Ideally, you want to know what your Testosterone level was before treatment, but sadly that baseline value is rarely obtained.
SHBG (Sex Hormone Binding Globulin) level is one way to calculate the free to total Testosterone level. It's also notable because if you're still under the influence of hormone therapy, it will be high, causing low free Testosterone, because more will be bound to SHBG.
To investigate your Testosterone level, you ideally want to know if your brain wants more, or if you are currently at the level your brain is aiming at. This is done by measuring the level of LH (Luteinising Hormone) to see if your brain is requesting more Testosterone than your current level. LH is the signal from your brain to your Testicles, asking them to produce more or less Testosterone. Sometimes FSH is measured instead - I'm not sure why - it's the signal from the brain to your Testicles to produce sperm which is a separate testicular function, and it's cyclic (like a woman's periods - same hormone used to tell ovaries to release an egg).
If LH is high, that suggests your brain is asking for more Testosterone than your testicles can produce. Assuming there's nothing wrong with your testicles which is fixable, then the only way to get more testosterone would be to have extra Testosterone via TRT.
If LH is normal, then your brain doesn't want any more Testosterone. It might be that this is normal for you (and that's why it would be useful to know what your Testosterone level was before treatment). Different people have different sensitivities of androgen receptors, and if your androgen receptors are very sensitive, your brain sets your Testosterone level at the low end of normal, and if your androgen receptors are not very sensitive, it sets your Testosterone level at the high end of normal. Your brain (hypothalamus and pituitary glands) contain androgen receptors to sense your Testosterone level and adjust it to the required level corresponding to your androgen receptor sensitivity. If your LH is normal but it's still thought you need more Testosterone, then rather than add extra Testosterone via TRT (which would cause your body to produce even less as it compensates), it might be better to get your brain to produce more LH so your Testicles produce more Testosterone more naturally. This can be done by using low levels of Tamoxifen which will partially block the androgen receptors in the brain so the brain thinks there's less Testosterone than there really is, and consequently requests the testicles to produce more. (Note, Tamoxifen won't have this effect if you're on hormone therapy.) Tamoxifen is not without risk itself, so as with any medication, you and your clinician need to weigh the pros and cons of any treatment.
Given your oncologist is happy for your Testosterone to be higher, and the evidence suggests that for prostate cancer patients believed cured with no evidence of disease, treating low Testosterone levels doesn't increase risk of recurrence, I think your best option would be to ask for a referral to an Andrologist to investigate your Testosterone level and suggest if appropriate how to rise it.
Edited by member 12 Apr 2023 at 17:57
| Reason: Not specified