How Do You Know Which Treatment Option Is Right For You
Determining the type of treatment option right for you depends on a few factors. For example, what is the dosage ideal to treat your symptoms? If you have more symptoms or require greater levels of testosterone, then topical treatments might not work for you. Your age and physical ability might also be factors, as well as the symptoms you are seeking treatment for. We will help you determine which treatment option is the best fit for your particular needs.
Gnrh Antagonists For Advanced Prostate Cancer
These drugs block messages from the brain to the testicles telling them to make testosterone. They work more quickly than LHRH agonists and do not cause tumour flare.
At the moment degarelix is the only GnRH antagonist available. You have it as an injection under the skin of your tummy once a month. It may be used for advanced prostate cancer that has spread to the spine . As well as hormonal side effects, it commonly causes skin reactions.
What Is Hormone Therapy
Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.
Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body.
Hormone therapy on its own doesn’t cure prostate cancer. But it can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.
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There Are Other Costs Associated With Trt Such As Doctors Visits Bloodwork Etc
Obviously, you cannot simply inject testosterone without doing a few tests first. Numerous TRT doctors in the United States can help you. An initial blood test to determine your testosterone levels might cost around $100. You might also need to measure your estrogen levels and this test can cost about $200.
Monitoring your hormones is essential during your TRT, so any bloodwork done will also increase the total cost of the therapy. Some doctors recommend taking a dose of HCG as well as testosterone. HCG is good for men who have fertility problems.
Doctors visits are also important in this equation. Again, you need to talk with specialists in TRT and most of the time youll need to pay your doctors in cash. Each visit might cost around $100 and any follow-up routines will also be added to your TRT bill. Although this seems like a lot of money, having normal levels of testosterone is worth more than anything.
How Should I Use Hcg
Use HCG exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.
HCG is given as an injection under the skin or into a muscle. Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.
Use each disposable needle only one time. Throw away used needles in a puncture-proof container . Keep this container out of the reach of children and pets.
To be sure HCG is helping your condition, your doctor will need to check you on a regular basis. Do not miss any scheduled appointments.
Some brands of HCG come in powder form with a separate liquid that you must mix together and draw into a syringe. Other brands are provided in single-dose prefilled syringes.
Intermittent Versus Continuous Hormone Therapy
Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. The hope is that giving men a break from androgen suppression will also give them a break from side effects like decreased energy, sexual problems, and hot flashes.
In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.
At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.
The Cost Of Trt Injections Also Varies Depending On Your Location
Not only the dosage and frequency of TRT injections affect their price, but also your location. If you live in a heavily-populated metropolitan area, you should expect to pay more for your injections. On the other hand, people who live in rural areas can get cheaper TRT products simply because the costs of manufacturing and shipping are much lower.
What Are The Side Effects Of Puberty Blockers
While puberty blockers are generally considered safe, they have some side effects. Not everyone experiences the following, but some people do.
Possible long-term side effects of puberty blockers
- Lower bone density. To protect against this, we work to make sure every patient gets enough exercise, calcium and vitamin D, which can help keep bones healthy and strong. We also closely monitor patients bone density.
- Delayed growth plate closure, leading to slightly taller adult height.
- Less development of genital tissue, which may limit options for later in life.
- Other possible long-term side effects that are not yet known.
Possible short-term side effects of puberty blockers
- Headache, fatigue, insomnia and muscle aches.
- Changes in weight, mood or breast tissue.
- Spotting or irregular periods .
For children who want to delay or prevent unwanted physical changes, the mental health benefits of puberty blockers may outweigh these risks.
Controversies In Hormone Therapy
The use of hormone therapy requires as much art as science. Physicians do not always agree about when it is best to start treatment, whether it needs to be continuous or can be stopped and started up again periodically, and whether monotherapy or combination therapy is best. Here are the salient issues, what the studies say and what I believe and follow in my own practice.
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How Often Do You Need To Get Your Hormone Replacement Therapy
The frequency of use may be a significant driving factor for some people. You need to take the pills every day, knowing if you miss one, you may be facing mood swings and an increased risk of various side effects, and will also make the first pass through the liver. If you are disciplined, this may not be an issue. But, you have to take into consideration your habits.
People who are seeking a more natural application can use creams and gels. These need to be used several times per day without fail. It is the most cost-effective method, but the most labor-intensive. Absorption rates may vary greatly from patient to patient and also within the same patient.
Injections need to be done one to three times per week, requiring you to have a doctors visit for each injection or do the injection from yourself. Each time you visit the doctors office, you have to take time off from work, have transportation, and possibly face additional charges that include co-pays for the office visit. Injectables are often associated with uneven absorption and a roller coaster effect of hormone delivery, resulting in high peaks and low valleys.
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
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The Truth About Hgh For Weight Loss
Can human growth hormone help you burn fat and build muscle?
Can a naturally occurring hormone that promotes growth and development be a dieter’s dream come true? The quest for an easier weight loss solution has some people taking human growth hormone in pills, powders, and injections.
A few small studies have linked HGH injections with fat loss and muscle gain. But the changes seen were minimal — just a few pounds — while the risks and potential side effects are not. And experts warn that HGH is not approved by the Food and Drug Administration for weight loss.
Efficacy Of Injections Of Growth Hormone In Dogs
Growth hormone injections are considered very effective in resolving conditions associated with inadequate production of growth hormones. However, tumors and cysts on the pituitary gland must also be removed if present or the condition cannot improve. It is also important to note that this treatment is expensive. Dogs diagnosed with growth-hormone responsive dermatosis may not require treatment since the hair loss does not have an adverse effect on their health.
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At What Age Can You Start Taking Puberty Blockers
Because every child is different, there isnt a single best age to begin puberty blockers.
In general, starting puberty blockers in early puberty leads to better outcomes and prevents the lifelong difficulties that can result from living with undesired sex characteristics. While they can stop puberty from progressing, however, blockers cant reverse changes that have already happened.
What Are Your Treatment Options
When it comes to the treatment methods used for hormone replacement therapy for men, you have several treatment options. These treatment options include:
Testosterone is injected into the buttocks every few weeks, usually about once or twice a month. Intramuscular injections are ideal for patients who prefer a quicker absorption, or who have more severe symptoms that benefit from a quicker treatment.
Pellets are generally a long-term treatment with a slow, consistent release of testosterone into the body. Testosterone pellets, which are about the same size as a grain of rice, are injected into the buttocks once about every three or four months. Pellets are a good option for patients who are searching for a steady treatment of multiple symptoms.
Topical Gels or Creams
Topical gels or creams are loaded with a certain percentage of testosterone and are applied daily to various parts of the body, such as the arms or the abdomen. Topical treatments might be good choices for men who have minor symptoms or who are using testosterone to target a specific issue.
Patches are another topical treatment in which a small patch of testosterone is applied to the body each day, typically in a rotating pattern to get the best results. Patches are ideal for patients who seek consistent levels of testosterone but who do not want injections.
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Figure : How Hormone Therapy Affects The Androgen Cascade
The male sex hormones are known as androgens. Probably the best known hormone in this family is testosterone. Most androgens are produced in the testicles.
Androgens fuel the growth of prostate cells, including prostate cancer cells. Hormone therapy also known as androgen-deprivation therapy seeks to cut off the fuel supply. But different therapies work in different ways.
A. The hypothalamus releases pulses of LHRH, which signals the pituitary gland to release the hormones FSH and LH.
B. LH travels through the bloodstream. When it reaches the testicles, it binds to specialized cells that secrete testosterone into the bloodstream.
C. In the prostate, the enzyme 5-alpha-reductase converts testosterone and other types of androgens into dihydrotestosterone , which stimulates the growth of prostate cells and fuels the growth of cancer, if it is present.
Centrally acting agents
LHRH agonists flood the pituitary gland with messages to crank out LH. This causes a temporary surge of testosterone until receptors in the pituitary are overloaded. Then testosterone levels drop sharply.
The GnRH antagonist jams receptors in the pituitary gland so that it cannot respond to the pulses of LHRH sent by the hypothalamus. This prevents the LH signal from being sent and no testosterone is made in the testicles.
DES inhibits secretion of LHRH from the hypothalamus.
Peripherally acting therapies
Orchiectomy removes the testicles, preventing testosterone production.
What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
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How Often Do You Need To Visit The Doctor
Every time your prescription renews, you will need to visit the doctor. There will be an office charge that may or may not be in your co-pay. Most of the time, you will also need a test to evaluate your hormone levels. A blood test is typically the best in the form of testing to identify your hormone levels and is used to verify the level of hormone therapy you are receiving is accurate. This test may range from $80 to well over $500, depending on what the doctor needs to testblood test range from$80 to $200.
Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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What Are Male Sex Hormones
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
Side Effects Of Hormonal Therapy
Reducing the level of testosterone can cause different side effects. There are different ways hormonal side effects can be managed or treated. Your doctor or nurse will explain these to you. Some side effects are only likely to affect you when you have hormonal therapy for over 6 months.
Common side effects include the following:
- Erection difficulties and reduced sex drive
This usually improves after you stop treatment, but it may take a few months. If you have erectile dysfunction , there are drugs and treatments that may help.
- Hot flushes and sweats
Hot flushes and sweats may reduce as your body adjusts to treatment. They usually stop completely 3 to 6 months after treatment finishes.
- Tiredness and difficulty sleeping
- Mood changes
Talking to someone close to you or a counsellor may help.
Different hormonal therapies have different side effects. It is important to discuss these with your doctor or nurse before treatment so you know what to expect.
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How To Tell If Hormone Therapy Is Working
If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.
If you are taking hormone therapy for breast cancer, you will have regular checkups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably wont need a mammogram of a reconstructed breast. Your doctor may also order other imaging procedures or lab tests.