Stopping TRT because Dr says PSA is high.

[gashuffer]

Been on trt for a year now. T Levels were around 208 when started PSA was .08. At last exam T level was 478 at 200mg 2x a month and PSA was 1.9. Dr says to stop trt now, and get to an endo. Just needing some input. I know psa is elevated at times with trt. However I do have "prostate cancer" in family history. In addition, if I stop and get to endo would running clomid be enough to get straightened out or should I run my tamoxifen with it? I never really have any bad E sides.

[TestingMe]

Not an expert by any means but isn't the normal range below 4? This is all age related as well..

PSA Levels - What is a normal PSA level?

Is your doctor prescribing your meds? Shouldn't he or she be advising you?

200mg 2x a month?

[ppwc1985]

Agree psa is gtg at your level. My last cycle it went to 4.2 and urologist gave me antibiotics and it went right back to normal. But if your dr prescribing test only two shots a month he don't know what he is doing, find a new one.

[MuscleInk]

Been on trt for a year now. T Levels were around 208 when started PSA was .08. At last exam T level was 478 at 200mg 2x a month and PSA was 1.9. Dr says to stop trt now, and get to an endo. Just needing some input. I know psa is elevated at times with trt. However I do have "prostate cancer" in family history. In addition, if I stop and get to endo would running clomid be enough to get straightened out or should I run my tamoxifen with it? I never really have any bad E sides.

Hey gashuffer,

It's not uncommon for the prostate to become swollen or enlarged with anabolic steroids . The transmembrane layer of the prostate fossa is saturated with androgen receptors. Endogenous testosterone will bind to these androgen receptors (AR) and trigger a number of effects. The standard therapy for prostate cancer is therefore castration which can be achieved surgically (orchiectomy) by complete removal of both testes including the spermatochord. Most men avoid this procedure for the obvious reason. A more popular approach for achieving castrate levels of testosterone is chemical castration (aka androgen suppression, androgen deprivation, or androgen blockade) using LHRH agonists such as digarelix or GnRH antagonists such as triptorelin, goserelin or leuprolide HCl. Both procedures result in a negative feedback loop down regulating the synthesis of DHT and testosterone. Castrate levels are achieved when testosterone levels measure <70 ng/ml. Often it is necessary to use a secondary hormonal blockade via adrenal activity. The zona reticularis of the adrenal cortex produces testosterone, DHT, androstenedione, and DHEA - a precursor for estrogen production. Drugs such as flutamide and bicalutamide enter the transmembrane layer of the prostate fossa and BLOCK androgen binding of testosterone and DHT to AR sites on the prostate. Ketoconazole, dexamethasone, and prednisone are also used in combination with other androgen blockade strategies because they inhibit the activity of enzymes necessary for the conversion of cholesterol to testosterone. Unfortunately about 97% of all prostate cancer patients will become hormones refractory or castration resistant, meaning the disease spreads despite successful blockade of androgens in the body (there are many factors that contribute to tumor growth in the prostate but I'll skip it here).

There are several factors related to risk for prostate cancer:
- age
- race
- nationality
- excess weight
- familial history
- anabolic steroid use
- elevated IGF-1
- elevated PhRp
- low zinc
- low selenium
- high calcium
- low dietary omega fatty acids

In your particular case, the PSA test is suggesting increased PSA-AR activity. Is the 1.9 measured in ng/ml or some other unit. If its 1.9ng/ml, the standard cut off for healthy prostate tissue is a PSA of 2.5 ng/ml or less. A PSA of 4-10.0 ng/ml carries a 25% risk for prostate cancer while a PSA >10 ng/ml is associated with more than a 60% risk for prostate adenocarcinomas. IMO, 1.9 ng/ml is nothing to be alarmed about, however it should be actively monitored. Your MD could perform a digital rectal exam or transrectal ultrasound to properly diagnose. PSA tests alone are inconclusive and the standards are changing from absolute PSA to looking at PS-doubling time (PSADT) or PSA density which is a ratio of PSA to prostate volume.

In your particular case, I would think a small adjustment to your dose may help rather than taking you off completely. If a dose adjustment showed no PSA improvement or a PSADT less than 3 months, then stopping the low T therapy and a proper diagnostic test (TRUS, DCE-MRI, PET-CT) would be in order.

Is you doc prescribing an AI? At that low dose I wouldn't think an AI is necessary, however, if your bf% is high (over 20%) or the testosterone at 200 mg q2w is aromatizing, an AI will reduce estrogens which do contribute to prostate changes. Have you had a complete blood panel done with E2 sensitive assay recently?

At 20g q2w, a small dose adjustment

[MuscleInk]

Not an expert by any means but isn't the normal range below 4? This is all age related as well..

PSA Levels - What is a normal PSA level?

Is your doctor prescribing your meds? Shouldn't he or she be advising you?

200mg 2x a month?

No, most docs will screen yearly for anyone between 2.5-4.0ng/ml. 4.0ng/ml was the old standard. Now docs prefer scores at 2.5 ng/ml or less as a measure of prostate health.

Incidentally, most PSA is found in semen (liquifies sperm and digests mucosal layer of cervix to facilitate insemination), not blood, but there is enough in serum to get a PSA measure.

[Rusty11]

Can't answer your specific questions, but did you ejaculate within 24 hrs. of testing? Did your doc refer you to an endo or simply tell you to "get to an endo". Either way, the wait is probably going to be a long one. It wouldn't be right for anyone here to tell you to go against your doc. I'll let the experienced guys answer your question regarding clomid.

Edit: looks like you got a great answer.

[powerlifterty16]

No, most docs will screen yearly for anyone between 2.5-4.0ng/ml. 4.0ng/ml was the old standard. Now docs prefer scores at 2.5 ng/ml or less as a measure of prostate health.

Incidentally, most PSA is found in semen (liquifies sperm and digests mucosal layer of cervix to facilitate insemination), not blood, but there is enough in serum to get a PSA measure.

op 1.9 isnt too bad..and psa can be elevated due to things other than cancer.
i was actually surprised..i just had my psa taken and it was 0.5, which is low but higher than i thought considering im 23 with low t.

[bass]

^^^ good responses above. I wouldn't worry about it. like the guys above noted your doc pulled the plug because he is clueless of how TRT works. estrogen can raise your PSA far more than testosterone . has he checked your e2? did he prescribe AI's? if you have complete BW post it all with ranges.

[MuscleInk]

op 1.9 isnt too bad..and psa can be elevated due to things other than cancer.
i was actually surprised..i just had my psa taken and it was 0.5, which is low but higher than i thought considering im 23 with low t.

Actually, 0.5-1.1ng/ml is typically seen in cases of low testosterone . Circulating testosterone of any type (exogenous v endogenous) will activate AR sites on the prostate and stimulate PSA increases but as testosterone drops, so too does PSA because there is less circulating T (depending on the TRT protocol of course) to bind and up regulate the AR complex.

[ppwc1985]

[QUOTE="MuscleInk"]

Actually, 0.5-1.1ng/ml is typically seen in cases of low testosterone . Circulating testosterone of any type (exogenous v endogenous) will activate AR sites on the prostate and stimulate PSA increases but as testosterone drops, so too does PSA because there is less circulating T (depending on the TRT protocol of course) to bind and up regulate the AR complex.tQUOTE]

Hey muscleink, I respect your opinion because I have been here long enough to know who you are and what you know. Sometimes I wish you would put it more in laymans terms, loool. I've learned alot from your post, I've actually lowered my cholesterols due to your recommendation to lunk. I'm not stupid, I can tear anything apart and put together but when it comes to some of this trt stuff I'm lost but interested in your opinions. Thanks for me and the op.

[powerlifterty16]

thanks muscle link, i was just concerned bc my dad's is lower and he is 56 and has test in the 400s and im 23 with test of 340-370 on a good day lol

ppwc what is lunk and how'd it lower your cholesterol?

[powerlifterty16]

[QUOTE=ppwc1985;6647712]

Actually, 0.5-1.1ng/ml is typically seen in cases of low testosterone . Circulating testosterone of any type (exogenous v endogenous) will activate AR sites on the prostate and stimulate PSA increases but as testosterone drops, so too does PSA because there is less circulating T (depending on the TRT protocol of course) to bind and up regulate the AR complex.tQUOTE]

Hey muscleink, I respect your opinion because I have been here long enough to know who you are and what you know. Sometimes I wish you would put it more in laymans terms, loool. I've learned alot from your post, I've actually lowered my cholesterols due to your recommendation to lunk. I'm not stupid, I can tear anything apart and put together but when it comes to some of this trt stuff I'm lost but interested in your opinions. Thanks for me and the op.

wel i wouldnt say concerned...5 is low..just was a little surprised.

[ppwc1985]

Loooool, lunk is a op here. And muscleink gave him a regimen to follow that lowered his cholesterol levels, I used this same regimen and lowered mine also.

[powerlifterty16]

Loooool, lunk is a op here. And muscleink gave him a regimen to follow that lowered his cholesterol levels, I used this same regimen and lowered mine also.

mind sharing

[ppwc1985]

mind sharing

Here it is

[powerlifterty16]

Here it is

awesome! i was going to buy cholestoff plus..it looks like good stuff.
i will prob try jsut the cholestoff first..just curious if i need to use it permanently.
is that from a forum thread btw?

[MuscleInk]

awesome! i was going to buy cholestoff plus..it looks like good stuff.
i will prob try jsut the cholestoff first..just curious if i need to use it permanently.
is that from a forum thread btw?

You can find Cholestoff at Costco in the US and most nutrition stores. It is gaining in popularity due to its efficacy and safety profile relative to statins that are often prescribed and over used.

Good to hear the Cholestoff is working well for those I suggested it to.

[powerlifterty16]

You can find Cholestoff at Costco in the US and most nutrition stores. It is gaining in popularity due to its efficacy and safety profile relative to statins that are often prescribed and over used.

Good to hear the Cholestoff is working well for those I suggested it to.

i was going to order it from amazon...i buy my b12 and d from amazon. maybe costco is cheaper..hmm.
meh just looked it's only 25 bucks for a 100 day supply at 900 mg on amazon...

[ppwc1985]

Muscleink I told my Dr about that protocol and she wrote it s down. She also said the same thing about cholestoff. Thanks.

[xcraider37]

You can find Cholestoff at Costco in the US and most nutrition stores. It is gaining in popularity due to its efficacy and safety profile relative to statins that are often prescribed and over used.

Good to hear the Cholestoff is working well for those I suggested it to.

Just went and purchased cholestoff, based on this thread, hope it lowers and keeps cholesterol down. Thanks for the tip.

[powerlifterty16]

Just went and purchased cholestoff, based on this thread, hope it lowers and keeps cholesterol down. Thanks for the tip.

did u get cholestoff PLUS...the other isnt as good.

[gashuffer]

Lots of good information. Really appreciated. So Dr did refer me to endo, but it will be a month before I get in. Yes, my Dr prescribed 200mg 2x a month which I break into 4 pins. No, I don't think my Dr is up on trt and has never prescribed AI. I just keep clomid and tamoxifen on hand based on research I've done. I also have adex, but honestly I have never "felt" the need to take it. Dr will not run full Hormone panel, so I have know idea what e2 has been. All the more reason I am going to follow up with endo, not only to have psa checked out, but hopefully get better treatment and testing. From what I've read here psa is "ok". So what I would like to do is stop test and run clomid in hopes this will get me back to a normal natural baseline when I get in to the endo so I can start fresh. Is this advisable?

Other info:
Age 38
Weight 255
BF 18-20 (based on calculated meas.
BF has dropped since trt weight hovers 10lbs give or take, but over all physique has changed alot.)
Exerc lift heavy 3-4ED with very light cardio.
Diet eh great at times.

[bass]

Lots of good information. Really appreciated. So Dr did refer me to endo, but it will be a month before I get in. Yes, my Dr prescribed 200mg 2x a month which I break into 4 pins. No, I don't think my Dr is up on trt and has never prescribed AI. I just keep clomid and tamoxifen on hand based on research I've done. I also have adex, but honestly I have never "felt" the need to take it. Dr will not run full Hormone panel, so I have know idea what e2 has been. All the more reason I am going to follow up with endo, not only to have psa checked out, but hopefully get better treatment and testing. From what I've read here psa is "ok". So what I would like to do is stop test and run clomid in hopes this will get me back to a normal natural baseline when I get in to the endo so I can start fresh. Is this advisable?

Other info:
Age 38
Weight 255
BF 18-20 (based on calculated meas.
BF has dropped since trt weight hovers 10lbs give or take, but over all physique has changed alot.)
Exerc lift heavy 3-4ED with very light cardio.
Diet eh great at times.

how tall are you?

[gashuffer]

6'1"

[ppwc1985]

I'm by no means an expert, I just started trt but if you were low enough to start trt I wouldn't stop. Just talk to your new dr first and see what he says.