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Treatment choices for testosterone replacement?
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Treatment choices for testosterone replacement?

Hello,

I was the one that asked the question less than a day ago, about my husband taking testosterone even though his levels were normal. I did have another question, the doctor gave my husband the choice of taking shots, patch, gel or pellets. My husband did not like the idea of taking shots every two weeks, so that left him with the other choices.
  
My husband likes me to come in the room and ask all the questions, he says that he does not understand and I talk better. I know he is very smart but when it comes to medical issues he does seem to get lost in the conversation and very easily frustrated. Because my husband likes me to help make medical decisions for him, this does add extra pressure on me to make right choices for him. I asked the doctor not knowing myself what method he preferred and he said the pellets, so he is set up with an appointment for them.

After doing some research on the internet, I am finding a lot of urologists do not highly recommend the pellets. Mainly I have read that they are an old method and that the pellets are hard to correct the dosage if there should be a problem. Also some suggested they do not absorb well and should not be used in elderly men. My husband is 71.

I am asking all these questions because my husband had a bad reaction with another medication that this doctor prescribed for BPH. His regular internal medicine doctor said she would not have given such a high dose to a 300 pound man, my husband is only 140 pounds. We really trust his internal medicine doctor which helped him through cancer so this has caused some mistrust with the new doctor.

His regular doctor took him off the high dose and the urologist apologized and stated that he was given an average dose and that he did not know he would have such a reaction. I understand this thing can happen and no one is at fault. I am just so protective since my husband had jaw cancer that I just want to be sure he is making the best choices for his overall health. Because I am over protective I am not sure if he should get a second opinion on what testosterone to try and if he should even try testosterone? Hopefully someone will be able to read my posts. Thank you very much for your time.

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Avatar_dr_f_tn
Hi,

I have not read your previous post regarding testosterone.

But my opinion regarding testosterone supplementation tends to be rather conservative here; If your husband can function normally without it, it would be better not to start it.

Testosterone is a male hormone that regulates a complex array of functions that varies among men and women.
The hormone is produced by the testes and the adrenals in men.

The reason for testosterone supplementation will need to be assessed carefully prior to commencing treatment.

If the treatment is to reverse the natural aging process, it is not a good idea. If it is for the treatment of hypogonadism-related symptoms affecting quality of life adversely, it can be considered for use with frequent monitoring of levels.
Testosterone replacement causes the testes to atrophy and cessation of treatment will bring about severe withdrawal reactions as it is a steroid and the body gets dependent on it for its normal functioning.

The transdermal delivery systems (patches) are considered ideal for supplementation as they tend to deliver nearly the exact dose of drug required by the body.
Oral supplements and injections fail to achieve this balance and cause resultant fluxes that may be detrimental.

Testosterone replacement also aggravates BPH ans increases risk of prostate cancer, hence an evaluation of the prostate gland should be done prior to starting treatment and at regular intervals during treatment.

Do keep us posted on your doubts .
regards,
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Avatar_f_tn
Hello Dr. Mathews,

I cannot thank you enough for your answers. I was hoping you would read my other post in order to see if my husband is even a good candidate for testosterone therapy. Below I have copied and pasted my first post.

My husband is quite a bit older than me but I love him very much and we have been together for 18 years. He has been having problems with no sex drive and I have been having a hard time dealing with the rejection.

Since my sex drive is high and his is non existent, I have been trying to find a way to make our relationship work. He went to an urologist that specializes in sexual issues and the nurse said on the phone that his testosterone levels came back in the normal range at 336. But the doctor said his testosterone was low and wants to put him to use testosterone pellets.

I was confused after I left and called the office back, the nurse said that even though his testosterone levels were normal that a study was done and that they really like the levels to be at 400 for a man his age.

My husband is 71 years old and he would be fine if we could just kiss and hold hands and take trips together and never have sex again, but I find the rejection to be too painful.  I know he is trying these pellets only for me. My concern is that he had jaw cancer in the past but is in very good health now, could trying these pellets cause him cancer or other problems? Should he be trying testosterone if he is in the normal range? I could never forgive myself if something bad happens and I was the one who pushed him to go to the doctor in the first place.


He and I both feel that our marriage cannot work if we cannot find a conclusion for this problem. I was only 19 when I met my husband and he has lived another whole life before me. I have sacrificed children, and so many activities that a younger couple would experience.

My self esteem is low and I feel unwanted and less like a lady should feel, even though he constantly tells me it is not me.  I never thought sex was as important as I do now.  I now realize it defines a friendship verses a couple.

I am only 37 and not ready to give up sex completely. With no help my husband states that there will be no more intimate relations between me and him. I could live if we had intimate relations only twice a month.

Perhaps I am being selfish but I do not think I could accept never having sex again. I hope there is help for us. Is there anything safer than testosterone that could help us? My heart and I can tell my husbands heart is breaking. He even suggested I had other relations and not tell him about it. I cannot and will not do this to him. I would have to let him go first and that thought just kills me as I know it would kill him. To be still in love after 18 years and to let go, I cannot bare the thought of it but I know this will happen. Is there any safe help? I am sorry this is so long.
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Avatar_dr_f_tn
Hi,

The situation is not as bleak as it appears.

Depending on when your husband had treatment for his cancer, you will have to assess whether he has had enough time to recover.

The normal range of testosterone for a man between 70-80 years of age is 38-850 ng/dl. The optimal anti-aging range prescribed by some studies for this age group happens to be 500-800 ng/dl.

Since your husband has a T level of 336, it is within the average normal for his age.

Have you considered Viagra or Cialis to boost performance? These drugs act at the vascular level and should be discussed before trying something more radical.

The side effects of these drugs would be minimal and of so much lesser intensity than that with the T replacement.

T replacement has risks of cancer associated with it, and you can try other options that include testosterone-enhancing food groups and supplements first. These include having a balanced diet with adequate proportions of carbohydrate, protein and fat (a nutritionist can help you out, or you can compile a balanced diet based on the principles of avoiding high-protein, high-carbohydrate, low-fat diet), adequate zinc, boron, and vitamins (shellfish, wheatgerm, cashewfruit, etc.), and DHA supplements (cod liver oil capsules). Vitamin E and B complex will also aid in increasing testosterone levels naturally.

The disparity in age could result in a gap in drives, but understanding your husband and letting him grow into a normal pattern of conjugal relations after all that both of you have been through would help with the situation. The lack of sexual intercourse will definitely bother you since you are in the age range where your body's physiological reactions will be in full swing in terms of sexual appetite and the drive for procreation.

Exercise, diet management, a few pharmacological aids (viagra, cialis, etc.) can all be tried before you consider T replacement. Having a baby may also help deal with some of the elements of this situation, if that is an option.

Do post here for any additional advice you require.
regards,
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Avatar_f_tn
Hello Dr. Mathews,

Thank you once again, I am so sorry to keep taking all your time as I know you are busy. I wanted to address some of the things we did try. My husband tried Viagra about five times. He hates it, he says why should he take something when he absolutely is not in the mood for sex and that it does nothing for him. His regular doctor said it will not work if the mind is not there, he agreed and will not try this stuff any further.

I have tried to comfort him as I stated to him that intercourse is not important. I honestly would give that up completely for him. It is the act of foreplay and experiencing other sexual methods that means so much to me because we are trying. I workout, I am 5’ 5’ 114 pounds and try to take care of myself really well. I tried being creative in the privacy of my home, talking, not talking even tried getting him porn, but nothing works. He says nothing could turn him on. He feels bad about it, but he says he does not know why and he keeps saying I guess it is because I am old.  

He had cancer 8 years ago, has a very lousy appetite that has always worried me, meaning he could live without food if he had it his way. His mom said he was always like this. He has been trying harder to eat since he had the cancer and it scared him but since he lost an inch and a half of his jaw eating is very hard for him to do. He gets most of his calories from a supplemental drink, Boost. He is also extremely picky. So I just make him what he wants in order to get him to eat. He would be very hard person to push anything else with food than what we are trying now.

His takes thyroid medication for the last 10 years, his doctor checks it every three months and so far the medication shows it has been working well. He also takes medication for BPH called Terazosin. He takes no other medications at this time. Heart is good, blood pressure good, cholesterol is normal. Our sexual problems starting getting worse about four years ago. We had foreplay twice in the last year. And before that we had not had sex or any type of foreplay in 2 years. I have tried to be patient, I have only been really on him to get help in the last three months. Before we only talked about a little bit maybe twice a year because he would stop the conversation. But something changed in me, my sprit and my libido and I cannot let this go anymore. He does not seem depressed he says he is not, he gets excited about things and does things everyday, but in the last four years he has been sleeping less.
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Avatar_f_tn
I also wanted to say that my husband had three kids from a past marriage and he does not want kids. I feel because he does not want to have kids and because of his age, it would be unfair to bring kids into the picture. I cannot thank you enough for your time. This means so much to me.
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Avatar_dr_f_tn
Hi,

If an aspect of life is important to you, you need to communicate the fact to your partner. If sexual relations are important to you, you will need to identify how best the problem can be approached. It is possible that the ravages of disease and inadequate diet may have taken a toll on your husband's health and libido. The problem can also be that there is too much stress on a particular aspect, either food or sex, and the individual develops resistance as a response to any reference to the subject.

Side effects of terazosin include sexual dysfunction, but if there is no interest in sexual activity, then it is possible that the problem is not drug related.

You can try masturbation and avoid denial of your physical needs and wants. It need not be that your spouse finds you unattractive or old, but could just be reacting to his own problems. Just ensure that you care for yourself and interact with friends who can give you additional emotional support.

Food can be prepared as soup or pureed to include more of the vital nutrients needed for normal health.

regards,
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Avatar_f_tn
I cannot thank you enough for your help. I talked with my husband and told him your advice on testosterone. As a result he would like to get a third opinion. No offense to you it is just that we have his urologist for the treatment and you seem more against it.  Also after doing more research I have now found as many arguments for it, as well as against it. It seems that doctors are divided on this issue. I do want to say that you answers did help me a lot to know what questions to ask the new doctor.

Besides the low libido, my husband has been complaining that even though he is eating more he cannot put weight on. Four years ago on the boost he was able too. He also says that he cannot sleep, he has night sweats, he cannot think as clearly and he is more tired and definitely more irritable. These are all things that I read that seem to go hand and hand with the still questionable phenomenon of male andropause. He has been to his regular doctor for these other issues, but after several tests his doctor always says he is in good health and can find no other medical issues.

Is the treatment of andropause fairly new? It seems that there are no clear cut answers as to what testosterone therapy can do to men that are being treated for andropause. The only thing I can find that doctors for it and doctors against it agree on is that testosterone does cause prostate cancer to grow if it is already present.

I wish they would do long term studies on this issue.  My mother who is healthy was still having problems after menopause. She decided to take hormones, even though she knows they are dangerous. She felt her quality of life on them is worth the risk. That is the question, what risks our worth the quality of your life and how high are the risks? I cannot seem to get any clear answers as to how high are the risks of testosterone therapy.

I will do my best to learn as much as I can and express clearly to my husband what I find out and allow him to make the decision. We can always try psychological therapy if he decides not too. I can see how the stress of making me happy could affect him, I do not want this for him.  I only wanted him to try to get help or even see if we could be helped and somewhere in between I may have got scared and lost what was important to me. I have told him a thousand times that it is he that I want and love and I will continue. There has to be a way through this, I will think positive.

Thank you!

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