Concerned with My 6mo Check-up: PA vs Dr.

I'm at month 18 on TRT (T-Cyp with no add-ons) and everything is going well @ 50mg every 3.5 days. My PSA was .5 before I began and it increased and has held at 1.1 after beginning TRT. My Urologist at Univ MD has not been concerned about the PSA and straight up said from day one that he administers TRT to treat symptoms not the numbers (of Test). My total T has been ~ 850 at 6 mos and then 1050 at 12 mos and now 850 at 18 mos.

So, for the first time the Dr has my 6mo check-up done by his PA and sure enough the PA says my total T at 850 is too high and he wanted to reduce the dose namely because my PSA concerns him at 51 yrs old and with a family history of prostate cancer. He also doesn't like that I'm on 1mg of Propecia every other day and says it's masking my PSA reading and that my PSA is really 2.2.

Everything else in my bloodwork is totally "normal." I actually went into this appointment wanting to boost my TRT by 20mg per week because I don't feel as good as I did when my reading was 1050 but I didn't even get a chance to say anything because he hit me with his reduction lecture right after "hello."

Of course, I countered with there being nothing to support T or Propecia "causing" prostate cancer or making me more susceptible to developing prostate cancer ... in fact, some studies show it may reduce chances of developing prostate cancer and if you do get it there's information to support it possibly being a less aggressive form. I totally understand that once prostate cancer is present TRT is not good ... but that's why I'm getting checked twice a year.

In Conclusion: I don't see how my level of T being at slightly +1,000 puts me at higher risk and I'm disappointed I didn't get to bump up my T by 20mg per week because this PA is such a reversal from the Dr. I don't want to rock the boat realizing I have a good thing going at this Urology practice. In June, I'm going to insist to see the Dr instead of this PA and ask about the cause and effect of T readings in the high range on my PSA.

I'd appreciate advice here. Thanks!
 
My Dr orders blood labs 48 hrs post injection (I know trough is preferred by most TRT Drs) and I remember being concern with my 1050 T reading heading into my 12mo appointment thinking the Dr was going to reduced me from 100 mg/wk back to 75 mg/wk ... however, he just asked how I felt remarking it was a bit high but said it was up to me whether I wanted to maintain at 100mg/wk or reduce based on how I felt.

So, yes, I agree it's strange the PA pressured me to reduce.

Now that my own T production is shut down (with noticeable atrophy) I don't get the same feeling of wellness/happiness on the day of injection like I did when my T level was ~ 1,000 due to my body still producing last year ... this is why I want to nudge up another 20mg/wk.
 

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TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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