TRT After Testicular Cancer

Pharma / TRT Testosterone Replacement
1

I have read through the stickies, and I am beginning my case per the Advice for New Guys thread.

Age - 31 on August 28th
Height - 5’ 11"
Waist - 32 Inches
Weight - 175 lbs
Body/Facial Hair - Naturally Ectomorph (Graduated High School at 125 lbs) / Grows Slow (Only shave once a week and can not grow a beard or mustache)
Carrying Fat - Mostly around the waist. More so in the past 4 years.

Health Conditions - Diagnosed with testicular cancer in the left testes in August 2011, left testicle removed and no radiation or chemo needed. 1.5 years prior to this became very tired, low sex drive, brain fog, etc. and went to an endocrinologist. He noticed my left testicle was around 1/3 to 1/4 the size of the right. I do not know when this occurred but I was not born this way and did not have any injury to that area. I was surprised by this, and he sent me to a urologist who tested tumor markers and an ultrasound that revealed only calcification. He would check me every three months to keep an eye on it but said it was unlikely it would become a tumor. I still had symptoms of low T, so I went to a wellness doctor who because me on 200mg/ml test every two weeks and HCG. I only was there for 1 month before my cancer was diagnosed. (Left testicle became as hard as a marble.)

I still felt horrible still after the surgery, especially low sex drive, and this especially was effecting my marriage. My urologist did a Testosterone Serum test on 2/28/12 and the results were 397 ng/dl with the reference interval of 348-1197. I began 200mg/ml test shot EOW in his office beginning 5/31/12, knowing that after two months he would allow shots administered at home.

My last shot in the office was on 7/12/12, and now I have a script for test cypionate 100mg a week administered however I’d like at home. I spoke to him on 7/12 about an AI and Nolvadex (no HCG for me because of the type of cancer tumor in the testicle) and he blew me off saying the AI is only needed in older fat men, and he wouldn’t even speak to me about Nolvadex although I explained to him that my feet are now swelling, I am having crazy mood swings, and the sex drive is nothing like it was the first two weeks of the first shot.

I have ordered anastrozole and Nolvadex myself and should be here later this week. I am not sure if I should tell the doctor I am taking these or not. I was going to begin shots at home on 7/26 with 50mg every Thursday and Monday with AI 1mg a week and Nolvadex 10mg a day.

Doctor is not very willing to do much blood work, but will do TT, FT, and E2 on 8/14. I found a lab willing to do the following tests for $456, and I am wondering if I should or not: TT, FT, E2, PSA, DHT, TSH, T3, T4, DHEA, DHEAS, Pregnenolone. I am not sure how ofter to do which tests exactly, but just wanted to do this the right way even if it costs more initially because TRT will be for life and has already helped so much.

Rx and OTC Drugs - Loratadine 10mg a day, Fluticasone nose spray once a day (both allergy related); Advil maybe once a month; DHEA 50mg a day and Vitamin D 4,000 IU a day.
Diet - Breakfast two to four eggs in a whole wheat wrap, lunch and dinner whatever the wife makes (ground turkey or chicken for protein, lots of veggies, and brown rice, sweet potato, or quinoa for carb). Whey protein PWO.
Training - 4x a week 30 minutes with weights followed by 15-30 minutes on treadmill running or intervals. 1 or 2 days a week light jog with family.
Testes Ache - Yes, the left before surgery but never the right. Never ache associated with a fever.
Erections - No morning wood for as long as I can recall, no nocturnal erections in the past 4 years (except since 5/31/12 with the first two weeks on TRT morning wood and night erections, and now only night erections 3 times a week or so followed by sex with the wife).

*No tumor on the pituitary gland.

KSman has been very helpful along with others. Wondering when I should get lab work and what exactly to get done since it may come out of pocket. Two times a week 50mg each time enough times a week? Following the Protocol to for Injections stickie but will be substituting HCG for Nolvadex 10mg a day. Any questions or advice? Looking forward to this journal and becoming my own health care professional!

2

“no HCG for me because of the type of cancer tumor in the testicle”

What? That makes no sense, especially given that the testicle, and therefore the tumor, was removed. Many of us on here are on hCG and had testicular cancer. I had a non-seminomatous germ cell tumor that was predominately embryonal carcinoma, which is the second-most common type. Do you know what you had?

(On a side note, I’ve seemed to notice that more guys seems to lose their left testicle than the right (me and a few others on here). I wonder if there’s any stats out there showing how many lose which one.)

In terms of getting on an AI, if your doctor won’t play ball then you either need to get a new doctor, or get an E2 test that shows a need for an AI. My first Endo said “People put too much weight on E2; I don’t see a need to get it tested”. I switched doctors the next day. Your doctor should know every medication you are on, and getting insurance to pay for it is cheaper than getting it on your own. Maybe if you tell him you’re taking it he may cave and prescribe it, but you have to make sure it’s necessary first. Get the test done before you start an AI (if you’re planning on starting one soon) otherwise you have no proof to give him that you need one.

I’ve had a couple arguments about this with a few people, so keep that in mind, but: The PSA test is worthless. Here’s an article about it: PSA tests can cause more harm than good

So I’d say you can skip that test. I’d venture that you can also skip TSH if you’re trying to cut corners since that is largely considered a preliminary test at best, and getting the more “in depth” thyroid tests will prove to be more effective indicators of thyroid issues. As for the others, do what you can afford. TT, E2, and thyroid should be a priority for now. Why do you take DHEA?

3

I had a seminoma germ cell tumor. The doctor checks Beta HCG every six months now. if Beta HCG raises then it could possibly be an indication that I have cancer. (This is what he had told me.) Because of this, it seems that Nolvadex is the next best option.

I will make sure to have E2 tested before going on an AI to prove to him, although I hate to have to wait until mid August considering how good I felt the first two weeks on T. It was difficult to find a doctor that would allow T shots at home, but I will continue to look around. My current Urologist caught the cancer and preformed the surgery, so I was trying to stay with him if possible, although it is clear now that rushes through patients and may not be willing to listen.

Thank you for the updates on what tests to get done. I will trying and have insurance cover all if possible. I take DHEA because previous “wellness” doctor said it would help with T. I am guessing this may not be true based on your question. This is still very new to me, and I am thankful others have been through it to help.

4

With only one teste, pregnenolone will be down and DHEA would be expected to be lower as a result.

Can you post any current lab work?

You can do labs on your own at LEF.org, get a membership. There is a male panel with TSH, not including fT3, fT4 or pregnenolone.

Thyroid status: Make sure that your iodine intake is adequate and monitor morning and afternoon body temps.

Endo’s are not into health/QOL management, they are into disease management. You cannot expect much from endos or urologists. Finding a different doc would be a good idea.

For others: Some testicular cancers produce hCG and in that case, that is a tumor marker. That is why hCG cannot be used at this point in time. Nolvadex may increase LH and that can get the job done.

PSA: The current problems with PSA are how the medical profession reacts to increased PSA levels. There is nothing wrong with the test itself. Yes, there are false positives and the problem is with the interpretation and response. In my case, with 6.5 years of TRT, my PSA keeps getting lower and lower; interesting.

At this point, you will need to watch for signs that you are an anastrozole over-responder.

Never do labs for DHEA, only for DHEA-S. DHEA half-life in serum is low and thus highly variable. DHEA-S is a metabolite of DHEA and it is what really gets the job done. In this case, DHEA-S is a proxy for DHEA status; just as IGF-1 is a proxy for GH status.

5

I too get the bhCG test done. In fact, I just came back from the lab. This is my first test after starting hCG and I’ve been wondering for a while now if hCG will scew the bhCG test. My oncologist didn’t know whether taking hCG will screw up the test, but he said that even if it does there are the other markers, regular x-rays, and regular CT scans, so missing out on one test probably won’t be a big deal. Once I get my test back I’ll let you know what’s going on, and I’m also going to call my oncologist again to see what he thinks of the results. Should happen tomorrow or Thursday.

6

My friend had prostate cancer, now has low T - NHS nurse said TRT will bring the cancer back, is this true or WTF?

7

[quote]JackNeedsHelp wrote:
My friend had prostate cancer, now has low T - NHS nurse said TRT will bring the cancer back, is this true or WTF?[/quote]

This is off topic, as prostate and testicular cancers are not at all the same, but yes, TRT is not advised for those with prostate cancers…

OP. You are only getting beta hcg done? You should also be getting LDH and alpha feta protein as part of your regular workups. As well as regular CAT Scans (once every 6 months for first couple years then once a year for a few after that).

Urologists are not adept at TRT. I would find a doctor who is good at that. Being in New Jersey, you shouldn’t have a problem.

As ctastrophe pointed out, your doctor’s comment about taking HCG due to the type of cancer you had is not very logical. If you need it, you need it. What exactly is his fear? doesn’t make sense.

You do not need a full panel at this point. Although it would be helpful. Best bet is to find a good doc that will allow insurance to pay for it. privatemdlabs also has good rates (female hormone panel taht will cover everything you need–yes even if you are male).

Nolvadex on TRT is stupid and will not help. It is not enough to overcome the exgenous shutdown caused by the TRT, so you will get no benefit from pituitary output. May help block estrogen at breast tissue, but may increase it elsewhere. AI is what you need.

8

Sorry, I’ve been out of town for the last eight days, and just got back!

On every blood test, aside from this current one, I have gotten the standard <2iu/L (0.0-3.0iu/L) result. This test, my first AFTER starting hCG was 5.0iu/L. So it looks like hCG raises this test score (or I have cancer again which would suck). My two other blood markers came in clear as usual: LDH 135U/L (100-210U/L), and AFP 2.0ng/mL (0.0-9.0ng/mL). Pending the results of my CT Scan and Chest X-Ray, I will be able to confirm that the bhCG score was caused solely from my hCG use as my doctor and I figured it would. I won’t be discontinuing hCG as the bhCG test is only one of several tests needed to confirm the presence of a cancerous tumor, so the other tests will do. I will continue getting the bhCG test done to see if the results are consistent, or if they fluctuate.