I’ve never understood the controversy that surround TRT as a treatment for PVPS. Few doctors, even our handful of vocal champions and supporters, seem to roll their eyes at it.
I spoke with Kevin Hauber, author of If It’s Not Broke, Don’t Fix It and probably the founding father of the movement to get out the word about the dangers of vasectomy. He was still taking TRT several years after numerous surgeries and strongly believed that keeping his sperm count low was the only way to keep the pressure off his post-reversal and post-vasectomy damaged epis.
Back during my initial bout with PVPS in the 2005-06, many men were being treated by a Dr. Witt in Atlanta. I spoke with him once and going on memory, I believe he’s the one who put all his potential reversal-for-pain patients on TRT first for at least a month. He was using TRT as a diagnostic…TRT reduces sperm count, so in a vasectomized man, that should reduce congestive pain and was a positive sign that reversal would be effective. Other than he and Dr. Pienkos, I’m not aware of anyone proactively incorporating TRT into PVPS treatments.
In my case, my reversal uro was skeptical, but he pointed to my PSA that had skyrocketed to 4.2 as a reasonable to avoid TRT (for me) since it tends to increase PSA on its own. My case aside, I think more of us should be trying TRT before succumbing to surgery.
For congestive type pain strictly at the back of my epi and some referred pain in pelvis when pressure is high down there you’d say reversal would be best? I’m early post VAS but the pressure in my nut really hurts. I had a granuloma and the relief I had at the nut was amazing even though the granuloma sucked.
I don’t understand how that is even possible.The risks, pros and cons, etc’s have been broken down so many times on this website, I don’t understand how you missed it.
TRT has its own inherit risks. Period. I hate to give the firing order in which any man should consider as most important thing to consider first. I’ve seen many guys roll their eye regarding the risk of permeant testicular atrophy’. There are several other things to consider, but that’s the risk I see getting brought up most often here and elsewhere. It seems the risks aren’t to important unless they happen to you or whomever that might be. Somebody/s draws the shortest straw.
Much fact based information regarding TRT risks and side effects can be found all over the internet. I’ve listened to men roll their eyes at all of that information too, like it was completely bullshit and put online to only scare people.
Testicular atrophy – is a medical condition in which the male reproductive organs diminish in size and may be accompanied by loss of function. We can prescribe Human Chorionic Gonadotropin (HCG), which will prevent testicular atrophy associated with testosterone replacement therapy. Additional causes of testicular atrophy can include atherosclerosis, cryptorchidism, insufficient luteinizing hormone production most frequently seen in the hypothyroid state, and vascular injury during inguinal hernia surgery.
I believe from what I’ve read in my TRT forum, there isn’t a link between TRT and prostate cancer. Rising PSA levels don’t necessarily mean you have cancer, but you should get checked for it regardless.
Here is a great video put on the YouTube channel of our forum by the urologist, Jordan Grant.
This myth of testosterone causing prostate cancer started in the 1940s when they used to castrate men who had prostate cancer. It would regress the cancer. So they assumed the opposite of giving testosterone would make the cancer worse.
Sorry out getting groceries. Watch this video! It has all the studies linked underneath the description.
FYI, I had my vasectomy Jan 2019 and my granuloma formed 3 days later. Went on TRT in August 2019. Granuloma pain continued to get worse, but I was also doing a cycle of HCG like 3 months out of the next 12 months because I was worried about atrophy.
In hindsight, wish I never took the HCG because that increases sperm production. Stupid me.
The article states "Testosterone cypionate administered IM in 400 mg doses monthly for 3 months is an effective, frequently permanent, solution to this problem and should be used in all first-line cases of CPVPS. "
For people that have gone on TRT, what drug(s) exactly were you given, what dosage, for how long?
I understand that there are (mainly) long term side effects, with atrophy being the main risk, but it seems this would be less of a risk for only an (initial, but possibly effective) 3 month treatment?
I’m currently 5 weeks in my TRT experiment. Testosterone enanthate, 250 mg i.m injections every three weeks. 2 injections so far. T cypionate isn’t available where I live, so I figured 250 mg T enantathe every 3 weeks would be equivalent of what the article says. The dosage and interval is probably not optimal, but this is what I’ve started with.
I think it has effect. I’ve noticed that in the middle week I have less testicular symptoms, occacionally none. The days before the second injection I had increasing symptoms. The days after the injections I’ve felt a little bit woozy - might be a side effect of the dose.
But, I’m gonna continue this for at least three months, as long as i don’t find any concerning side-effects.
I showed this article to a urologist and he criticized it because there is no placebo-controlled study, just a case study of one patient. In any case, he prescribed me TRT so I could try it. I had side effects from the testosterone and stopped taking it.
I tend to agree with that thought process or risk assessment but I have heard that permanent testicular atrophy can happen to some men way faster than the majority that did the exact same thing.
I don’t have any data ATM to present a fact based argument with, but I will spend some time researching the topic later today. The odds of that happening in the short term could be 1 in 10k or they could be 1 in 1 million. I really don’t know. I had a respected pvps doc tell me this could happen right to my face. Could happen and will happen are two different things.
Side note, another member recently posted a short term positive review with TRT as well. So, that’s two positive stories in less than a few weeks.
I just read through 100’s of websites and countless pages of reference regarding the potential risks and side effects of various forms of TRT (again). I used various search terms, but mainly used “testosterone replacement therapy short term testicular atrophy”. Like always, I came up with a lot of data, some of it was contradictory, but the majority of it echoed one another.
Anyone that promotes the idea that TRT is perfectly safe because a few doctor’s over yonder say so… All I can say is - wow. A few doctor’s over yonder suggest vasectomies and a bunch of other contraversial stuff are perfectly safe too. I digress.
Keep in mind that there is a big difference between men that are considering using TRT for PVPS, and those that are trying to balance their hormones. These are two completely different paths.
Men that are in pain would be completely defeating the purpose of the benefit of TRT which is lowering sperm production considerably or to nill - by simultaneously using HCG to reverse or offset testicular atrophy, shrinkage, etc.
Bottom line - men that are in pain don’t have many if any such option/s that I am aware of.
I never found any statistics in regard to how many men draw the seemingly rare straw that I am still trying to find some fact based reference to.
That rare straw pertains to how many men end up with irreversible testicular atrophy and/or irreversible hormone production after using TRT for a short period of time (~2-12 months). At this point, those who draw the seemingly rare straw from short term use of TRT seem to be quite rare, but I was already aware of that.
In the other hand, numerous potential side effects from the used of various forms of TRT seem to be common, fairly common, etc. There is a lot to consider. TRT certainly isn’t something you pick up from your doctor and go about your merry way and don’t look back. I won’t elaborate. With a bit of research, anyone can figure that much out for themselves.
Keep in mind that I have a daughter that ended up having a heart attack that stemmed from the use of birth control. I’m sure that is rare too, but the risk of blood clots (in her leg) that lead up to the heart attack was printed as a risk in the paperwork that came in the packaging. Nobody thinks blood clots will happen to them, let alone lead up to having a heart attack. What are the odds? Obviously it happens to someone/s.
Keep in mind that I’m not trying to scare anyone. I’m just trying to keep it real. The majority of men that end up posting on this website were never warned about so much and some of them are foaming at the mouth upset about that. That said, it seems rather silly and contradictory to me to not give others a proper warning beforehand that are considering many things that carry significant inherit risks of their own.
A quote worthy of sharing.
"200mg will completely suppress almost every man’s HPTA. I have seen profound testicular atrophy on only 75mg of test cyp per week".
This PDF below titled -Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility- was a unique and very interesting read. It is full of relevant data, literature, TRT studies, etc.
One of many relevant quotes from the PDF
"Testosterone as a contraceptive can suppress sper-matogenesis and lead to azoospermia in 65% of nor-mospermic men within 4 months of use. Cessation of exogenous testosterone will lead to the reversal of hormonally-induced azoospermia in 64% to 84% of men with a median time of about 110 days. All men in these studies recovered to baseline levels after cessation of therapy; however, it took up to 2 years for some men to recover. These studies were performed in a controlled setting for a clinical trial, with a limited duration of testosterone use. In actual practice, recovery may not be as pronounced".
Here’s the thing one must consider about TRT. You’ve had a vasectomy, if you’re not worried about your chance of ever fathering children again, why are you so worried about testicle atrophy? In my opinion, my testicles being about 1/4 smaller is a blessing. Less in the way, less of a chance of injuring them even more.
Most men do exactly that, get scared away from TRT because they start on the wrong dose or don’t split their injections. It takes at least 8 weeks for your levels to normalize. Splitting your doses will help you keep your levels from spiking and lowering too much. But that goes against the above study.
You can restart your body’s natural HTPA loop with the use of clomid and hcg for a cycle. You’ll more than likely restart to a point where your levels would have been beforehand, minus how much your levels would have dropped due to natural aging. Honestly I can say, starting TRT has been the best decision in all areas of my life, especially if you are deficient. Just because your levels are in the normal range, doesn’t mean you are optimal. It has been proven that testosterone at the top end of the range decreases all cause mortality compared to though in low, and even moderate range. Lab ranges are based on a sick population.
I’ll drop this lecture here by one of North America’s top hormone doctors, Dr Neal Rouzier. If one is deeply considering using testosterone, i would highly recommend sitting down with some popcorn and watching this video.
The benefits have been proven and proven time and time again that the benefits far outweigh the risks. I can drop a bunch of literature here if you guys want, but joining the Facebook group TRT and Hormone Optimization and lurking, and learning is probably your best education on the subject. They have a complete files section at the top with all the science based literature you would like to read.
There are a lot of things to consider, including but not limited to - personal opinion, personal choice, age of the man, TRT is expensive, TRT carrys inherit risks of it’s own, etc. I have seen TRT described as a life long ordeal by many. Once you get started on it, it’s difficult to go back to the former.
That life long decision, including the $ spent over time, travel, potential withdrawals, etc, is probably the biggest reason I have never gave any form of TRT a whirl. I have a feeling that I would be a TRT for life guy if I ever gave it a try.
In my language there’s a saying, sometimes you must choose between plauge or cholera. Lesser of two evils is the English term I guess. I guess this is the case with just about any pvps treatment. I know how the plague is (pvps), so if I can convert it into cholera (TRT side-effects) I might be ok with that. Sure there’s a risk of getting both, but that’s a choice each must make. Informed choice though, which is why I’m happy for all the info & research you provide here.
The quote above is from one of my previous posts in this thread and it’s probably the closest thing I have came across regarding the answer I am still looking for.
Side note - I am a member of several other online forums that are well known for digging really deep into topics. Some of them have strict moderators that will kick people off the forum because they didn’t post any links to reference. Generally speaking, on such websites, personal opinions that are not based on some sort of fact are not allowed.
Also, I noticed smaller testicles with less frequent injections (1x weekly). The less I injected the more side effects I had. More anxiety, too much of an energy rush, heart palpitations. As soon as I split my dose to at least 2x weekly, my side effects all went away.
I didn’t word my statement as precisely as I should have. Yes, I definitely understand the risk. I meant RELATIVE risks…relative to denervation or reversal surgery.
No doubt, we PVPS victims are put into a really lousy situation if we draw the short straw. None of the treatment options are without risk. Heck, we’ve got guys here who had really bad reactions to Cipro and Levaquin which is often the vasectomist’s first line of defense assuming our PVPS is an infection. The anti-convulsant and opioid pain meds have risks, too, but the docs seem to dispense them off-label like they’re dispensing Pez candies.
Next rung on the ladder is typically injections, again, not without risk, but routinely prescribed by uros, GPs, and Pain Mgt. Last on the list are the various surgeries, and no doc I’ve seen will jump into surgery. In that one instance, I think there’s general agreement that surgery is last resort.
I guess that’s where I incorrectly stated my position. Yes, I understand the risks of TRT, but I don’t think the risks of a 1-3 month short-term trial are as high as, say, a 3-hour reversal surgery. Yet, if one asks for TRT, many docs will look at you as if you’ve grown a 2nd head when, compared with the options, it doesn’t seem all that crazy. That’s all.