Elevated PSA

[Rwy]

Hi everyone- Not sure if any of the old members are around its been awhile since I last posted. Hope everyone is doing well-

I have been on TRT for about seven years now. I am 40 years old. I am currently taking 100 mg once a week, and I am at a test level between 500-600, and I am okay with that. All my blood work is excellent except over the past 12 months my PSA has been jumping between 2 to 2.76. My current TRT Dr wanted to rush me to biopsy. I got a second opinion and that DR was not well versed in TRT, so we abruptly ended the appointment. My 3rd opinion today told me its time to start taking a more in-depth look.

Today my PSA came in a 2.25 which is down .25 from three months ago. However, my rectual exam revealed my prostate is def enlarged but smooth. The 3rd opinion stated today he wants me off everything. I am currently taking HCG on my own because my wife and I are going to start trying for our second child soon. I am okay with pausing the Test but not the HCG. If I do have prostate cancer and need to have my prostate removed, I will not be able to have another child.

I am curious to hear others suggestions or thoughts.

I am really hoping the test is causing my prostate to grow which reflect a higher PSA and I do not have prostate cancer. However, if it is cancer I do not want to be infertile. I want to try and get my wife pregnant before having my prostate removed.

[kelkel]

Odds are it's simpy age causing your prostate to grow. It happens to the best of us. Doesn't mean you should not look into it but I definitly would not push the panic button or hop off your TRT. Consider the psa range is normally 0.0 to 4.0. Many things can cause psa spikes such as infections, bacteria, ejaculation to close to blood work and the list goes on. TRT though is only known to initially elevate psa, it then returns to its baseline.

It's also not really testosterone directly but DHT that can cause the issues over time. The prostate saturates with testosterone at around 240 ng/dl from memory. This was proven by Dr. Morgantaler who is arguably the most knowledgeable doc in the world when it comes to testosterone. He's studied it for decades. In particular it's called the "Saturation Model."

New Concepts Regarding Testosterone and Prostate Cancer: A Breath of Fresh Air | Cancer Network | The Oncology Journal

https://www.ncbi.nlm.nih.gov/pubmed/18838208

If you want an in depth look into it then I'd opt for a T3-MRI. It's non invasive (meaning nothing shoved up your arse) and is like a typical MRI. I had it done when my prostate started having a mind of it's own and bouncing all over the place. It would normally run at .08 or so. It came back at 1.2 which like you, alarmed me. I re-tested in about two weeks and it was a 2.0. At this point I scheduled the T3 which came back clear. I'm now on Finasteride at 5 mgs p/d and do just fine. My new norm is probably around a 1.6 or so. That's life. I've had no issues with Fina which is a type 2 - 5 Alpha Reductase blocker. Basically it blocks the conversion of T to DHT. It's effective at about a 70% rate.

Not that your asking but in my opinion I'd continue on your test and hcg until further testing is done. Try to get the T3 asap. Anything less will probably be invasive. Take a minute and read this on Maintaining Fertility while on TRT with HCG. If you don't read the whole article at least drop down to the HCG section. Show it to your doc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

Hope it helps!

kel

[Rwy]

Thanks for this information Kel. I was full on panic mode earlier and neglected to mention he only wanted me to come off TRT for 6 weeks so he could do blood work and then measure my PSA. If my PSA was still high after 6 weeks of no Test or HCG he would want to do a biopsy. I think coming off Test for 6 weeks is not ideal but doable.

I just googled T3 Mri for prostate and that sounds more reasonable than coming off trt. I am going to speak with him about it. As for adding something to help with the enlarged PS this Dr is def not the right fit. He was perplexed on why my old fertility Dr put me on HCG with TRT. He thought I should have been taken off trt and HCG should have bumped my levels enough to give me desire to have sex.

[kelkel]

I forgot to mention step one medication wise for you imho should be low dose daily Cialis. It's approved by the FDA for BPH and is simply a healthy item for any man to take. Only reason not to implement it would be if you suffer from abnormally low BP. I do 10 mgs per day (5 x 2) and have for years. I couple it with Doxazosin at 1mg x 2 per day. Doxy is an alpha blocker / smooth muscle relaxer so it will benefit you in two ways as both the prostate and penis are smooth muscle. Win-win.

Request it from your doc but be prepared to educate him on it. It's possibly out of his league as is TRT with far to many docs.

Be well Rwy. Hope it helps.

[bullshark99]

RWY,

Panic mode, been there.......My baseline 7 yrs ago was 1.7. Six months into TRT I jumped to 2.5, this absolutely freaked me out. Short version here, turned out to be nothing. Over the last 7 years I have gradually gone from as low as 2.0 all the way up to 3.05 last year. A month ago I was 2.95, I retested 5 days later with a different lab and was 2.65. OK, think you can see where I am going....... the number is gonna bounce around natarually and also depending on the lab so don't "split hairs" and get too dialed in on a specific number.
I have seen multiple Drs and have had multiple DRE's and all said you have nothing to worry about. If the number Double's PAY ATTENTION, this is not good, btw its called "velocity".
One of the urologists acted as I needed to get a Biopsy IMMEDIATELY or I was gonna die.....(he probably just wanted to get paid). My PSA was only 2.5 when I saw him. People with cancer many times have PSA in the 20's and 30's and even higher so don't freak out if you increase 20 or 30 basis points, a million things can cause that, all benign.
I completely agree with Kel, if you need to do something or "feel" you need to then go with the MRI. Keep everyone posted here, this is obviously a subject matter that is very important to most of us.

Best

[Youthful55guy]

Good advice all around. Not much more to add except to reiterate some points.

1) PSA values can vary from lab to lab, so don't compare results from different labs.

2) Keep in mind too that there are two types of PSA tests, screening and sensitive. Make sure you are not comparing the results of one type of test to another, even if it's from the same lab.

3) There is debate in the medical community as to whether even DHT plays a primary role in prostate cancer. The old "truths" are being questioned. Current thought is that it may be related more to the T:E ratio, but that's still open to debate. One thing is for sure, exogenous T (or DHT) does not "cause" cancer. It may (or may not) exasperate it when it is present. The latter is what is being intensely debated.

4) I want to reiterate Kel's advice on the MRI. I've read posts where guys claim that the biopsy itself can elevate PSA because you are causing trauma to the prostate, so repeated biopsies can make the situation look even worse.

5) If you didn't know this already, it's good to point out that recent or frequent ejaculation can elevate PSA levels. The act of ejaculation can cause minor trauma to the prostate and temporarily raise PSA. You should abstain from all sex (with a partner or solo) for a minimum of 72 hours prior to the blood draw.

6) I also support kel's advice on Cialis. I take 2.5 to 5 mg daily for health reasons. I could get by sexually without it, but it certainly gives the erection a boost too. I have no experience with Doxazosin. One more thing to add to my research list.

Best of luck! Keep us informed.

[Rwy]

Thanks everyone for the information and support. During my panic, I forget that my best friends brother is a top trauma surgeon in Manhattan who took my call yesterday.

He said-Smooth Surface during the exam, PSA is currently 2.25, not direct relatives with Prostate cancer tell them to piss off with their biopsy and see more patients.

Its intrusive and comes with its own inherent risk. Tell them to get one if its a walk in the park.....He did think it would not be a terrible idea to come off for six weeks and have PSA tested again just for shits and giggles. But he agrees with you guys that its BPH.

[David LoPan]

The PSA test is not a good indicator IMO and a lot of doctors as well. Nothing like a good finger up the ass to check and see first. Glad I have a doctor that is a woman. Also, at age 40 it is time to get your colonostomy done. Are you having any stream issues?

[kelkel]

Thanks everyone for the information and support. During my panic, I forget that my best friends brother is a top trauma surgeon in Manhattan who took my call yesterday.

He said-Smooth Surface during the exam, PSA is currently 2.25, not direct relatives with Prostate cancer tell them to piss off with their biopsy and see more patients.

Its intrusive and comes with its own inherent risk. Tell them to get one if its a walk in the park.....He did think it would not be a terrible idea to come off for six weeks and have PSA tested again just for shits and giggles. But he agrees with you guys that its BPH.

Good to hear. In future rounds of BW start monitoring your dht levels as well. It doesn't always take a lot of testosterone for dht to be above range.

[Youthful55guy]

Good to hear. In future rounds of BW start monitoring your dht levels as well. It doesn't always take a lot of testosterone for dht to be above range.

I can testify to that! I'm convinced that even if I ate the whole $^%# saw palmetto plant, it wouldn't bring my DHT levels down. I've recently adjusted my T dose down after dropping my Armour Thyroid dose and seeing a drop in SHBG with concomitant rise in Free T. I'm hoping that finally brings DHT into range. BPH has not been a major issue, but I have been told by two docs that I have a big prostate (but with a smooth surface and very low PSA).

[Rwy]

The PSA test is not a good indicator IMO and a lot of doctors as well. Nothing like a good finger up the ass to check and see first. Glad I have a doctor that is a woman. Also, at age 40 it is time to get your colonostomy done. Are you having any stream issues?

I have a pretty powerful stream still. Maybe once in awhile at night I have to get her going

[Rwy]

So I came off TRT for two months, and of course, my PSA test post test was the highest its been at a 3.25. I switched Dr's, and he specializes Urology and in TRT. He even said this is why this test can be so frustrating. We both were expecting the number to be down now that my body had more than enough time to clear the test. He gave me an exam and said everything felt fine. He ordered a 4k blood test and another PSA.

My PSA came down to a 2.67, and because of that number, my 4k test was rejected by the company that does it. They said I am in range for my age. Talk about frustrating! This Dr is not pushing biopsy but does not think its wise to be on TRT until we get this figured out.

[kelkel]

So I came off TRT for two months, and of course, my PSA test post test was the highest its been at a 3.25. I switched Dr's, and he specializes Urology and in TRT. He even said this is why this test can be so frustrating. We both were expecting the number to be down now that my body had more than enough time to clear the test. He gave me an exam and said everything felt fine. He ordered a 4k blood test and another PSA.

My PSA came down to a 2.67, and because of that number, my 4k test was rejected by the company that does it. They said I am in range for my age. Talk about frustrating! This Dr is not pushing biopsy but does not think its wise to be on TRT until we get this figured out.

A properly run TRT protocol will not hurt you one bit. What about asking for the T-3 MRI?

[Rwy]

A properly run TRT protocol will not hurt you one bit. What about asking for the T-3 MRI?

I agree with you. I think its obvious now that TRT played no role in my PSA bouncing all over the place. The problem I am now running into is no one wants to give me a script for TRT with a PSA thats considered high for my age.

As for the MRI. I was told the 4k test was more accurate. I have no idea if that is true or not.

[bullshark99]

Very confusing if this Dr specializes in TRT??? Little off topic but curious how you have been 'feeling' over the past 60 days being off TRT??

[Rwy]

Very confusing if this Dr specializes in TRT??? Little off topic but curious how you have been 'feeling' over the past 60 days being off TRT??

I do not feel great but do not feel like the world is ending either. I thought I was doing a good job keeping my dose down and not bloating but once off I def shed some water weight. This TRT Dr has been added to the list of not seeing again. I called the company who does the 4k test, and told me I was denied only for my age. Not that I was in range. Why he would make up such a thing. I have no idea.

[kelkel]

I called the company who does the 4k test, and told me I was denied only for my age. Not that I was in range. Why he would make up such a thing. I have no idea.

Maybe having a doctor write a letter of medical necessity to your insurance provider would help?

[Rwy]

So I wanted to update this.

My last post my PSA was a 2.67. A month after that my PSA dropped to 1.3, so that was a total of three months off test. I was so relieved with the results, and this new DR (Urologist highly recommended in my area) said to go back on TRT. He sends me to their testosterone specialist who is a male nurse in their office to get a script for test. I sit down with him, and we have a very in-depth conversation about this whole experience. I can tell he is well versed in TRT

He tells me that he has specialized in trt for six years and when young guys like me on TRT have high PSA's like this they at some point are going to get prostate cancer. It's not if it's when. I was floored he was saying this to me.

The nurse could tell I had been drained from this whole process, so we made a deal. He gave me a script of test and said let's get you back on for a few months, and if your PSA starts to get back up there again, he recommended I should get a biopsy. If I have a high PSA and don't get a biopsy, he said he would no longer treat me for low t.

So stressed again by all of this I started opening up to my friends about this whole situation and my buddy tells me I need to talk to someone he knows. Low and behold His father in law is a trt/hormone dr who recently had his prostate removed because of prostate cancer. This Dr told me if you have prostate cancer testosterone is like throwing gasoline on it. New data is showing that my PSA should be between .5-1

So I got blood work done, and my psa has already jumped back to 1.6. I am getting blood work next month and then paying for a t3 MRI (like kel said)

Keep y'all in the loop.

[macmathews]

Very interested in this
Sub'd

[Youthful55guy]

I wish you the best of luck whichever turn this takes.

Consider also getting your E tested with the correct lab. I am not well versed on the subject, but there are people out there who claim that the T:E ratio is important.

[kelkel]

This Dr told me if you have prostate cancer testosterone is like throwing gasoline on it.

The doctor needs to crack open a new study and self educate a bit more. That's old school dogma that was taught in med school for years unfortunately. Remember the links noted in my first post here and the "Saturation Model" where the prostate saturates with T in the mid 200's. More makes no difference.

Did you implement low dose daily Cialis? Consider low dose Doxasosin in conjunction with this as well.
Have they discussed Finasteride with you?

[Amuuzen]

Certainly wish you the best RWY, I agree with Kel, sounds like the doctor is talking old school, but I believe most Dr's will back off from TRT with your history barring a specialist.

Kel, you suggested Tadalafil and Doxasozin as a treatment for BPH. At what point is this considered? Curious as BPH is a common theme in my family and keeping my eye on DHT and PSA during TRT. Could it be considered palliative treatment before symptoms? Any references? Can PM me if you want to keep it off of this thread.

Good luck Rwy

[kelkel]

Cialis is a great first step with mild BPH, ED and LUTS. Ton's of studies on it. I've attached two but there are many. At what point is it considered? To me it would be based on blood work and conversations with your doctor. That said, I personally recommend Cialis for any older adult due to it's many health benefits as noted above along with it's originally intended purpose.

When it comes to the combination of Cialis and Doxazosin. Doxy is an Alpha-Blocker, meaning it's a smooth muscle relaxer. The prostate is smooth muscle as is the penis. So, the combination of the two drugs works synergistically for enhanced benefits. Unfortunately, not many doctors other than Uro's (or so it seems) are up on this tactic.

I've been on both for years at 5 mg Cialis x 2 and Doxy at 1 mg x 2 per day.

I'm curious where your DHT level normally is when on TRT and what your TRT protocol is?

https://www.ncbi.nlm.nih.gov/pubmed/25083163

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826864/

https://onlinelibrary.wiley.com/doi/...rol.111.013185

[Mr.BB]

Take some finasteride, it will help keep with the prostate enlargement.

Don't know why some ppl are against it without even testing their dht levels.

[Amuuzen]

I'll try to be brief as to not high-jack the thread completely. First BW showed normal levels of DHT, 2nd didn't assay for it, so I'll inquire when the next BW comes up. Most recent BW:
Testosterone 150mg/week given in 2 doses 3.5 days apart.
Total testosterone: 992
Calculated Free testosterone: 29.6 (a little above goal but we will continue to monitor)
Estradiol: 67
Started with Anastrazole 1mg twice weekly and we'll see what that does to the Estradiol. Vitamin D was a bit low too so I added that also. I have had inflammation of the prostate in my past and both sets of grandparents had BPH, so I'm a strong candidate for it to hit me, but as now is within the norm.
PSA 0.4 (0.3 first BW)
Anyway, I'd like to start Terazosin or Doxazosin as it seems indicated and Tadalafil (depending on price), but I'll mention it to my PCP. My PCP is going to write the Testosterone and I'll pay OOP to avoid any insurance hassle. He wants another BW (me too) before writing the next Rx for Test and I'll know more then. I have a good relationship with him and I'll be bringing in these studies you cited as well as some others (hCG mainly) to get his take on it, but I presume it will all be a go. I'll post to another thread with results when they come in.

[kelkel]

That's way to much adex. You're going to crash your estrogen. Remember that standard estradiol can often times read much higher in men as the test is geared to women and not sensitive enough for men's lower levels. This caused doc's to over-write adex. I'd simply go with .25 each day you inject and retest in a month. Small, incremental changes are always best.

Re Finasteride it will definitely help. I'm on it at 5 mgs per day (had no choice) and I believe BB is as well but maybe at a lower dose? It's still a last resort imho. If you do take it combine it with Cialis.

Just saw your psa is at 0.4. That's excellent. Fina def not needed.

[Youthful55guy]

Take some finasteride, it will help keep with the prostate enlargement.

Don't know why some ppl are against it without even testing their dht levels.

I'd like to try finasteride, as my HDT is very high, even though my TRT protocol is on the low side of what everyone else does and my T levels are within range all the time. I seem to be a hyper converter of DHT. I even have an unopened box of finasteride on my drug shelf, but reason I don't use it is that you cannot donate blood while taking finasteride and for at least a month after discontinuing. There's good reason too. Studies in rats show that even at very low concentrations (I seem to remember <1/100 normal use in men), the male fetuses in pregnant rats showed malformed genitals. I certainly don't want to be responsible for a guy having to go through life with a micro penis or some other deformity!

[Youthful55guy]

That's way to much adex. You're going to crash your estrogen. Remember that standard estradiol can often times read much higher in men as the test is geared to women and not sensitive enough for men's lower levels. This caused doc's to over-write adex. I'd simply go with .25 each day you inject and retest in a month. Small, incremental changes are always best.

Re Finasteride it will definitely help. I'm on it at 5 mgs per day (had no choice) and I believe BB is as well but maybe at a lower dose? It's still a last resort imho. If you do take it combine it with Cialis.

Just saw your psa is at 0.4. That's excellent. Fina def not needed.

AGREE! 1 mg per week is way way too much for a E level that's just moderately high (assuming you have the correct lab method and that the upper range is around 40 pg/mL). I find that even 0.25 mg 2X per week that Kel recommended is too much for me (though my uncontrolled E never got above 58 pg/mL).

Conside the vodka/eye dropper method. It really worked well for me. I find that 2-3 drops per day (0.2 to 0.3 mg/week total) was enough to bring my E to about mid range. https://forums.steroid.com/hormone-r...astrozole.html

[macmathews]

It may be because for some its known to cause serious depression

[Mr.BB]

It may be because for some its known to cause serious depression

Some get depressed with anything, no real science there.

[Mr.BB]

I'd like to try finasteride, as my HDT is very high, even though my TRT protocol is on the low side of what everyone else does and my T levels are within range all the time. I seem to be a hyper converter of DHT. I even have an unopened box of finasteride on my drug shelf, but reason I don't use it is that you cannot donate blood while taking finasteride and for at least a month after discontinuing. There's good reason too. Studies in rats show that even at very low concentrations (I seem to remember <1/100 normal use in men), the male fetuses in pregnant rats showed malformed genitals. I certainly don't want to be responsible for a guy having to go through life with a micro penis or some other deformity!

I've stopped donating cause of finasteride, anyways didnt really need to donate while on nebido and if keep the blasts short enough.

DHT also contributes greatly to erythrocytosis, so unless your primary donating reason is to help the blood bank, you might want to try it and help your prostate. (Elevated Dihydrotestosterone is Associated with Testosterone-Induced Erythrocytosis)

[Rwy]

True or False taking something to combat BPH can cause a low PSA reading which could actually mask prostate cancer?


I will tell you what sucks. I have seen like 6 Dr's, and every one of them has a different answer than the next

[kelkel]

I've read that. The alternative would simply be a competent doc, testing via MRI or DRE with fat fingers. I'd imagine there are ton's of drugs out there that a similar claim could be made about. Remember there are other signs indicative of prostate cancer other than just psa.

[Rwy]

I've read that. The alternative would simply be a competent doc, testing via MRI or DRE with fat fingers. I'd imagine there are ton's of drugs out there that a similar claim could be made about. Remember there are other signs indicative of prostate cancer other than just psa.

Competent Dr, HA!!!

Ive been in the TRT game for 6 years now and my best run was when I did it by myself. As soon as I started working with Dr's I am dying. Ive had five different fingers in my ass in the past 12 months and only 1 said bph. There are no more fingers going in my ass.

Its MRI and 4k next month when I turn 40 and if all is goog I think I am going back on trt with out a dr.

[kelkel]

Competent Dr, HA!!!

Ive been in the TRT game for 6 years now and my best run was when I did it by myself. As soon as I started working with Dr's I am dying. Ive had five different fingers in my ass in the past 12 months and only 1 said bph. There are no more fingers going in my ass.

Its MRI and 4k next month when I turn 40 and if all is goog I think I am going back on trt with out a dr.

Great post! Keep us updated on this thread please. This stuff helps people.

[almostgone]

This is really for my own education; you guys are way over my head with a good bit of this, but was prostatitis ruled out?
I dealt with it for for quite some time in my 40s, and it played hell with my PSA as well causing some unexpected/unpleasant...... umm....events. Was afraid it was going to be a chronic condition as it kept coming back. The symptoms would improve, PSA would drop. Symptoms rebounded, PSA would go back up.
I actually had epididymitis from a groin injury ( I got popped in the cubes with a stray sledgehammer, but only the left really got the brunt of the hit) and then later on prostatitis Twas very unpleasant all around. Still blame my torn spinal erector on the multiple rounds of fluoroquinolone, but I may be wrong.

[almostgone]

Cialis is a great first step with mild BPH, ED and LUTS. Ton's of studies on it. I've attached two but there are many. At what point is it considered? To me it would be based on blood work and conversations with your doctor. That said, I personally recommend Cialis for any older adult due to it's many health benefits as noted above along with it's originally intended purpose.

When it comes to the combination of Cialis and Doxazosin. Doxy is an Alpha-Blocker, meaning it's a smooth muscle relaxer. The prostate is smooth muscle as is the penis. So, the combination of the two drugs works synergistically for enhanced benefits. Unfortunately, not many doctors other than Uro's (or so it seems) are up on this tactic.

I've been on both for years at 5 mg Cialis x 2 and Doxy at 1 mg x 2 per day.

I'm curious where your DHT level normally is when on TRT and what your TRT protocol is?

https://www.ncbi.nlm.nih.gov/pubmed/25083163

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826864/

https://onlinelibrary.wiley.com/doi/...rol.111.013185

Glad you mentioned DHT. I need to add it to my next self-ordered labs.

[Mr.BB]

I've read that. The alternative would simply be a competent doc, testing via MRI or DRE with fat fingers. I'd imagine there are ton's of drugs out there that a similar claim could be made about. Remember there are other signs indicative of prostate cancer other than just psa.

Competent Dr, HA!!!

Ive been in the TRT game for 6 years now and my best run was when I did it by myself. As soon as I started working with Dr's I am dying. Ive had five different fingers in my ass in the past 12 months and only 1 said bph. There are no more fingers going in my ass.

Its MRI and 4k next month when I turn 40 and if all is goog I think I am going back on trt with out a dr.

The 1st line of exam diagnosis for prostate is a regular good'ol ultrasound. It will easily tell you the volume of the prostate.

Sure, it may be off by 1-2 ml's, but is good to know if your prostate is below the 30 or 100ml, no?

I can pay 30€ in a private diagnostic center and ask for an abdominal ultrasound with prostate, liver, kidneys, spleen, etc. Everything will be checked. Only if finding something out of order the MRI shoud be ordered.

Any half ass family doctor knows this ffs...

[kelkel]

Had my prostate up to 40 once. Thought I'd win a prize. Got nothing.

[Mr.BB]

Had my prostate up to 40 once. Thought I'd win a prize. Got nothing.

Above 30 it's considered bph. Mine was 30 on last check, was 27 before :/

Edit: slowly we are all getting there ..