is 101, I keep it high for the headache prophylaxis

I did a trial of the T pellets about a year ago, 1033 ng/dl a month after insertion, with much lower DHT, but I felt sluggish, gained some fat, so I went back to the transdermal.

Now, due to the high PSA, I am considering going back to the pellets, as I think a lower DHT level would chill out my PSA. Thoughts?

Does DHT carry a significant anabolic effect that I would be missing with the pellets? I am wary of the roller-coaster effect of the shots - but my doc said there’s new shots that can be taken every third day that even things out.

I’m also on FloMax to counteract the urinary troubles, and eating saw palmetto and beta-sitosterol to see if it will help the acne/BPH stuff that’s going on. I’m going to hold off on finasteride until I know more about the possibility of cancer, or whetther I go back to pellets, etc.

I’d love to hear your thoughts about all of this, and if you need any other questions answered, I’ll do my best.

Thanks

Lenny

2

I inject testosterone cypionate daily. No roller coaster

3

Umm, nothing new. It’s always been there. Smaller dose more frequently. I use the same test cypionate they were using in the 80’s, twice a week.

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4

That’s interesting - vial and syringe, or pen-type device?

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When on TRT I inject daily, it’s as far from a rollercoaster as one can get. Clycling does put pressure on the prostate and can cause sexual dysfunction.

I would hold off on Finasteride because it can wreck your life permanently, in PFS suffers quiting the drug does not make the symptoms go away, gene expression is changed and is life long.

7

Um, no.

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The multiparametric MR is a good option, unless you have issues with gadolinium. Especially so if you can get an unequivocal report. If there is a lesion, at least they know where to go with the biopsy.

I would also look into also getting free PSA checked next time you get labs.

Cycling can increase PSA, so can squats, intercourse, etc., but you probably already know that.

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