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Androgel and Shrinkage
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An_248030 posted:
Hi All,

My psychiatrist has advised me to add Arimidex and HCG to my Androgel regimen.

I had no idea testosterone metabolized into estrogen. I have increased breast tissue, reduced hair in my armpits, and I have lost at least two inches in the length of my penis. Androgel has not helped my post orchiectomy libido disappearance.My testosterone is in the low "normal" range, but he said the goal is to get it to 800. I've had prostate cancer, so this is a bit concerning to me. Anyone here used these drugs, and did they help libido or penis shrinkage?

My shrink's handwriting is bad, but I believe he is suggesting 1/4 of a 1g tablet (0.25g) twice per week for Arimidex.

For HCG, which mimics LH and FSH, its 500Iu twice per week.

Several of his patients are body builders who have low testosterone and he knows what he is talking about, but he would prefer that my urologist be the one to originate the prescriptions.

He also said opiate use depletes libido.

My recent medical is long. To summarize: Chronic left groin pain, Prostatectomy, left orchiectomy (which did not help the left testicular pain!), then libido loss, supplemented with Androgel 1.62% two squirts daily, one to each shoulder.

Thanks

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counterso responded:
There's no associated penis shrinkage with testosterone use. Gonad shrinkage yes, penis shrinkage no. Every urologist is going to tell you that you're imagining your penis shrinking and are more likely to attribute a change in apparent length to body fat (making an assumption).

To say that testosterone metabolizes into estrogen is highly imprecise. Only 0.3% of testosterone converts to estradiol. Regardless, your psychiatrist is a fool and putting you at extreme health risk by prescribing androgel. Can we assume that the prostatectomy was related to cancer? If so, the supplementation of testosterone is likely to encourage the recurrence of cancer and speed it along faster than anything else you could do.

The ONLY person that should EVER manage hormone replacement therapy is an endocrinologist, or in some cases a urologist. Both scenarios require MONTHLY monitoring of at least 6 hormone levels using a combination of saliva test and blood test. A blood test is insufficient and not accurate enough.

First course of action is to stop testosterone supplementation immediately until you talk to your urologist and have proper hormone testing. Second, you need to discuss the perpetual pain with the urologist. Third, you need to realize that low T is NOT the primary cause of low libido.

I see a huge medical train wreck here, and it's going to take some work to sort out. The first thing to do is fire your psychologist though. He could be liable for malpractice if you were treated for prostate cancer and he's prescribed testosterone replacement.
 
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meddeveng replied to counterso's response:
Hi countero,

Apologies for the confusion caused by my trying to be brief in my post. Here is the full sequence of events:

1) Right foot surgery requiring me to put all my weight on my left side for three months. I used crutches at times, but mainly used one of those rolling knee walkers (like this https://www.rentakneewalker.com/item_details.php?id=10285&Free Spirit Knee Walker).

2) Mild left testicular pain after 2 months of getting around work, etc.

3) STD tests by my urologist, antibiotics no help. My urologist finds prostate cancer during rectal exam.

4) Prostatectomy using robotic DaVinci system by a different urologist. No change in left testicle pain.

5) A few months later - Epididectomy by my urologist. Some evidence of former infection upon pathology tests on removed left epididimus. Major increase in left testicle pain.

6) About 5 months later - Left orchiectomy. Post-op bleeding caused scrotum to fill up so big it looked like a water balloon.

7) Several months later - Surgery to remove scrotal hematoma due to bleeding after orchiectomy. No change in left testicle pain. Pain so debilitating, can no longer work.

Several months later flew cross-country to have a surgeon cut my genitofemoral nerve (genital branch only). Hi countero,

Apologies for the confusion caused by my trying to be brief in my post. Here is the full sequence of events:

1) Right foot surgery requiring me to put all my weight on my left side for three months. I used crutches at times, but mainly used one of those rolling knee walkers (like this https://www.rentakneewalker.com/item_details.php?id=10285&Free Spirit Knee Walker).

2) Mild left testicular pain after 2 months of getting around work, etc.

3) STD tests by my urologist, antibiotics no help. My urologist finds prostate cancer during rectal exam.

4) Prostatectomy using robotic DaVinci system by a different urologist. No change in left testicle pain.

5) A few months later - Epididectomy by my urologist. Some evidence of former infection upon pathology tests on removed left epididimus. Major increase in left testicle pain. Libido intact.

6) About 5 months later - Left orchiectomy. Post-op bleeding caused scrotum to fill up so big it looked like a water balloon. Painful recovery. No change in left testicle pain. Tried Androgel, did not help my now non-existant libido, so stopped it after breast tissue increase and lump on left nipple.

7) Several months later - Surgery to remove scrotal hematoma due to bleeding after orchiectomy. No change in left testicle pain. Virtually bedridden with pain.

Several months later - Flew cross-country to have pelvic pain surgical specialist cut my genitofemoral nerve (genital branch). No change in left testicle pain.

9) Saw an endocrinologist about no libido. He gave me a testosterone injection. Let's just say that negatively affected my personality with disastrous results personally. My ultra sensitive PSA test went from undetectable to 0.2 away from recommended level for radiation treatment for cancer recurrence (has dropped back to undetectable now). Helped libido a bit, but had me sleeping on the couch!

10) Few months later - Flew to have same surgeon cut the perineal branch of my pudendal nerve. During flight back, penis and scrotum fill with fluid due to air pressure in the airplane.

11) Re-started Androgel usage, 3 - 5 times per week. Still zero libido. Testosterone ~280.

12) A couple months later - MAJOR penis shrinkage occurs. Not an optical illusion by any means. You'll have to trust me on that one. I'll spare you details, but lets say I am almost half my previous "somewhat average" penis size.

13) My psychiatrist recommends Arimidex and HCG to block estrogen and says my testosterone level should be 800. My urologist says he knows nothing about these drugs. My primary care doctor says she thinks they are "alternative medicine" treatments and knows nothing about them.

So how do I get back my libido? How do I get my penis back to its original size?
 
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meddeveng replied to meddeveng's response:
To again clarify, my urologist, and not my shrink prescribed the Androgel. I see the shrink to help me deal with my constant pain, the loss of my career, the loss of my libido, and depression.
 
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counterso replied to meddeveng's response:
Most prostate cancer is testosterone sensitive, so prescribing T replacement therapy instead of ADT (androgen deprivation therapy) is very unusual and potentially very dangerous, as it can prompt a recurrence. Keep in mind that prostate removal does not eliminate all prostate cancer cells, just most of them, which is why there is also radiation and androgen deprivation in many cases, to try to further eliminate the remaining cells circulating in the bloodstream. By the time they reproduce and form tumors again, the hope is you'll be so old it won't matter.

Arimidex can cause depression (among many other side effects including pain and swelling). If your urologist isn't familiar with HCG, he sounds like a hack.

Many men after prostate surgery find a lack of libido, whether it comes from the trauma of having that area cut up, or hormonal changes, or something else. It's not always repairable. And that's a trade off some men make, surviving cancer in trade for sex drive.

You've additionally had several other traumatic surgeries, which could quite easily lead to the further destruction of the pleasure functions of your penis. From the severity of surgeries, you may need to resign to that no longer being part of your life. Chronic pain alone can be a 100% killer of libido.

As for reported penis shrinkage, with as many surgeries as you have had, it's hard for a layperson to predict what kind of traumatic reaction your body has had to the incursions. There may not be anything to do here either. It's very individual and requires professional assessment.

Dealing with chronic pain is a different issue, and also something that can drive depression (and depression also suppresses libido). Your issues are intensely complex.

While you may find support from a prostate cancer survivor's group or board, the level of expertise required to assist you I believe far exceeds what you'll find on WebMD.
 
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meddeveng replied to counterso's response:
Was never told about ADT. Thanks for that!

My cancer was "fully encapsulated" with good margins. I know that the biopsy can allow cells to escape. The fact that the testosterone injection caused my PSA to rise dramatically is a bit worrisome.

Libido was fine after the prostatectomy. Enjoyment of sex was obviously diminished from the surgery. Nerves were intact. Prostatectomy can cause shrinkage as the anastamosis (joining of the two ends after removing the prostate) is formed by stretching the two cut ends to join them back together.


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