14 October 2021: I’m feeling the impact of low testosterone. From past experience I recognise the subtle changes. For the last couple of months, I’ve generally been a bit more lethargic. I’ve had less physical energy. Even after increasing my daily exercise routine, I am still running slower over my usual Saturday morning 5 kilometre run. And orgasms seem to have become more elusive again.
Today I got the blood test results that confirm my testosterone has dropped from its normal lowish level into the zone where it really affects my mind and body. I also got the good news that my PSA is still undetectable, so my prostate cancer seems still in remission.
In this post there’s a bit more about the symptoms and history that alerted me to the issue. And then there’s the research linking testosterone and prostate cancer and the difficult decisions to make.
How I noticed my testosterone was sinking lower
For the last couple of months I’ve noticed that my core energy has dropped. It has showed in both sexual energy and running – I can do both, but there isn’t the same eagerness and verve.
Physically I’m sometimes capable of penetrative sex. But my erections are not firm enough to reach orgasm in this way. Overall my hopes for further recovery of sexual function have gone into a bit of a decline.
Also my speed over a 5 km run had been slowly improving since my surgery 20 months ago. But for the last couple of months it has slowly declined. I was down to 28 minutes in June; now I can’t get below 30 and often take 32 or 33 minutes to cover the same route.
My history with low testosterone
This reminds me of what happened to me back in 2011. Then aged 53, I remember feeling “over the hill.” I just didn’t feel like exercising, or working in the garden, or going out for runs or walks – all things that normally give me joy and put a spring in my step. I was not much fun to be with – for myself or those close to me. My wife suggested perhaps it was a kind of “male menopause” often described as andropause. Yet we were still sexually active and I thought, wrongly, that meant my hormones were fine.
Here’s what the data showed: in 2011 my testosterone level went into the red zone.
I remember back in 2011, going to see the doctor who later saved my life and she said “sexual dysfunction is often the last symptom that emerges when a man’s testosterone levels get too low.” This fits my experience back then. The impact of low testosterone for me was mostly in my general lethargy and lack of physical strength. Other symptoms commonly include fatigue, reduced lean muscle mass, irritability and depression as well as erectile dysfunction and loss of libido.
This has started again in 2021. Remembering what I felt like ten years ago helped me to recognise the symptoms. And the latest lab results show my testosterone level is dangerously close to the red line again. For those who like numbers, the lab report says total testosterone is down to 9.2 nmol/l, which is 265 ng/dL in US units.
Ten years ago I got treatment that took me out of the danger zone. But with prostate cancer in the mix it’s not that simple.
Research links testosterone with the growth of prostate cancer (with provisos)
Almost everybody who has had a brush with prostate cancer knows it is linked in some way to testosterone. One urologist described it to a friend in this way:
“Testosterone doesn’t cause prostate cancer. But for many prostate cancers, it is like a fertiliser: feeding the growth of the cancer.”
[Editor’s Note Jan 2023 – adding provisos: The above common view, which matched my thinking at the stage this article reports, is not well supported by the data available. A 2015 scholarly review found “there are a growing number of studies demonstrating no increase in prostate cancer incidence among men on testosterone replacement therapy.” See directly below this for a link to the full article in the journal Therapeutic Advances in Urology.]
Here’s a review of the research data. One question is about how testosterone promotes the growth of prostate cancer. And the other question that’s top of my mind: is it OK for me to get treatment to raise my testosterone levels?
Dilemmas with low testosterone after prostate cancer
I don’t want my prostate cancer to come back. And I would love to avoid the general fatigue and limpness that comes with low testosterone. It looks to me as a layperson that if there are any stray cancer cells still wandering around in my body, it would be a bad idea to encourage them by artificially boosting my testosterone levels.
My problem is small compared to many others with more advanced cancers. I’m painfully aware that complete hormone suppression treatment is frequently prescribed with similar but much more devastating symptoms to mine. Here’s more about the impact of this treatment for prostate cancer (e.g. Zoladex) and breast cancer(e.g. Tamoxifen).
For now I’ll hold off on any treatment for my low testosterone, push myself to exercise more, and talk to some experts. Next: my treatment choice to boost low testosterone using a natural remedy.
It most surely is a dilemma. Even without the risk of feeding cancer, artificially boosting hormones is fraught with complications. Once you start, you cant stop because the “crash” would feel awful. Definitely a balancing act based on long term pros and cons. I also think that andropause flys below the radar because it is not as sudden a shift as it is in women. “Stealth-pause” Maybe wait till you are 80 or so, and go out in a blaze of glory🤣. Keep fighting!
Rhys makes some excellent points, but the potential effects of low testosterone can surely motivate one to find help to treat its issues. My testosterone is low as well over one year after my prostatectomy. With my surgeon’s approval, my primary urologist placed me on daily injections of Human Chorionic Gonadotropin (a low dose of 30 units of HCG injected with an insulin needle). This activity raised my testosterone level somewhat, but it remains low. Now, he wants to prescribe a testosterone cream, but before he will do that, I must first get a RGCC test that will detect any free-floating cancer cells in my body. I haven’t done that yet, and wonder if it all is worth it when things feel fine to me the way they are; that might change if the effects of low testosterone that you describe Mish, appear. I thus remain hesitant to pursue manipulating hormones further than I am already. For now, I’ll stay with the HCG injections. Echoing Rhys, I say “Keep fighting!” Indeed, may we all keep fighting cancer and the effects of the treatments we have all experienced!