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Topics - Steady

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1
Testosterone, Hormones and General Men's Health / Elevated PSA
« on: March 07, 2015, 06:37:33 am »
Upfront I want to say that I'm a bit biased against PSA testing but understand why the PSA for routine screening is so tempting. I believe anyone reading this forum is likely to be interested in how the PSA can impact TRT and male hormone therapy. I strongly recommend reading "The Great Prostate Hoax"  by Richard J. Ablin, PHD who is credited with the discovery of PSA.

If it is possible to avoid an elevated PSA then it should be avoided!
Now here is my experience with an out of normal range PSA:

Back in June my regular 6 month labs came back with a PSA of 4.1. It had been steady at around 1.5 before this. I had some symptoms of prostatitis a few weeks prior to the test, a burning sensation when I pee'd, mild fever, low back pain, that cleared in a couple of days .The clinic administering my TRT had me stop injections until I could be cleared by a urologist.. I chose a urologist near my home that my insurance company recommended. This doctor insisted on doing a prostate biopsy, no other options were offered. I wanted to clear myself and get back on TRT and agreed with an understanding that a biopsy wasn't that bad. Now, with a few months perspective, I will say that the biopsy is more unpleasant than it was portrayed. The doctor told me there would be a little discomfort. It is like having a bb gun stuck in your butt and shot 12 times, maybe that's "a little discomfort." He said "there could be blood in your urine and semen for a short time after the biopsy. "Fountain of blood" better describes ejaculation after the biopsy. I was still passing clotted blood more than 2 months after the biopsy, with condoms other wise unnecessary but just to keep from freaking out my wife. I endured two very unpleasant weeks of waiting for the results from the biopsy (is it cancer? what happens if it is? prostatectomy? incontinence?, impotence? penile atrophy?) and was reading a lot. Enough that I understood that maybe the biopsy wasn't called for, that I was pressured into it more because it makes money for the urologist than because it could save me from a horrible unnatural death.
The results were negative. The urologist simply said no cancer was found. I asked if there was any indication of inflammation or something that explains the high PSA, he had no answer. It seemed he was disappointed he wasn't going to get to remove my prostate, and he was surprised that I wasn't satisfied with "no cancer"  as the happy results from this painful, degrading procedure. When I asked where to go from here he said we would test PSA again in 4 months and if still high may need to biopsy again. I decided I didn't like his doctor and asked if I could get a copy of my results. He left the room for a copy and when he returned, surprise, there were in fact indications of inflammation. I checked later and this urologist charged my insurance more than 400 dollars to cover me on the results from the biopsy that he would not have even read if I hadn't asked for a copy.

4 months after the biopsy I had another PSA, this time it was way elevated, 7.1!

In the interim I had looked around for a progressive, compassionate urologist , instead of what I had searched for before , one that was near home and in network. My TRT clinic did not stop injections with this 7.1 PSA because I had  a recent negative biopsy and would provide evidence that I was under a urologist's care. I found a urologist at a Dallas teaching and research hospital. He authored and co-authored many papers on PSA, Prostate issues and TRT. It took a couple of attempts but I got an appointment. He reviewed my history and agreed that TRT likely had no impact on my PSA issue. He ordered a 3 Tesla MRI with Endorectal coil and contrast, imaging to see if there were some suspect area that might be appropriate to biopsy. The MRI was clean, no cancer, but BPH at 48.9 ML, and indications of inflamation, asymptomatic prostatitis, The procedure was uncomfortable, but way better than the biopsy, and I was better prepared for it.

So all told, I have BPH and some prostatitis that doesn't usually present symptoms. This incident prompted discussion with my brother and it turns out he has had prostate problems, BPH and inflammation, but never cancer since his 20's and so did my father, I had no idea.

I just had bloods done and PSA is 3.2. Which is not ideal but is headed in the right direction. I'm still on TRT, happy with everything it is doing for me.

I hope my experience can help others and want to point to key learnings. Take care in the selection of your care giver. Question the options. Research the impact and benefit of intrusive tests. And most important don't freak out about PSA.

2
I've been on the trifecta version of TRT for close to 2 years now and I'm very pleased with it. But currently using an online T clinic it's more trouble than it's worth to get insurance reimbursement. I have also found the need to develope a relationship with a Urologist (PSA), and found one that seems like what I'm looking for. I'm thinking about having him manage my TRT but he may want me to leave off the HCG at least for a few weeks to see if it is really needed.
I started HCG about 3 months into weekly IM TCyp. I had a pretty bad ache in my testicle. It was as if I had been wearing pants that were way too tight. I mentioned it to my doctor at the time and he prescribed HCG promptly as if it was something he'd seen before and the HCG completely eliminated the discomfort. It also seemed to help libido and I think gave me an even better sense of well being.

I'm interested in any experiences the forum members have either going off of HCG or never having used it. Do you think I'll miss the mood boost and the ache will return? I hadn't paid attention to the shrinkage side effect until after I was already on HCG. Is that really a significant consideration?

3
This was surprising to me. A study has found an increased risk of Prostate Cancer with higher levels of Vitamin E and Selenium.

http://www.pcf.org/site/c.leJRIROrEpH/b.8989109/k.82C5/Vitamin_E_Selenium_Supplements_Might_Double_Chances_of_Prostate_Cancer.htm

4
I've come back to this article for the last few weeks and it is very encouraging to me. If dogs can do thisthen surely some research can find the component in urine they are detecting.

98% accuracy !!! So much better than PSA which is "only a little better than a coin toss" according to the discoverer of PSA, Dr Richard Ablin.

http://www.pcf.org/site/c.leJRIROrEpH/b.9133689/k.34D/Dogs_May_Help_Spot_Human_Prostate_Cancers_Study_Finds.htm

5
I've been waiting for the results of my Prostate Biopsy for 9 days now and have spent a lot of time reading about Prostate Cancer. A few things seem apparent to me now that I think should be important to the followrs of this forum.

1. We need better methods to screen for Prostate Cancer. The PSA which is relied upon very heavily doesn't do a good job. PSA has a 78% false positive rate, sending way more men to have a biopsy than should have to endure that procedure with significant risks and discomfort. The PSA has a 15% false negative rate and some of the Cancers missed by the PSA are the most virulent forms. At first my thinking was to rail against the PSA but the fact is we don't have anything better.

2. We need better treatments, more alternatives, for PC sufferers. Radical Prostatectomy seems to be the first recommendation after a PC diagnosis even though many cancers would be slow or no growing. Differentiating the types of cancer could reduce the negative impact profoundly by just letting us know which must come out.

3. Urologists believe that Testosterone causes Prostate Cancer. They don't come out and say it but you will hear terms like 'it adds fuel to fire' and the traditional therapy for Prostate Cancer is Castration to eliminate all testosterone. This helps explain why TRT is difficult to get from urologists and why it is automatically withheld on a suspicious PSA result.

4. Prostate Cancer is not getting the needed attention and research dollars that it should. While Breast Cancer and Prostate Cancer have similar incidence rates, both new case and death rates, Breast Cancer gets almost twice as much funding for research from government and the private sector. I understand there are reasons that is the case. Breast Cancer deaths are more likely young or middle aged women and PC deaths are mostly old men. Breast Cancer survivors have become more vocal. PC victims are likely embarrassed as a result of treatment. Impotence, incontinence, penile atrophy and castration are still difficult for a man to stand up and talk about.

We need to understand how easily this can impact us and wherever we can push for more research, better screening and better treatments for Prostate Cancer.

[MODERATOR:  Split out from Steady's original thread here: https://www.peaktestosterone.com/forum/index.php?topic=4454.0]

I've been looking into private charitable organizations focused on Prostate Research. It seems that the Prostate Cancer Foundation (www.pcf.org) is the most forward looking with an emphasis on research into better treatments, diagnostics and screening. Should I be concerned that it is headed by Mike Milken?

What other ways can we support Prostate Research?

6
There have been many discussions on the forum about the differences between the 2 Labcorp tests for Estradiol, the "Standard Estradiol" test #4515 and the "Sensitive Estradiol" test #140244. I hope we can use this thread to post actual results from these 2 tests when taken simultaneously. Perhaps then we can each evaluate how best to make use of these tests for our own circumstances.

I've searched the forum and only found one case with numbers from both these tests and today I have my own results to get us started. If you have results for simultaneous tests in the past that I've missed in my search please post them here. If you would like to include any symptoms you feel are related to E2 at the time of the tests that may be useful information also. Thanks in advance to anyone willing to contribute to this data collection.

March 19, 2014 JustAskin posted 4515 E2=33 & 140244 E2=19
July 28, 2014 Steady - 4515 E2=65.6 & 140244 E2= 46 Morning wood not as regular, but libido is good, minor water retention.
August 25, 2014 outside source - 4515 E2=30.1 & 140244 E2=34

7
Testosterone, Hormones and General Men's Health / Preloading Syringes
« on: July 22, 2014, 04:17:37 pm »
When I was doing IM injections I would use a 22g needle to draw and would load 2, one for immediate use and one 3.5 days in advance. Now, doing SubQ, I'm using 28g. It does require a little patience so I set aside time for just preparing syringes in advance. Once they are filled I recap and store along with the TCyp vial in a locked box in a cabinet.
Should I have any special concerns about safety? And if not how far in advance could the syringes be prepared?

8
I've been waiting for the results of my Prostate Biopsy for 9 days now and have spent a lot of time reading about Prostate Cancer. A few things seem apparent to me now that I think should be important to the followrs of this forum.

1. We need better methods to screen for Prostate Cancer. The PSA which is relied upon very heavily doesn't do a good job. PSA has a 78% false positive rate, sending way more men to have a biopsy than should have to endure that procedure with significant risks and discomfort. The PSA has a 15% false negative rate and some of the Cancers missed by the PSA are the most virulent forms. At first my thinking was to rail against the PSA but the fact is we don't have anything better.

2. We need better treatments, more alternatives, for PC sufferers. Radical Prostatectomy seems to be the first recommendation after a PC diagnosis even though many cancers would be slow or no growing. Differentiating the types of cancer could reduce the negative impact profoundly by just letting us know which must come out.

3. Urologists believe that Testosterone causes Prostate Cancer. They don't come out and say it but you will hear terms like 'it adds fuel to fire' and the traditional therapy for Prostate Cancer is Castration to eliminate all testosterone. This helps explain why TRT is difficult to get from urologists and why it is automatically withheld on a suspicious PSA result.

4. Prostate Cancer is not getting the needed attention and research dollars that it should. While Breast Cancer and Prostate Cancer have similar incidence rates, both new case and death rates, Breast Cancer gets almost twice as much funding for research from government and the private sector. I understand there are reasons that is the case. Breast Cancer deaths are more likely young or middle aged women and PC deaths are mostly old men. Breast Cancer survivors have become more vocal. PC victims are likely embarrassed as a result of treatment. Impotence, incontinence, penile atrophy and castration are still difficult for a man to stand up and talk about.

We need to understand how easily this can impact us and wherever we can push for more research, better screening and better treatments for Prostate Cancer.

9
Testosterone, Hormones and General Men's Health / Urologist's & TRT
« on: June 12, 2014, 05:48:13 pm »
While visiting a urologist yesterday for other purposes I discussed the possibility of him taking over management of my TRT. I'm currently using an online clinic but wouldn't mind a change so I could use my insurance coverage. I asked a few questions:

Do you currently manage TRT for some patients? "Oh, sure."

Do you allow self injection and if so how about twice weekly injections? "If someone was interested in self injection it's allowed but there is no value to such frequent injections."

How do you gauge if it is working? "I maintain total testosterone between 400 and 500 using gels or injections. "

So, just the number not symptoms or patient's perceived benefit? <No answer, just changed the subject.

How about HCG and Aromatase Inhibitors? >Pause, blank look, and then changed the subject.

Needless to say he won't be getting my TRT business. I truly don't understand why these doctors don't enthusiastically jump into what could easily be a lucrative service of real value to the patients in need.

10
My latest labs showed a bump up on PSA. I Have been consistently 1.5ish but this was 4.1. Now I have a biopsy scheduled. I had symptoms of prostatitis about 4 weeks ago and I'm really hoping that some remaining inflammation caused the spike in PSA. I've been very happy with TRT for almost 2 years now. The whole situation is scary.

I recall Peak had a similar event a few months ago. Is there anyone else? What was the biopsy like? Are there any questions in retrospect you would have asked the urologist before the procedure?

I wonder also about the logic of stopping TRT just based on the PSA. I'll follow doctors orders of course. But it seems that the PSA should only prompt a biopsy. They wouldn't start anti-androgens on a man not on TRT with high PSA until after cancer was truly indicated. Thoughts?

11
I saw a news item on television this morning while I was at the gym. The sound was off so I didn't catch what was said but the captions indicated a new study showed increased risks of heart disease for men on Testosterone Replacement Therapy. Does anyone know what the study was and what it really concluded?

12
Being new to the forum I want to avoid appearing like I'm endorsing one any place selling them. But when I googled "1ml luer lock syringe" lots of places came up. I settled on global pharmaceutical solutions.

http://www.syringesandneedles.com/

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