Timing for starting Hormone Replacement after Orchiectomy

[NovaMike (imported)]

I got the runaround with the doctors. I scheduled an appointment with one doctor and she said she wasn't comfortable leading my care when it comes to hormone replacement. She referred me to another doctor. When I contacted that doctor, the earliest I could schedule an appointment is a month after the orchiectomy.

What is the ideal timeline for starting hormone replacement? I had assumed I needed to see a doctor before the orchiectomy to get bloodwork done related to current health/hormone levels to best set the hormone replacement strategy. Is a month off hormones too long?

I am not sure where to find another doctor, it took a month to get the appointment for the one I just saw.

[WheelyCurious]

Not an expert, but what are you planning for hormone replacement? And what are your current / pre-orchi levels if you know what they are? (if not what would you expect?)

I've been on E for most of the past year as part of my chemical test, and have no detectable T, with the doc saying she wants to maintain 'average normal pre-menopausal female levels' - this is sort of a difficult number to find as in normal females it fluctuates widely as they go through their cycle...

What I'd sort of expect if you are going to be on E is that you'd be able to start it almost any time, including before the orchie as part of T suppression.... If going on T, I'd think you'd want to ramp up fairly quickly after the surgery to maintain at least enough T to avoid the mental and bone health issues.

Are you seeing an endocrinologist, or is this doc more of a generalist or some other specialty? If it isn't an endocrinologist I'd suggest trying to find one, as they are the ones that are supposed to be the experts on hormones specifically...

WheelyCurious

[Losethem (imported)]

I am not sure where to find another doctor, it took a month to get the appointment for the one I just saw.

As much as that month of waiting sucks, you're actually doing a lot better than I am in our area, as it's taken me a year to get a care team together in my area. I say this just to let you know things are tough all over when it comes to scheduling care lately. You're not the only one waiting.

Am I to understand you're having your orchiectomy imminently? While not optimal, I'm not sure waiting a month to get in to see the doctor to get a prescription for your hormones will be all that detrimental, other than you may develop hot flashes in the meantime. Once you're on the HRT, you should be ok. I've gone up to 6 weeks not taking my shot, and while not optimal, it wasn't the end of the world. I waited about 5 weeks after my castration to start HRT. I'm still here.

So if you're worried about negative health effects from not starting immediately after your surgery, I think you won't have any other than the potential for the hot flashes until you get on HRT.

[Rory Smoot (imported)]

NovaMike, it sounds like you're asking what to do about determining your testosterone level NOW, before your

orchiectomy, rather than have doctors shooting in the dark about an appropriate level for testosterone replacement AFTER your major sources of natural testosterone are removed. If that's what you're asking, and you can't get a doctor to order the tests now, and you don't have testosterone levels from prior blood tests, there are various labs to which you can mail a blood sample and have it tested for various things, like testosterone. Remember too that peak natural production is in the morning, so if testing for testosterone, they always say to have the blood draw before 10 a.m.

[Lenkusov (imported)]

You could try a walk in at Planned Parenthood for a pre-op level check, they do bloodwork on-site but they'll also write you a paper order to take to any Labcorp location if they're understaffed and they can't get you in. They're also a great place to get HRT, although usually that service is booked several months out just because it requires an actual doctor and not just an RN to do it. As for how long you can go without HRT post-op, the answer is "It's Complicated." My personal record is like 9 or 10 weeks without HRT, not for any bad side effects but just because I wanted to go back on estrogen, others get extremely depressed in a matter of DAYS post-op but that's rarer in people actively seeking out castration. You can wait around 6 months with no hormones before things actually start to be a problem except for the usual hot flashes and possible mood swings, that's when stuff like osteoporosis becomes bad enough to see on a bone scan if your adrenal glands can't keep up with your needs on their own (and the only way to KNOW whether they can is to go off HRT and check levels...) but most people get uncomfortable with the side effects long before then.

[JustMe (imported)]

I was castrated March 21st. And my first appointment with the endocrinologist is April 25th.

Had a bloodtest on April 12th where they checked everything. T level 0,51nmol.

In the last week I really began feeling the effects of low T, I’m tired a lot, but that’s because I’m experiencing extreme insomnia (that’s how I feel it), When I do manage to fall asleep, I don’t sleep more than a couple of hours at a time, I wake up, go back to sleep for another couple of hours, and so it repeats. Even though I feel tired, in my case I simply cannot fall easily asleep.

Hot flashes are brutal when they hit, but only lasts for max 10 minutes, or so.

I feel week, arching muscles even after only light work. Easily out of breath.

Mentally I don’t seem to feel any different, can still get pissed when needed

I take multi vitamins and calcium supplements. The vitamins seems to help a bit, or at least I feel they help a bit. Calcium to help mitigate any bone loss, as I read when getting castrated almost immediately there will be a negative effect on bone density, not much but it’s there.

[NovaMike (imported)]

I was castrated today and see the doctor next Wednesday where I can hopefully begin hormones. I ride 8-10 miles a day on my bike and really don't want to lose the muscle mass and strength.