no to trt

Michael,

This is a difficult one, and I've discussed it many times with consultants, including England's top urologist at a conference, CNS's, and patients.

I would say that if you are in full remission with the expectation of a cure, then you should be given access to TRT if your testosterone fails to recover after hormone therapy or is lost for some other reason (such as age related loss). This should come with a talk about the risks, including the likelihood of someone with your diagnosis, treatment, and current state relapsing. However, if with that full knowledge you choose to have TRT, then that should be your choice.

My thinking on this is that for most patients who have had successful radical treatment and are in full remission with the expectation of a cure, you could put them on lifelong hormone therapy and reduce the chance of recurrence. No one would countenance doing this because of the QoL issues and other medical complications of lack of testosterone. Preventing someone having TRT after their successful prostate cancer treatment is doing exactly this. For this reason, I don't believe such a refusal is acceptable, but I would expect the patient to be fully advised of the risks before making the choice, and that risk is going to vary from one patient to another. This was also broadly the view of several top urologists.

I've had some CNS's ask me my view on this after delivering a hormone therapy session, which I told them as above. They agreed with me but were unable to get their consultant(s) to prescribe TRT. You could try using my argument above. There certainly are urologists who will provide TRT. It may be a case of trying to get referred somewhere else.

Sorry for your issues with getting access to TRT, but you are far from alone. I've come across several patients who are in effect stuck on HT because their testosterone didn't recover afterwards. I haven't remained in touch, so I don't know how successful they eventually were with getting TRT.

Edited by member 12 Sep 2020 at 14:21  | Reason: Not specified

I don't think the reason you are low on T is relevant, although that explains it.

It is also quite common that T doesn't return after hormone therapy even if it was normal beforehand (which is what I assumed for you). The longer you've been on it, the more likely this is, and it almost never comes back to the original level.

I would suggest you try my logic with your urologist or oncologist, and maybe find another one if that doesn't work. They are concerned that TRT can result in prostate cancer, but I'm not aware the chance is any higher than if you'd had the correct T level in the first place and didn't need the TRT. However, I'm not very familiar with TRT and how accurately it can set the level. You probably should be at a level between the minimum normal range and average, rather than at the higher end of the scale, but I don't know if that controllability is available.

That applies to everyone who's been successfully treated for prostate cancer, but we don't put them on lifelong hormone therapy just in case.