Getting to Know Jack, and His Experience with Supplemental Testosterone

I moved from New Jersey to Florida and was looking for a job in the field of pelvic floor physical therapy. It didn’t take long to find one. Prostate cancer is quite common, and many people relocate to Florida after retirement in search of sunny skies and a break from cold winters. One of my first patients in the new job was named Jack. I met him because he was having trouble with his penis clamp; it simply wasn’t holding back urine as it was designed to do.

Jack speaks like a guy who has been in construction for a long time and is someone you can trust. Jack used to manage the construction of hospitals in the Philadelphia area before he retired. He played a huge part in the construction of the hospital in Philadelphia where I went to college to study physical therapy. When I inspected the penis clamp of this larger-than-life personality, I noticed that it wasn’t fitting securely around the tissue underneath Jack’s glans penis. I adjusted it and we got to talking.

Jack's experience with prostate cancer

I learned that Jack had had prostate cancer and needed a radical prostatectomy several years back. When his PSA levels began to rise, Jack required cyberknife radiation to remove errant cancer cells within his pelvis. This was then followed by a diagnosis of bladder cancer; Jack underwent further surgery to remove a portion of his bladder.

It was at this time when I met him, and he was leaking urine like a faucet. Nothing would stop it but a penile clamp. (I have always secretly admired men who utilize clamps to manage urinary incontinence. It sounds so primitive to clamp down a penis to stop pee from escaping it. But penile clamps can play a very important role in retraining the bladder to fill and empty in a timely fashion, so that the bladder can learn what it feels like to contain urine once more).

Anyway, Jack and I got to talking about Philadelphia. His accent is so reminiscent of my younger years that I began to feel younger when he came to the clinic. Jack is 80 and I am 46, but we felt like comrades in our respective life journeys. I needed help in whether or not I needed permits to install new windows in my house in Florida. (People can get around permits in the Northeast, but the town municipalities of Florida do not mess around in hunting down homeowners who fail to get permits and their fines are extortionate).

An unorthodox tactic

Jack needed help getting his pelvic floor muscles to get firing again. I taught him to also work on his core, timed with breathing exercises, and it really helped. (Jack was used to doing crunches and holding his breath while exercising; I've found these techniques can make urinary leakage worse).

Jack improved quite well in pelvic floor physical therapy. He no longer requires the penile clamp and manages his leakage with pads. But he also utilized another tactic that is considered unorthodox in the realm of prostate cancer rehabilitation. A couple of years ago, Jack started getting pellets of testosterone placed within the tissue of his gluteus maximus. These pellets contain a substance which is identical to the testosterone his body once produced before he developed cancer.

Taking supplemental testosterone

I raised both eyebrows when Jack told me this. “Many studies argue that testosterone can feed cancer and that androgen deprivation therapy, which is medication to tamp down testosterone, can prolong life for men,” I explained. Jack shrugged. “I understand that you are citing medical studies. And that other guys might think I am insane. My wife questions what I am doing as well.” There was a long pause here, when the sunbeams danced in the shape of palm fronds through the window of the treatment room.

“But this is my life,” Jack continued with conviction. “When I am using testosterone, my memory is sharp, I have more energy to play with my grandchildren, and I can tear down the walls to renovate my kitchen. I have already had cancer. Three times! I am willing to take my chances.”

I closed my eyes and had one of the best realizations of my career. This wasn’t my body. This was Jack’s body, and he had every right to live as he saw fit. And from feeling younger when being around Jack, to getting him weaned off the penile clamp, to listening to his tips on how to oversee renovation of my own home in Florida, I knew that he was following his best instincts.

Honoring his choices

When I was just a young student who knew nothing of life and physical therapy of the pelvic floor, I was taught to read research studies and follow them to the letter. I was trained to follow the rules. It wasn’t until I moved to Florida at 46 and met Jack at 80 that I finally learned that there are times when we must heed another calling. For Jack, that means taking supplemental testosterone for his own quality of life. For me, it means allowing other people to make their own choices and honoring them.