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I had 3+4 as well. Chose robotic prostatectomy at Memorial Sloan Kettering in NYC. Excellent surgeon, excellent outcome. My surgeon allowed me to remain on TRT until week before surgery. I was allowed to resume TRT 6 weeks post surgery after an undetectable PSA test. I remain cancer free...

Yes. I had been on 5mg daily and switched to 2.5mg. 20mg daily does seem unnecessarily insane.

I think it was relatively indifferent. My surgeon was well informed on TRT and had no issues with resuming as long as surgery went as expected (it did). A small part of my decision to have surgery vs other treatment options was a desire to restart TRT as soon as possible. When you have RP...

I was on TRT until two days prior to my surgery. I resumed TRT six weeks after surgery (following a great pathology report and undetectable PSA).

Good article overall, and active surveillance can make sense in many men. But be careful about the details of their “argument,” that mortality in the “treatment group” was no better than the “surveillance,” group, while acknowledging that the cancer in the surveillance group is more likely to...

I had similar path, with RP done at 51. My PSA was only 2.6 yet the tumor was sized at about 20% of the prostate gland, and immediately adjacent to one of the two nerve bundles. A decision to watch and wait at 70 is a lot different than if you’re 50.

your high free T indicates low SHBG; you can very likely lower your T dosage and still be at the high end of Free T range. If you’re concerned about low iron, stop donating blood. You can likely bring down hematocrit by lower T dose. Stop taking AI and let your E2 settle naturally - it will...

So the challenge is determining the “physiological ranges” for estradiol in a healthy older male, at a healthy weight, with healthy testosterone levels.

Anyone else have heartburn issues with daily Cialis? I had to stop for that reason.

In most cases, the thing making the most difference is frequency of injections rather than “subq” vs “IM” as most people doing IM are injecting 1-2 times per week, while most people doing “subq” are doing every 1-2 days. Part of it is simply a practical matter if needle gauge. Most people...

Sorry to hear your story. Been there, done that. Awful experience - I've never felt worse in my life. I was also told to take 2mg Arimidex. It completely killed my estradiol. I had no idea what was going on. The doctor didn't know what he was doing. Like you, I finally just stopped cold...

For whatever it's worth, I was on TRT for 5+ years, was diagnosed with PCa in 2021 (Gleason 7 3+4). I had RP surgery in August 2022 at Memorial Sloan Kettering in NYC. I was asked to stop TRT the week prior to surgery. I was then able to resume TRT after surgery given a clean biopsy report...

I had prostate cancer last year at 52; had surgery, cancer-free and doing quite well.

As you said, the issue is not the pharmacy, it's what your insurance does not want to cover. Insurance is not worth the effort for the testosterone itself. Use GoodRx and look for the lowest cash pay cost in your area. My last prescription was $27 using GoodRX pricing for 4 1ml vials of...

Depending on your age, you would want to eliminate cancer as a possible cause. Various supplements may or may not be masking an actual issue. An MRI would be ideal if your insurance would cover it. Could also consider something like a 4K blood test (there are others) which predict cancer...

I, too, have low SHBG tested through years of labs (usually 10-15). No metabolic syndrome, no diabetes, etc. Very good health overall, lean, low body fat, low inflammation, etc. In experimenting over the years, I found that I subjectively felt better with frequent injections - more stable I...

Good advice! The big flaw with the minimal “lives saved” argument, which is essentially suggesting that screening should be very limited, is that there can be a long, hard road between detecting PCa and actually dying from the PCa. So the death count ignores those that require extensive...

For whatever it’s worth, I’ve ordered from Quest both the regular Estradiol and ultra sensitive Estradiol, and had them drawn at the same time. Did this twice. Did not see any appreciable difference between the two results (for me) to justify the extra cost. I realize they may produce...

I used 29g. Daily injections take me literally 2-3 minutes. I travel a lot and have never pre-filled for travel. I take what I need with me in my carryon. Not a big deal. Keep it simple.

For me, 2.5mg daily is just as effective as when I tried 5mg daily, but without side effects.

I inject into muscle with 1/2” needle. Some call this shallow IM. I did switch to daily shots but recently went back to EOD.

It’s puzzling why your urologist would insist on ADT for Gleason 6 cancer. I’m Gleason 7 and having surgery in two weeks at MSKCC and my urologist is fine with my TRT (assuming no surprises during surgery). One of the primary reasons I chose surgery is it’s compatibility with TRT. Meaning...

I agree. My point on the 4K was after other options exhausted but before one might jump into a biopsy.

If you have an elevated PSA and not sure why, do a 4K blood test (there is another similar test by another name). It will predict with a high degree of accuracy whether a biopsy is likely to find Gleason 7 cancer or above. Put another way, it’s a great screening tool to eliminate unnecessary...

On the other side of the coin . . . my PSA was “only” 2.6 and I’ve got Gleason 7 cancer growing adjacent to the interior wall of the prostate. It was a 4K blood test that suggested a biopsy was needed.

My regular urologist, who is not the doc I see for TRT (but is generally supportive of TRT), wanted me to stop testosterone completely prior to surgery and then evaluate six months after surgery (to make sure PSA was near zero). I think that was a pretty reasonable approach. However, I next...

My biopsy was more mentally challenging than physical. The pain was much less than I was expecting. After discovering a slightly abnormal DRE seven years ago, we’ve been monitoring regularly. Recently added a 4K prostate blood test which indicated intermediate risk of Gleason Score 7 or above...

If thinning hair was your reason for stopping TRT, you must not have thought much about the benefits of being on TRT?

If you really want to know your SHBG levels, just get the test done yourself. Self-pay cash lab costs are pretty cheap and easily accessible.

If you’re really lean, there really isn’t any difference between subQ and “shallow” IM. I use 29g 5/16 directly into muscle (I have very little fat). I do daily mainly because my SHBG is very low.

~18mg daily - gets me around 850-900 TT - low SHBG (about 12-15) - use 29g 1/2” needle into shoulders, glute - No HCG, No AI - no hematocrit issues - I started daily injections several years ago, originally thinking SubQ into abdominal fat - didn’t see any specific benefit to trying to hit fat...