Low Testosterone Treatment

Geico266

Geico266

Touchdown! Greaser!
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We have been giving women hormone replacement for decades just to make them feel better. Initially it was believed that HRT would give health benefits but research subsequently showed that there are health risks. Testosterone replacement is also a controversial issue. There is controversy on who should receive androgen replacement and the recent findings will make this issue even more complicated.
 
More anti-male crap. Can't have men upping their masculinity. Any siren warnings for the hormone taking men pure sex change? Nah that's OK. FYI I'm not on test, but gladly will be if I think I need it.
 
I do not understand why it's just fine to give almost any post menopausal woman HRT on request but guys need to have a free testosterone level lower than 95% of men of that age to qualify for replacement. Over-replacement is dangerous but why not let a guy have the average testosterone level of someone that age?
 
Gary F said:
I do not understand why it's just fine to give almost any post menopausal woman HRT on request but guys need to have a free testosterone level lower than 95% of men of that age to qualify for replacement. Over-replacement is dangerous but why not let a guy have the average testosterone level of someone that age?
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And the part I bolded is the major problem.
 
Gary F said:
I do not understand why it's just fine to give almost any post menopausal woman HRT on request but guys need to have a free testosterone level lower than 95% of men of that age to qualify for replacement. Over-replacement is dangerous but why not let a guy have the average testosterone level of someone that age?
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Norman said:
And the part I bolded is the major problem.
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Giving an excess of many medications can be dangerous but that does not stop us from using them. It is the physician's job to make sure each patient gets the appropriate dose.
 
C'mon Norm look at the crazy plastic surgery we allow, then you are going to tell us limiting test is all about public health. Yeah right.
 
Gary F said:
We have been giving women hormone replacement for decades just to make them feel better. Initially it was believed that HRT would give health benefits but research subsequently showed that there are health risks. Testosterone replacement is also a controversial issue. There is controversy on who should receive androgen replacement and the recent findings will make this issue even more complicated.
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I would think there would need to be a good medical reason for HRT in both men and women. Wasn't it shown years ago that HRT in women wasn't necessarily a good idea?
 
Everskyward said:
I would think there would need to be a good medical reason for HRT in both men and women. Wasn't it shown years ago that HRT in women wasn't necessarily a good idea?
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HRT can help someone feel much better. What is the purpose of medicine? I believe it can be summed up as helping people feel better and/or live longer. Sometimes these goals are at odds and the patient should have some say if they are willing to accept risks. HRT can improve both men's and women's quality of life at a reasonable level of risk (depending on the individual). Who should decide if a treatment option is a good idea other than the patient and medical provider?
 
Gary F said:
I do not understand why it's just fine to give almost any post menopausal woman HRT on request but guys need to have a free testosterone level lower than 95% of men of that age to qualify for replacement. Over-replacement is dangerous but why not let a guy have the average testosterone level of someone that age?
Click to expand...

Norman said:
And the part I bolded is the major problem.
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Not a doctor, but I've read that prostate cancer feeds off testosterone. While my doctor says I don't have it anymore (over 5 years since surgery), I'm not taking any chances.

Like Geico, I'm kicking and screaming all the way too. Getting older isn't for sissies.
 
Ghery said:
Not a doctor, but I've read that prostate cancer feeds off testosterone. While my doctor says I don't have it anymore (over 5 years since surgery), I'm not taking any chances.

Like Geico, I'm kicking and screaming all the way too. Getting older isn't for sissies.
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Prostate and certain other cancers are a contraindication to the use of supplemental testosterone. Anyone receiving testosterone should have periodic PSA tests.
 
Gary F said:
HRT can help someone feel much better. What is the purpose of medicine? I believe it can be summed up as helping people feel better and/or live longer. Sometimes these goals are at odds and the patient should have some say if they are willing to accept risks. HRT can improve both men's and women's quality of life at a reasonable level of risk (depending on the individual). Who should decide if a treatment option is a good idea other than the patient and medical provider?
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I never said people shouldn't be allowed to have it. I just think there is a tendency to overmedicate, and that people don't always consider the consequences of the side-effects especially when taking something long-term.
 
Everskyward said:
I never said people shouldn't be allowed to have it. I just think there is a tendency to overmedicate, and that people don't always consider the consequences of the side-effects especially when taking something long-term.
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How do you define "overmedicate"?
 
Gary F said:
How do you define "overmedicate"?
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Pushing drugs for no good medical reason. We talk about it all the time on the ADHD threads.

Personally I would not do HRT unless I had some pretty profound symptoms and FWIW I am that age now.
 
My wife and I are both in our 60's and neither of us do hormone replacement.

Personally, I've found that I'm more even-tempered and agreeable in old age and I'd hate to see that go away if I started testosterone treatment. I heard the same opinion from a friend of mine who has had to deal with anger issues all his life That and wanting to avoid the possible increased risk of prostate cancer.
 
Everskyward said:
Pushing drugs for no good medical reason. We talk about it all the time on the ADHD threads.

Personally I would not do HRT unless I had some pretty profound symptoms and FWIW I am that age now.
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What constitutes "no good reason" is a subject of debate. I agree that many medications (especially antibiotics and some psychoactice drugs) are commonly over prescribed I would not make the claim that HRT is always inappropriate.
 
Gary F said:
Seemed to imply that. Sorry if I misinterpreted your posts.
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No problem. Obviously it needs to be a risk/reward decision between the physician and the patient. I'm just looking back 20-30 years to when they more commonly prescribed HRT to menopausal women until they found out that there was a statistically significant increase in breast cancer among other things. Now women (and doctors) are more cautious.
 
Everskyward said:
No problem. Obviously it needs to be a risk/reward decision between the physician and the patient. I'm just looking back 20-30 years to when they more commonly prescribed HRT to menopausal women until they found out that there was a statistically significant increase in breast cancer among other things. Now women (and doctors) are more cautious.
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There are still women who want to stay on HRT in spite of the risks. They choose improved quality of life over possible adverse consequences or even premature death. Nearly every patient care decision I make includes one or more risk benefit calculations.
 
I have no doubt that there are individuals with abnormally low testosterone who benefit from replacement therapy.

It seems however to me that 'Low T' is for the most part a disease generated by TV advertising and a desire to find a pill to fix every problem in life. Many of the individuals who are being treated for 'Low T' could probably address some of their issues by getting more sleep and hitting the gym a couple of times a week.
 
Gary F said:
There are still women who want to stay on HRT in spite of the risks. They choose improved quality of life over possible adverse consequences or even premature death.
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Of course I know that there are women who decide on HRT. But it isn't as popular now as it was before the risks were as known, or at least publicized.

Gary F said:
Nearly every patient care decision I make includes one or more risk benefit calculations.
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I made a pretty significant risk/reward medical decision last year. Luckily it has worked out for me so far but I am fully aware that it might not have turned out that way. I'm also not sure other people would have made the same decision.
 
weilke said:
I have no doubt that there are individuals with abnormally low testosterone who benefit from replacement therapy.

It seems however to me that 'Low T' is for the most part a disease generated by TV advertising and a desire to find a pill to fix every problem in life. Many of the individuals who are being treated for 'Low T' could probably address some of their issues by getting more sleep and hitting the gym a couple of times a week.
Click to expand...

Or, as it is in my case, it is a disease that is caused by the body simply not producing enough T for a normal person my age (and, FWIW, much, much less than the normal amount).

I put off treatment for about 15 years because of the mindset you described above. Too many people do. At the end of the day, it has left me in my early 30s feeling like a very old man that has a lot of catching up to do. Perhaps people commenting on the validity of the use of a medical treatment to a medical problem should instead focus on targeting the abusers of the medication for personal gain (i.e., athletes that use it for an advantage).

As for "getting more sleep and hitting the gym," you have no idea what it is like to have low T. People see you as being lazy, but you're not lazy, you literally have zero energy to do what you need to do, let alone the additional energy needed to work out. People give pregnant women the benefit during their first trimester because they have absolutely no energy, but refuse to give the same benefit to men suffering from a very similar lethargy.

Whatever, it was the best decision I ever made. Increasing the chance of prostate cancer or heart attack later in life is worth being able to live life now. Had I had to go another 50 years feeling like I had the last 15, I'd probably not be a very happy old person.

FWIW - when I say much, much less:
Testosterone, Serum: Actual Amount: 222 ng/dL, Normal Amount: 348-1197
Free Testosterone: Actual Amount: 6.2 pg/mL, Normal Amount: 8.7-25.1
 
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weilke said:
I have no doubt that there are individuals with abnormally low testosterone who benefit from replacement therapy.

It seems however to me that 'Low T' is for the most part a disease generated by TV advertising and a desire to find a pill to fix every problem in life. Many of the individuals who are being treated for 'Low T' could probably address some of their issues by getting more sleep and hitting the gym a couple of times a week.
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That's good marketing. In theory about 5 percent of anybody tested will meet the criteria for replacement and the expense is incurred by the patient. The drug company can't lose.
 
T levels are universally lower then they used to be and falling, probably the same cause as all the androgynous fish and frogs. Which is almost certainly caused by the great environmental disaster of birth control getting into the water, good luck stopping that train. Be funny to publicize the cause and watch the enviro torchbearers shudder and turn their backs.
weilke said:
I have no doubt that there are individuals with abnormally low testosterone who benefit from replacement therapy.

It seems however to me that 'Low T' is for the most part a disease generated by TV advertising and a desire to find a pill to fix every problem in life. Many of the individuals who are being treated for 'Low T' could probably address some of their issues by getting more sleep and hitting the gym a couple of times a week.
Click to expand...
 
Everskyward said:
Of course I know that there are women who decide on HRT. But it isn't as popular now as it was before the risks were as known, or at least publicized.

I made a pretty significant risk/reward medical decision last year. Luckily it has worked out for me so far but I am fully aware that it might not have turned out that way. I'm also not sure other people would have made the same decision.
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It helps to have an experienced, knowledgable and unbiased medical provider who can explain the situation and options clearly.
 
SkyHog said:
Or, as it is in my case, it is a disease that is caused by the body simply not producing enough T for a normal person my age (and, FWIW, much, much less than the normal amount).

I put off treatment for about 15 years because of the mindset you described above. Too many people do. At the end of the day, it has left me in my early 30s feeling like a very old man that has a lot of catching up to do. Perhaps people commenting on the validity of the use of a medical treatment to a medical problem should instead focus on targeting the abusers of the medication for personal gain (i.e., athletes that use it for an advantage).

As for "getting more sleep and hitting the gym," you have no idea what it is like to have low T. People see you as being lazy, but you're not lazy, you literally have zero energy to do what you need to do, let alone the additional energy needed to work out. People give pregnant women the benefit during their first trimester because they have absolutely no energy, but refuse to give the same benefit to men suffering from a very similar lethargy.

Whatever, it was the best decision I ever made. Increasing the chance of prostate cancer or heart attack later in life is worth being able to live life now. Had I had to go another 50 years feeling like I had the last 15, I'd probably not be a very happy old person.

FWIW - when I say much, much less:
Testosterone, Serum: Actual Amount: 222 ng/dL, Normal Amount: 348-1197
Free Testosterone: Actual Amount: 6.2 pg/mL, Normal Amount: 8.7-25.1
Click to expand...
I would have no problem prescribing testosterone to someone with those numbers. Testosterone replacement is clearly a good idea for some people and less so others who may get it anyway. Unlike low thyroid it is a little more complicated and requires sound medical judgement and not just a couple of lab tests.
 
Certainly, there are medical reasons why HRT would be a good idea, but mass marketing has instilled in many a desire try and become something you are not, recapturing youth, if you will. Advertising has created a "disease" where one did not exist before.
 
SkyHog said:
FWIW - when I say much, much less:
Testosterone, Serum: Actual Amount: 222 ng/dL, Normal Amount: 348-1197
Free Testosterone: Actual Amount: 6.2 pg/mL, Normal Amount: 8.7-25.1
Click to expand...

That would cover you under the first sentence in my post:

weilke said:
I have no doubt that there are individuals with abnormally low testosterone who benefit from replacement therapy.
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The remainder of my post does not apply to you.
 
weilke said:
That would cover you under the first sentence in my post:



The remainder of my post does not apply to you.
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You missed the point. The reason I delayed treatment for so long was because of your mindset that it is just abused and not needed (coupled with the whole "less of a man" thing). There is nothing wrong with T treatments for anyone low except those that are only using it for unfair advantage.
 
SkyHog said:
You missed the point. The reason I delayed treatment for so long was because of your mindset that it is just abused and not needed (coupled with the whole "less of a man" thing). There is nothing wrong with T treatments for anyone low except those that are only using it for unfair advantage.
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I dont see how my opinion that only individuals who have been correctly diagnosed with the condition should undergo treatment would keep someone who objectively has the condition from receiving treatment.

Before anyone starts on replacement therapy they need to be competently evaluated. Low testosterone could just be a symptom of a bigger problem, anything from a non-cancerous brain tumor to immune diseases that affect different parts of the endocrine (hormone producing) system. And yes, sometimes it is just about losing a couple of pounds and getting more sleep (which is the time when someone in whom the plumbing works produces most testosterone).

Just the other day I talked to an acquaintance whose workup got started after him and his wife had fertility issues. In the end, he had an autoimmune condition that affected among other things his thyroid. He was properly treated, they have a couple of healthy kids. Also, once his thyroid hormone levels returned to normal, the tiredness he had ascribed to his challenging military career disappeared.

Endocrinology is a bit more complicated than obtaining an isolated hormone level and slathering on some testosterone gel.
 
Normal declines due to age are one thing. If a man has severely low T levels, he'll be a safer pilot when carefully supervised by a good doc and receiving enough testosterone to get him out of the severely-low levels and at a level normal for his age.

When T levels are too low a man's ability to focus, sleep, remember, have energy to operate throughout the day, etc. are all diminished - sometimes greatly. Not the sort of affects you want with people operating airplanes. Restoring the normal T level can solve those problems. So, if it's truly clinically indicated it can actually make a pilot safer.

Now, the current push in advertising and whatnot that seems to say anyone with low energy should try testosterone... Well... That's just BS if you ask me. If the blood levels are not super low, things like exercise and diet are a great place to look.
 
greghughes said:
Normal declines due to age are one thing. If a man has severely low T levels, he'll be a safer pilot when carefully supervised by a good doc and receiving enough testosterone to get him out of the severely-low levels and at a level normal for his age.

When T levels are too low a man's ability to focus, sleep, remember, have energy to operate throughout the day, etc. are all diminished - sometimes greatly. Not the sort of affects you want with people operating airplanes. Restoring the normal T level can solve those problems. So, if it's truly clinically indicated it can actually make a pilot safer.

Now, the current push in advertising and whatnot that seems to say anyone with low energy should try testosterone... Well... That's just BS if you ask me. If the blood levels are not super low, things like exercise and diet are a great place to look.
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Why does it need to be "severely low"? Who should decide the threshold? I have seen less than stellar physicians prescribe the stuff rather indiscriminately and that tells me something. However, if sensible replacement can improve somebody's quality of life at low risk then I think it is probably appropriate.
 
I forgot my scores its been so long, but when the doctor saw my results from the tests he said I had almost zero testosterone in my body.
I do not use any replacement for this, side effects where driving me nuts, I felt like a 20 year old again and wanted to act like one. Today I am tired all the time with zero energy to do much.
They found this over 10 years ago. I was in my early 40's when they found this. I might go back on this though. Being tired is getting old.
 
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