Testosterone After Prostate Cancer: What Levels Are Safe, and What About Libido?

Speaker 1: 0:09
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee .

Dr. Mistry: 0:16
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost Donna Lee .

Donna Lee: 0:21
Hello, everybody! Listen to our podcasts!

Dr. Mistry: 0:28
I am Dr. Mistry. This is my real name. This is a radio show brought to you by our friends here at KLBJ news radio. We really appreciate all their help. The show is sponsored by our urology practice, NAU Urology Specialists. We are the second biggest urology group in town, but the biggest in your heart.

Donna Lee: 0:43
That’s right. We are the most fun for sure. I mean, we’re still at that fun size, like those little candy bars.

Dr. Mistry: 0:49
Yes . That’s right. When you’re too big, that’s right–I can’t eat all this!

Donna Lee: 0:51
It’s too much to eat. It’s so much candy. I’m sure they love us. You know, I remember the story you told a couple of weeks ago about one of the guys at that group who noticed your show. I thought that was kind of cool.

Dr. Mistry: 1:02
No, it was, it was nice to get a little shout out from them.

Donna Lee: 1:05
But then it was me he said that made the show.

Dr. Mistry: 1:07
That’s right. Probably the recruiting letters coming from them already.

Donna Lee: 1:12
Yes, I got it yesterday.

Dr. Mistry: 1:15
I’m a board certified urologist. A urologist is a specialty-trained surgeon of the genitourinary tract. Most of us have both a mixture of clinical practice as well as surgical practice. That is the same for all of our doctors here. We have lots of availability. We are seeing tons of new patients and we have lots of practitioners here ready to take care of your urologic needs. What you’re going to get that’s different here is really a focus on the whole person. So a great example of that is going to be men’s fertility. If you have a male fertility concern out there, you may go and just get a semen analysis or just a set of labs to try to see what drug can be given to you or to assess what your fertility potential is going to be. Now, that seems boring to me.

Donna Lee: 2:08
Right? It doesn’t seem like very much.

Dr. Mistry: 2:09
Anyone can do that. No wonder people think that you can do medicine through a computer on the…you know what I’m saying? With the labs that you got on your own and at home sperm tests…

Donna Lee: 2:20
By Skype.

Dr. Mistry: 2:20
I mean, everything–there’s no, there’s no nuance. There is no really, you know, intelligent doctorly kind of information you’re getting from just a couple of labs and a semen analysis. What we do here is we first start with what are those factors that could be affecting your fertility? We look at genetic factors, hormonal factors, lifestyle factors, environmental factors, anatomical factors. You’re going to get your diet worked on . You’re going to get put on supplements. You’re going to get, we’re going to work hard so that you guys have a baby, because you know, that’s ultimately, that’s the difference. I’m not here to, you know, quote unquote “assess your fertility.” I’m here to help you have a child, and that’s gonna require going the extra mile, the extra step. And if, and that’s how we treat virtually all urologic conditions here. We’re not here to treat your kidney stone, we’re here to also help you stay stone free. Same with testosterone and feeling better and fatigue and weight loss, and prostate cancer and kidney cancer and all the different things that we take care of. We really look forward to going that extra mile for you.

Donna Lee: 3:30
You know, we had a patient called the other day and he was a fertility patient, and he sounded super relaxed and laid back. And he was like, “Yeah, I found out I don’t have any swimmers at all. Like none of my sperm are swimming around. And I’m, I’m told I have to see Dr. Mistry.” I said, “Well, you’ve come to the right place. Dr . Mistry is the best for sure.” And we were talking and talking. So I got all his information and I realized as I put in his date of birth, he’s 70 years old and his wife is 35.

Dr. Mistry: 3:56
That is, that is my favorite case, as you know.

Donna Lee: 3:59
I know. I was so excited to book him.

Dr. Mistry: 3:59
That’s right. That’s right. If I could, if I could always just treat men over the age of 65 who were looking to live like they were 35, it would be, I would be in heaven every day, because that is, that’s a motivated patient. He’s going to follow all the recommendations. He’s never going to miss a dose. He’s going to be there for his labs. He’s going to talk to me about his response, and he’s going to , he’s going to be on point.

Donna Lee: 4:22
Well, I don’t think that his 35 year old wife would have it any other way. So, she’s having a baby. Dang it.

Dr. Mistry: 4:30
Dang it. Well, your questions, your experience with us is what drives us. And so Donna Lee, how do people ask us questions and get ahold of us?

Donna Lee: 4:36
You call us during the week, if you want: (512) 238-0762. It is easier though, to send us an email that I can respond to with your questions that we can answer anonymously to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Dr. Mistry’s one of our patients or friends, rather, Carl, said that when he can’t listen to us on Saturday, when he misses the 3:00 PM show on KLBJ, he always catches it on Sunday at 4:00 PM. So we forget to tell people that we’re on twice.

Dr. Mistry: 5:03
That’s right .

Donna Lee: 5:04
So more fun for the weekend.

Dr. Mistry: 5:05
That’s right. And , you know, as people are driving around less and less for sports and things like that on the weekend , I feel like, you know , a lot of our listenership has changed to podcast, but then when things ramp up again, you know, I can’t wait to get that listenership listening in the car.

Donna Lee: 5:19
That’s right. You can get the free KLBJ app and listen anywhere. We listened, my husband and I listened in Vegas to our show on a weekend once.

Dr. Mistry: 5:25
That’s nice.

Donna Lee: 5:25
Yeah. I didn’t think it would work. And so anyway, get the app.

Dr. Mistry: 5:29
You were doubting technlogy?

Donna Lee: 5:29
I did, totally. I was like , “What is this amazing technology?”

Dr. Mistry: 5:32
Do we have a question?

Donna Lee: 5:33
We do. This patient sent in: “I had a prostate surgery about a year ago. My libido is poor. Would it be dangerous to start testosterone?” Now he’s in his sixties and he had cancer was fairly aggressive, but now he’s fine.

Dr. Mistry: 5:45
So this is a great question. And really what it’s getting at is, is it safe to use testosterone if you have prostate cancer, are at risk for prostate, or have already had prostate cancer and have had treatment? The short answer is that it’s not dangerous. The longer answer is that there’s ample evidence now to suggest that a normal testosterone level and feeling normal in your overall health is protective against cancer recurrence, better predicts whether you’re going to get through treatment better, and does not alter your prostate cancer risk whatsoever. But I think that somewhere, including my own educational mind, we convinced ourselves that testosterone and prostate cancer were linked. And I think it’s important that we explore how we got there. So years ago, scientists won even a Nobel prize when they discovered that if you had metastatic prostate cancer and you castrated these men and removed all their testosterone, or as much as you could, these men would have a slowdown in their prostate cancer. So it would, it would grow slower. It showed that cancer was responsive to testosterone, and if you took it away that the cancer slowed down–but it didn’t cure it. What it did was, it now it made the cancer something called androgen independent. It made it so it didn’t need testosterone. And that’s the bad boy on the block. Those guys grew faster. As soon as you develop androgen independent prostate cancer, you actually accelerate your death. So I have a number of patients that understand the biology of this. And so when we have to do something for metastatic prostate cancer, like take away their testosterone, we don’t take it away and then leave it away. We take it away and let them have some back, take it away and let them have some back. And what that does, it’s called intermittent androgen deprivation allows them to go longer and longer and longer having some of the good kind of metastatic cancer, not just the only the bad kind of metastatic cancer. And so that’s where people get the idea in their mind though. If taking away testosterone helps to stop prostate cancer, then giving testosterone must fuel it. And that is not what the data bears. The data shows that it doesn’t matter if your testosterone level is 200 or 700, it won’t grow any faster. It’s 50–50’s the cutoff. If your number’s over 50, then it will grow at the same rate. If it’s under 50, it’ll grow slower. Now you might say, “Well, listen, I don’t like cancer, doc. Just take all my testosterone away.” But this is, this is a cancer that very much lends itself to a balance between lifestyle and life years. You don’t want to feel like crap no longer how long you’re going to live. No libido, no erections, poor muscle mass, poor memory, bone demineralization. I mean, it’s not great to live with no testosterone. And so in most cases, prostate cancer is not going to be a lethal disease. You know, very few people die from prostate cancer relative to those that get it. You’ve already had it treated, now you say you have no libido, this, this caller. Usually it’s just a , it’s just a terminology issue. When we say no libido, we use libido to mean sex drive–your desire to have sex. But a lot of men use libido as their ability to get an erection.

Donna Lee: 8:57
Oh, that’s right.

Dr. Mistry: 8:57
So, but those go hand in hand. If you don’t want to have sex, that erection ain’t going to do you no good. And if you’re in your sixties, it’s rare that you’re going to just get spontaneous erections like when you were 15, when you were thinking about sex or not, but of course were 15 years thinking about sex all the time anyway.

Donna Lee: 9:11
Well, what if you’re that 70 year old guy with a 35 year old wife?

Dr. Mistry: 9:14
That’s right. You know what I’m saying? So if you have a high libido and aren’t getting erections after your prostate was removed, then that could be nerve damage related and you could need more aggressive treatment. Testosterone may not be enough. But if your sex drive really is low and your desire to pursue advanced treatments for your erectile dysfunction are low, then taking testosterone may help you in the libido department as well as others. But the last and final point I’ll make on this is that sometimes, if you don’t get an erection, your libido can be low as a result of that. Just like I tell people I don’t play golf because I play golf terribly, and I have no desire to play golf .

Donna Lee: 9:46
Why put yourself through it?

Dr. Mistry: 9:47
Why do I put myself through a disappointing experience like golf ? So that’s another consideration. And so then we work on those patients from the erection standpoint. We can use injections, inflatable penile prosthesis, vacuum erection device, all sorts of things to give you an erection and then see where your libido goes after that.

Donna Lee: 10:03
Good answer.

Dr. Mistry: 10:04
It was a great question.

Donna Lee: 10:05
It was a great question. You know what raises the woman’s libido naturally?

Dr. Mistry: 10:08
Doing the laundry.

Donna Lee: 10:09
The laundry and the dishes. That’s a little hint for you guys out there.

Dr. Mistry: 10:13
Dish soap–the world’s greatest aphrodisiac.

Donna Lee: 10:15
No, no charge for that little hint, y’all–Michael. Anyway, you can call us at (512) 238-0762. Our email address is armormenshealth@gmail.com. Be sure to send us your question and we’ll get them answered right away. Back later!

: 10:29
The Armor Men’s Health Hour is brought to you by NAU Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.