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2nd orchiectomy. TRT and surgery questions

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  • 2nd orchiectomy. TRT and surgery questions

    So I unfortunately have a second orchiectomy due. Am 35

    History: Pure multifocal seminoma removed in 2013. Caught early, stage 1, surveillance only, no spread. Caught on ultrasound at 0.5 cm, doc said to wait and see. Had doubled in size after two years so removed.

    Current one: Ultrasound found five hypoechoic lesions, largest 0.5 cm. Two clearly vascular, with a blood vessel running through the middle. Ultrasound presentation appears similar to previous seminoma. Small, but given history, likely TC. Other history: father had it, I have a super low sperm count, and I have microlithiasis. Last ultrasound was late 2016, no lesions showing then.

    TRT: Doc wants to start on three pumps of Androgel. Not sure dosage in a pump. Have been told to shoot for 60-80 mg, does that seem right (this was a forum person, not the doc)? Also, is there any bloodwork you recommend doing before the surgery, to get a baseline.

    Other hormones: I hear testicles produce other hormones apart from T. Is there anything else that may require external supply?

    Sperm Banking: Each time I go to the clinic, they can get one straw, which they estimate has 30-50 motile sperm. Extremely low, but probably enough for ICSI. I have five collections left before my surgery date, and actually was able to start doing it 2x during the colleciton window, which produced two straws when I tried. So, by surgery time I may have 15-18 such straws frozen. They will also take some of the seminiferous tubules and try to extract sperm. I have no kids now, would like to be able to tell future women I date that I have enough stored for 2-3 kids or however much they'd want. Both docs believe my surgery can be postponed if needed to extract more. Does it sound like I have enough for that goal? I know the more sperm the more morphology choice you have.

    Anything else it could be? I'm quite sure this is TC, but wanted to check if anyone can play devil's advocate. Anything else this might be? Doc said Leydig's hyperplasia would typically be larger in number and with clusters. A lot of other benign lesions would be avascular. One thing I wondered about was something fungal. I got the ultrasound in the middle of a BAD yeast infection that seemed to have come from somewhere internal. Is there any chance it could have been fungal and I picked a bad day to do an US?

    Testicular stem cell banking: I came across a few reports in the literature about this, but it doesn't seem that developed. Has anyone heard of this being done? In order to potentially one day restore testicles from one's own stem cells. Whether I would want to recreate my testicles is another question of course haha. But, if it's possible to do this I figure why not. I've already banked marrow.

    Also: the forum has been repeatedly down for me. Is this an issue with the forum, or could I be having some technical issue?
    Last edited by canadian; 04-30-21, 07:53 PM.

  • #2
    As for how I'm doing: pretty good. I found out about my low sperm in 2014, and did a deep dive into the literature. I concluded I had basically every risk factor for a second tumour. So, I've expected this possibility for a while, and did my grieving back then. Also, feel relieved on a few counts:
    • Found it early, fingers crossed it should be like last one with no spread
    • I already know what this is like, and the recovery was fine last time
    • I didn't realize I could bank sperm in amounts this low, so being able to do it is a relief. Had always worried about my production extinguishing
    • I've had some symptoms of low T for a few years; my free T has been extreme low end of normal range. So maybe I'll have better functioning?
    • Once this is gone I can't get any more TC haha


    • #3
      I have an empty bottle of the generic T gel I was on & looks like 4 pumps = 50 mg T. 4 pumps seems to be the lowest does I've heard of. You'd be getting 37.5 mg at 3 pumps. If it works then that's all that matters'.

      The forum has problems from time to time, nothing to do with your end.
      Last edited by Davepet; 05-04-21, 12:57 PM.
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP


      • #4
        Thanks. I guess the gels have different concentrations, as much as a 10x difference. So, I'll have to find out what the dosage is in what he's suggesting.

        Btw, have you ever heard of testicular stem cell preservation? Apparently that is a thing though very early. I only found papers on it, no commercial services. But as I'm already freezing part of the testicle for sperm it occurred to me this might be prudent in case restorative tech advances a bunch in our lifetimes.


        • #5
          I have not heard about testicular stem cell work at all, can't se any harm if the doc will go along
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP