1. #1

    Somewhat high PSA at age 27 and TRT

    I'm 27 with low T (seems to be idiopathic, my best hypothesis is that it's due to naturally very low cholesterol). I recently did some blood-work for my first consultation with Defy Medical after a disappointing experience several months ago with an endocrinologist (ran Clomid for 2 months, felt worse than ever even when my testosterone increased to ~1000). As expected, my T was low at 308ng/dL, but more concerning was my PSA of 1.5ng/mL. At first I thought it was "in range," but after doing more research I realized that someone my age should have a PSA of less than 1. The endo tested my PSA back in October, but he never showed me the results or brought it up, so I had always assumed it was healthy. I went by the office to pick up my old results from October 2016, and my PSA was basically the same (1.6). I'm assuming this means I probably don't have cancer since it hasn't increased at all in the past 5 months, but I don't have any symptoms of prostatis or BPH either. I've been feeling like total garbage from the low T, and was looking forward to starting treatment asap. Would I need urological clearance before starting TRT with a PSA of 1.5, or is this still low enough to start? I realize that either way, it would need to be very carefully monitored throughout the course of treatment. This whole situation is causing me a great deal of anxiety.

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  3. #2
    Quote Originally Posted by AbsoluteZ3R0 View Post
    I'm 27 with low T (seems to be idiopathic, my best hypothesis is that it's due to naturally very low cholesterol). I recently did some blood-work for my first consultation with Defy Medical after a disappointing experience several months ago with an endocrinologist (ran Clomid for 2 months, felt worse than ever even when my testosterone increased to ~1000). As expected, my T was low at 308ng/dL, but more concerning was my PSA of 1.5ng/mL. At first I thought it was "in range," but after doing more research I realized that someone my age should have a PSA of less than 1. The endo tested my PSA back in October, but he never showed me the results or brought it up, so I had always assumed it was healthy. I went by the office to pick up my old results from October 2016, and my PSA was basically the same (1.6). I'm assuming this means I probably don't have cancer since it hasn't increased at all in the past 5 months, but I don't have any symptoms of prostatis or BPH either. I've been feeling like total garbage from the low T, and was looking forward to starting treatment asap. Would I need urological clearance before starting TRT with a PSA of 1.5, or is this still low enough to start? I realize that either way, it would need to be very carefully monitored throughout the course of treatment. This whole situation is causing me a great deal of anxiety.

    A PSA of 4.0 is a contraindication for TRT. Your value hasn't increased in the past five months - a good sign, as you noted.

    The medical staff at Defy will be able to deal with this Ina straightforward manner. When is your consultation?
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  4. #3
    My consultation is Feb 25th, in person. I've read numerous accounts of guys who need to see urologists when their levels go beyond 2.0, but I also realize that the rate of increase is just as important as the value itself. Mine has been the same for at least 5 months, and for all I know it's been the same my entire adult life. Still, a value of 1.5 is concerning since this is supposedly the median PSA for healthy men older than 60.

  5. #4
    Quote Originally Posted by AbsoluteZ3R0 View Post
    My consultation is Feb 25th, in person. I've read numerous accounts of guys who need to see urologists when their levels go beyond 2.0, but I also realize that the rate of increase is just as important as the value itself. Mine has been the same for at least 5 months, and for all I know it's been the same my entire adult life. Still, a value of 1.5 is concerning since this is supposedly the median PSA for healthy men older than 60.

    Keep in mind that very few men your age have a PSA run. It's not a standard test for men prior to middle age. Try and not draw dire conclusions on the basis of limited sample size.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  6. #5
    Quote Originally Posted by CoastWatcher View Post
    Keep in mind that very few men your age have a PSA run. It's not a standard test for men prior to middle age. Try and not draw dire conclusions on the basis of limited sample size.
    Yes, I noticed that there is almost no information whatsoever on PSA for men younger than 40. I'm somewhat of a hypochondriac though, so I'm just expressing concern, even if the data pool is weak.

  7. #6
    Quote Originally Posted by AbsoluteZ3R0 View Post
    Yes, I noticed that there is almost no information whatsoever on PSA for men younger than 40. I'm somewhat of a hypochondriac though, so I'm just expressing concern, even if the data pool is weak.
    If it would ease your mind, contact Defy either by phone or email, and put the question to them now. I presume they have your lab work?
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  8. #7
    Quote Originally Posted by CoastWatcher View Post
    If it would ease your mind, contact Defy either by phone or email, and put the question to them now. I presume they have your lab work?
    Wouldn't the e-mail just go to a staff member? Are they really going to be able to answer that question? And yes, they have my lab work.

  9. #8
    Quote Originally Posted by AbsoluteZ3R0 View Post
    Wouldn't the e-mail just go to a staff member? Are they really going to be able to answer that question? And yes, they have my lab work.
    What have you no lose by trying? I know Jill and and Amanda, Dr. Saya's nurse and Pa, respond to quick patient inquiries. The answer to your question might well mean delaying treatment if you do need a urological consultation. I'd try and find out now. Call and see what they tell you.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  10. #9
    Quote Originally Posted by CoastWatcher View Post
    What have you to lose by trying? I know Jill and and Amanda, Dr. Saya's nurse and PA, respond to quick patient inquiries. The answer to your question might well mean delaying treatment if you do need a urological consultation. I'd try and find out now. Call and see what they tell you.
    Alright, I will do that. Thanks for your input.

  11. #10
    Not a contraindication and, as long as stable and absent symptoms, nothing to be concerned about.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

  12. #11
    Quote Originally Posted by Dr Justin Saya, MD View Post
    Not a contraindication and, as long as stable and absent symptoms, nothing to be concerned about.
    Wow, this is incredibly relieving to hear from you directly. Thank you so much!

  13. #12
    Free advice when testing PSA is to avoid sex and orgasm 24 if not 48hrs prior to the blood draw.

  14. #13
    I did ejaculate the night before the blood draw (probably less than 12 hours before), but I read that in men my age ejaculation has no impact on PSA secretion. It may have inflated the score somewhat though

  15. #14
    Quote Originally Posted by AbsoluteZ3R0 View Post
    I did ejaculate the night before the blood draw (probably less than 12 hours before), but I read that in men my age ejaculation has no impact on PSA secretion. It may have inflated the score somewhat though
    That can absolutely have an effect, but you've heard from Dr Saya himself, that it's not a concern.

    Plus, just to clear it up, if a staff member receives a medical question there's a protocol for it to be forwarded to a medical provider who is able to answer that question. All doctor's offices have that, Dr's don't answer the phones, MA's or staff do, and they all have ways of taking that up the chain of command.

    I've done it before, and either a nurse or PA will call you back. Their PA is great at that.

  16. #15
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    Quote Originally Posted by AbsoluteZ3R0 View Post
    Yes, I noticed that there is almost no information whatsoever on PSA for men younger than 40. I'm somewhat of a hypochondriac though, so I'm just expressing concern, even if the data pool is weak.
    I agree with you, that's in older men, over 49. But I also agree with everyone, I wouldn't worry about that level.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

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