# Growing a new pair after prostte cancer



## Julie's Husband (Jan 3, 2022)

When I was diagnosed with prostate cancer I looked for treatment that would give me the best prospects for quality of life. Besides remaining above ground (or in my case out of the crematory), this included remaining sexually active. For this reason I chose to have radiation and, unfortunately, ADT (androgen deprivation therapy AKA hormone treatment).

The radiation went well enough. 

ADT is (hopefully) temporary chemical castration. One of the "puberty blockers", Lupron is commonly used for this. ADT mucks up the feedback loop with the pituitary that controls testosterone production, cutting off production. This leads to male menopause with all the symptoms including emotions (mood swings), fatigue, usually loss of libido, eventual loss of muscle mass, loss of bone density and causes the testicles to shrink. The body has decided that no testosterone is to be produced so no need for testicles, right?

While I was on ADT, it was my perception at one point that I could not find anything other than epididymis in my scrotum.

There is a need for frequent erections to maintain the health of erectile tissue in the penis. Unfortunately, with no libido, erections are fewer to none, so I intentionally put myself on a program of having at least one quality erection a day.

I had the last injection on August 2, 2020 and was told that I should expect recovery over a 14 month period.

Sooo, would my testicles recover? I guess so, since testosterone began returning. 

A test at three months after end of treatment showed it up around low normal, but I still felt some menopausal symptoms. Now 26 months out I'm at 531, but still feeling emotions, fatigue and questioning the libido. Sometimes I feel some spontaneous arousal, but sometimes I can't tell whether arousal is from libido or conditioned arousal from my regimen of daily erections when I was castrate.

So the total testosterone has been on a steady increase and I'll be curious to see how high that goes. Unfortunately I did not do a baseline test before treatment so don't know what to expect.

I've come to believe that the total testosterone is the wrong number to chase. I'm thinking bio available testosterone should be the target. My total testosterone is mid average, but the bio available is still very low normal.

I have an appointment next month with an endocrinologist. I'll be asking whether total testosterone numbers are really the main target or the bio available is getting past menopausal symptoms. What needs to be done to maintain muscles and bones, gain some energy, stop finding myself ready to cry as inappropriate times. Maybe a bit of libido if needed. I am hoping that dealing with SHBG or some such will bring up the bio available level without having to consider TRT.


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## Rus47 (Apr 1, 2021)

Julie's Husband said:


> 've come to believe that the total testosterone is the wrong number to chase. I'm thinking bio available testosterone should be the target. My total testosterone is mid average, but the bio available is still very low normal.


When I was investigating this stuff, I came to understand that the free testosterone was indeed the number that mattered. A lot of chemistry going on with this stuff. I think.

"Most of the testosterone in your blood attaches to 2 proteins: albumin and sex hormone binding globulin. Some testosterone is free, which means it is not attached to proteins. Free testosterone and albumin-bound testosterone are also referred to as bioavailable testosterone. This is the testosterone that is easily used by your body. "

Surely your endo is well acquainted with all of this and will get things dialed in.

I will just say believe DHEA 25mg daily does me some good. Cheap and over the counter.


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## Julie's Husband (Jan 3, 2022)

Rus47 said:


> When I was investigating this stuff, I came to understand that the free testosterone was indeed the number that mattered. A lot of chemistry going on with this stuff. I think.
> 
> "Most of the testosterone in your blood attaches to 2 proteins: albumin and sex hormone binding globulin. Some testosterone is free, which means it is not attached to proteins. Free testosterone and albumin-bound testosterone are also referred to as bioavailable testosterone. This is the testosterone that is easily used by your body. "
> 
> Surely your endo is well acquainted with all of this and will get things dialed in.


The upcoming appointment is for a second opinion. The first basically blew me off saying something to the effect that I had normal total testosterone for my age. The age thing is a no go with me. What is important is whether that level is adequate for maintaining overall good health.


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## Rus47 (Apr 1, 2021)

Julie's Husband said:


> The upcoming appointment is for a second opinion. The first basically blew me off saying something to the effect that I had normal total testosterone for my age. The age thing is a no go with me. What is important is whether that level is adequate for maintaining overall good health.


Same thing my gp, endo, and 2 urologists said. And they all wouldnt prescribe T for me because I had prostate cancer more than 20 years ago. Get the guy (or woman) who treated your cancer to help.


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## Julie's Husband (Jan 3, 2022)

Rus47 said:


> Same thing my gp, endo, and 2 urologists said. And they all wouldnt prescribe T for me because I had prostate cancer more than 20 years ago. Get the guy (or woman) who treated your cancer to help.


My urologist referred me to the OHSU endocrinologists, saying the local talent is lacking.


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## Young at Heart (Jan 6, 2015)

Julie's Husband said:


> .....There is a need for frequent erections to maintain the health of erectile tissue in the penis. Unfortunately, with no libido, erections are fewer to none, so I intentionally put myself on a program of having at least one quality erection a day.
> 
> I had the last injection on August 2, 2020 and was told that I should expect recovery over a 14 month period.
> 
> ...


As I remember from other posts, you probably qualify for the senior discount at many places. If that is correct, I think that the questions for the specialist should be much different, depending on what you are looking at achieving.

As the male human body ages all kinds of things stop working or decline. Human Growth Hormone, stomach acids, levels of ability to produce nitric oxide (which is very important for erections), over all levels of muscle mass all tend to decline with age. It is not just testosterone, nor bio-available testosterone. Another thing as you get older, is that you get more set in your ways. That means that what you eat might not include the right mix of foods for you to get all the vitamins and minerals your body needs.

In my opinion, you probably should get a serious test of vitamin, mineral, stomach acid, stool analysis, urine analysis, HGC and other hormone levels (beyond just T and bio-T) to see where you are, so that your specialist, in consultation with you and your GP can figure out what help you need.

Good luck! As a 73 year old male, I have lots of friends and co-workers who have had prostate cancer surgery. Most of them value being alive, but it has truly wrecked most of their lives and their sex lives. From what I have seen in others, one need to focus on adding quality to one's life.

One of my conclusions to aging and the medical profession is that I believe more and more in nutrition and some naturopathic approaches in combination with traditional medical approaches. Where I live there are a number of medical providers who have both MD and ND licenses. To the extent that medical insurance will not pay for anything but disease treatment, I will freely pay for what I consider comprehensive health care. You and I have disagreed on this, but from my perspective, it is my life and I want to live it the best I can.

Again, I wish you the best.


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## Julie's Husband (Jan 3, 2022)

Young at Heart said:


> As the male human body ages all kinds of things stop working or decline. Human Growth Hormone, stomach acids, levels of ability to produce nitric oxide (which is very important for erections), over all levels of muscle mass all tend to decline with age. It is not just testosterone, nor bio-available testosterone. Another thing as you get older, is that you get more set in your ways. That means that what you eat might not include the right mix of foods for you to get all the vitamins and minerals your body needs.
> 
> In my opinion, you probably should get a serious test of vitamin, mineral, stomach acid, stool analysis, urine analysis, HGC and other hormone levels (beyond just T and bio-T) to see where you are, so that your specialist, in consultation with you and your GP can figure out what help you need.


I will be going into the endocrinologist with open questions. Things decline with age for a reason and I'm going after the cause rather than accepting the declines.

I also have a new PCP. We've only met once and I'm curious about what she will recommend over the next few visits. Her first step was a series of blood tests that required half the blood in my system. Well, not quite.

I avoided surgery, had radiation and, unfortunately, hormone therapy. One of the questions is whether the hormone therapy did long term or permanent damage.

So far I have no sexual issues other than wondering how much of my arousal is libido and how much is just regimented response from the program I kept on to be sexually active when I was castrate.

More concern with testosterone is energy level and other lingering symptoms and health issues from having been menopausal most of 2020.

We eat quite well, though I am looking to losing the belly I got from being menopausal. We prepare most of our meals from a wide range of fresh products.


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## Rus47 (Apr 1, 2021)

Young at Heart said:


> Most of them value being alive, but it has truly wrecked most of their lives and their sex lives.


Indeed. I think doctors are remiss in not explaining the ramifications of treating prostate cancer. What is the point in being alive if the life and marriage is wrecked? And even the prostate cancer support groups I joined NEVER mentioned that sex was going to be a problem after treatment. They greatly emphasized strategies to deal with incontinence, but never mentioned what was going to happen in the bedroom. Honestly, if I had known what treating the cancer was going to do, I would have told the surgeon to cut on someone else and taken my chances with the cancer. 

I think this lack extends to the women as well. A diagnosis of Breast Cancer will often lead to surgery, radiation, and hormone blockers like tamoxifen. The physicians describe the treatment with no mention of what the side effects will do to a woman. Again, save the life to live longer in misery.

We are all left to our own devices, and that shouldn't be. There is a wife on another thread who has dealt with her husband unable to get an erection for nearly a year. Understandably, she is very frustrated. No one explained to her or her husband that removing his prostate was going to destroy their love life. And his doctor has NOT offered him any recommendations for fixing the problem.


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## mwise003 (1 mo ago)

Julie's Husband said:


> The upcoming appointment is for a second opinion. The first basically blew me off saying something to the effect that I had normal total testosterone for my age. The age thing is a no go with me. What is important is whether that level is adequate for maintaining overall good health.


While I haven't been subjected to anything like you describe, I had the same problems with doctors blowing me off for low T they considered normal. If you want T and you feel comfortable taking it given your situation, there are ways to go around your doctor online. I still get blood work every 6 months or so, but I know what feels right for my body. My PCP is aware that I handle my own T-meds. He's not happy about it, but he still tests my blood and gives me his opinions on the matter.


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## Julie's Husband (Jan 3, 2022)

mwise003 said:


> While I haven't been subjected to anything like you describe, I had the same problems with doctors blowing me off for low T they considered normal. If you want T and you feel comfortable taking it given your situation, there are ways to go around your doctor online. I still get blood work every 6 months or so, but I know what feels right for my body. My PCP is aware that I handle my own T-meds. He's not happy about it, but he still tests my blood and gives me his opinions on the matter.


What is "normal" is irrelevant. What is healthy is important. The statistics on "normal" don't take into account quality of life, just the numbers.


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## mwise003 (1 mo ago)

Julie's Husband said:


> What is "normal" is irrelevant. What is healthy is important. The statistics on "normal" don't take into account quality of life, just the numbers.


Agreed!


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## plastow (Jan 4, 2022)

Julie's Husband said:


> When I was diagnosed with prostate cancer I looked for treatment that would give me the best prospects for quality of life. Besides remaining above ground (or in my case out of the crematory), this included remaining sexually active. For this reason I chose to have radiation and, unfortunately, ADT (androgen deprivation therapy AKA hormone treatment).
> 
> The radiation went well enough.
> 
> ...


i,m going through exactly trhe same as you,but ive not had an erection for 2 years now.


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## Julie's Husband (Jan 3, 2022)

plastow said:


> i,m going through exactly trhe same as you,but ive not had an erection for 2 years now.


Did you have surgery? Have you talked to your doctors about sexual rehab?


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