testes size

The whole point of zoladex and its equivalents is to halt testosterone production so yes, you are experiencing a male menopause. Your body may also go through changes similar to those of an adolescent girl during puberty; muscle definition is reduced, ligaments soften and stretch, breast buds tingle, a fat layer is laid down for future pregnancy and breast feeding and the pelvis widens.

All in all, it tells you that the zoladex is doing its job and the shrinking testicles are no indicator of how quickly you will recover testosterone production once the HT ends

Like you, Microcolei, I too would like to read more on this topic!  In September 2017 I had a radical prostatectomy without nerve sparing and also had 25 lymph nodes removed (22 infected).  A follow up PSMA scan showed micro mets in my pelvic region lymph nodes so was prescribed hormone therapy for life.  This kicked off in October 2017 together with the usual course of doxetaxel in early 2018.  I usually take Decapeptyl but sometimes have Zoladex if I am overseas at the time treatment time comes around.  My question:  Is the reduction in testes and penis size I have experienced going to continue on its downward path or does it reach a nadir point?  Despite all this I can still experience a pleasurable, if dry, orgasm.  I remain grateful for small mercies!!

Regards testicle size, you need to be clear if you are measuring linear dimensions (length, diameter), or volume (which is what medical profession tend to use), as the difference in size between these is enormous.

I measured a reduction of volume from around 23cc down to about 5.5cc. This sounds like a large reduction, but it's nothing like that large in terms of a reduction in linear dimensions, which are only a reduction of about 1/3rd in length, diameter, etc.

I've just got my testosterone back in the last month. Not remeasured testicles since then, but I don't think they've increased in size yet. Only a small amount of the testicles produces Testosterone (Leydig cells) - most of the testicles is about sperm production, which is shut down by loss of Testosterone, and probably the part which shrinks. I don't know how much of that recovers - there certainly is some permanent damage to the sperm production structures during the loss of Testosterone (not that you are likely to be able to ejaculate any sperm that are produced in any case).

I've yet to see anyone report what happened to their testicle size after recovery of testosterone.

So here is the Harvard research from 2013

https://ascopost.com/issues/april-15-2013/similar-outcomes-for-18-vs-36-months-of-androgen-blockade-in-high-risk-prostate-cancer-treated-with-radiation/ 

And here is the RADAR research findings 2018

https://www.pcf.org/news/18-month-adt-optimal-for-locally-advanced-prostate-cancer/ 

It isn't impossible to maintain fitness while on HT - it just takes a bit more effort. Irun has been running extreme marathons (like across the Sahara-type extreme) ever since diagnosis with metastatic PCa and lots of men here have continued to cycle, play rugby or whatever floats their boat. Loss of bone density is a major concern and, I think, underplayed by many oncology departments. When I first joined here, a large % of men on HT also had Zometa but it seems quite rare now - perhaps because Zometa also has some very unpleasant side effects.

My diagnosis was high risk locally advanced (or extreme risk because of high initial PSA >40 according to some research papers). My onco had me down for 18-36 months HT from the outset. I read some research papers which showed that getting PSA lower before starting RT was beneficial - one paper suggested getting it down to 1, and two more suggested getting it down to 0.1 before RT. My PSA was down to 5.29 when they suggested booking the RT, but I asked for longer. I worked out another 8 weeks would get me down to 0.1 at the rate it was dropping. In the event, the RT came through a week early and it was 0.12, but I was happy with that.

One research paper suggested if you got it down to 0.1, adjuvant HT (after RT) was not necessary, but neither I nor my onco were going to risk that. My PSA stayed <0.01 after the RT, so my onco said I could stop the HT anytime from 18 months. If it had been nearer 1 (maybe >0.5, I can't recall exactly what he said), he would have wanted me to do the full 36 months. The HT wasn't causing me any problems that I couldn't handle for a few more months for the chance of any slightly improved cure rate, so I elected to go on to 22 months. It's taken another 9-10 months after that for my testosterone to start returning, which is where I am now.

I also did an additional 6 months at the beginning on bicalutamide, but as that didn't work for me (didn't significantly drop my PSA, but did give me the classic side-effects), I don't count it. This was during what turned out to be an unusually prolonged diagnosis phase (bearing in mind it was pre-COVID).

Steve, read your blog, both entertaining and informative, thanks. Love your art work! I presume it's sitting on your urologist's desk disguised as a Covid virus. Your physics background makes your observations all the more meaningful. I noticed a couple of key differences between the RT procedure you received and the system here ... no enemas and no Spaceoar here and I think, looking at the "bed" used for the procedure that beyond the alignment using the three tatts, there might not have been micro-adjustment of the "bed" each day using a CT scan  and gold seeds as a guide. Perhaps I need to go back to the hospital to take a few photos and ask some questions?

On diet ... I watched/listened to the links you provided and no doubt they do outline current state of the art thinking on the gut biome and its importance to EVERYTHING. What remains a question for me, and I may have missed this, is that removing testosterone from our system undoubtedly causes weight [fat] gain and apparently causes muscle loss. The seminar mentioned fasting, amongst many other things. I did this well before my prostate adventure but there's no way I'd try it now. I had a go at a medium fast and it left me almost incapable of reasonable physical activity. On a diet that would satisfy any guidelines there is just no margin of reserves for such a strain on the limits. My feeling is [and yes, this is just my opinion :-) ] that the hit that our systems take by removing testosterone needs something more than a really good diet because we are seriously messing with the normal function of our endocrine system and the way it "chooses" to prioritize digestive functions, such as fat and protein assimilation. 

While still on HT, my exercise, including running and cycling is on the way up and while I don't keep tabs on running performance I can say that I've raised my average speed on the bike by several km/hr over distances above 50km and more qualitatively, it now feels like fun rather than being almost depressing [hard to describe but almost black feeling].

I haven't searched the site yet for "fitness" but an oncologist I know suggested that being fit improves your chances of staying on top of cancer by 20% [sorry, no references for that one :-) ] so I'm not happy with the idea that we just have to put up with being knobbled for 3 years or so as a necessary side effect of HT. PSA willing, I'll also be limiting my HT to 18 months [from the end of RT] for the same reason.

Peter, must be great to be enjoying the water again!

Jules

edit: I'm only on hormone suppressants for max 3 years while there are some who have to take this stuff for the rest of their life. I'd be interested to hear from anyone who's been dealing with this challenge for say 5 years [or more]. That must be very tough.

Edited by member 03 Nov 2021 at 04:51  | Reason: Not specified