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Is it safe to undergo testosterone replacement therapy when diagnosed with sleep apnea?

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Posted on Tue, 24 Nov 2015
Question: Seven years ago, I was diagnosed as having a mild case and treated for sleep apnea. The therapy for this condition was successful and for over six years I have slept well without the aid of any physical device or medication. I am 84 years old and I have recently been diagnosed as a candidate for testosterone replacement. A specialist for this condition prescribed Androgel. This medication had little if any effect. I have been informed my physician, that injections are another and usual treatment for this condition. However, I was also informed that I would have to have another sleep study performed before this treatment could be prescribed. While I understand there are some ramifications about injections, I think, at my age, undergoing another sleep study is "over protective" and not realistically dealing with quality of life issues. What is your opinion and are there healthy alternatives?
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Answered by Dr. Shehzad Topiwala (4 hours later)
Brief Answer:
Sleep study / Testosterone

Detailed Answer:
Your doctor is following standard practice guidelines because testosterone should not be prescribed in severe untreated sleep apnea, as treatment with testosterone can worsen it.
Although the evidence for this is not very strong and in fact on the contrary, treating sleep apnea well can result in improvements in testosterone levels to normal.

But I follow your point that it may seem like too much is being done. However, we live in a litiginous society and best practices are typically encouraged.

That being said, I would like to highlight the testosterone matter at your age. There is age related decline in blood testosterone levels. Whether this is significant and worth treating is best handled by an endocrinologist who will need to the opportunity to examine you in person.
There are complex and subtle details to be kept in mind while assessing testosterone. For example. the blood levels must be checked in the morning time before 9 am preferably, for
CBC
CMP
Total Testosterone
SHBG
FSH
LH
Prolactin
Ferritin
TSH
HbA1c
25 hydroxy Vitamin D
PSA
Lipids

Some of these tests are done on sequential manner based upon results of previous tests but for convenience sake I have lifted them all together above.

If testosterone is low it must be confirmed on a second occasion to be indeed low before further extensive evaluations are undertaken.

A genital examination including that of the testicles and penis is also relevant.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala (1 hour later)
I thank you for your response. The blood tests you have suggested and follow up were taken on more than one occasion. While I do not have the exact results in front of me, they confirm that my testosterone was/is low. It seems you confirm my current physician's opinion about apena. However, until 4 years ago, my sexual life was all that I could ask for. About 3 years ago, when I had some problems, a Urologist, with the test results at that time, examined me. He found some unusual issues concerning what seemed to be a circumcision that was not complete and suggested a lack of use. (I have always had one testicle that seemed in a different position) I dismissed the evaluation as my sex life, until a year or two ago, has been very active and satisfying. Other than suggesting the use of the gel, and some hernia and slightly enlarged prostrate related issues, I found the experience very negative and decided to look for help elsewhere.
I seem to be in limbo. My wife is very comforting and seems to able to work out our sexual compatibility. My question is: are there other solutions e.g., over the counter testosterone, vitamin, etc. that may help? I know you hear athletes use these to increase performance abilities. This is not a typical case of ED. Without sounding gross, I think you understand.

Many thanks,
XXXX
doctor
Answered by Dr. Shehzad Topiwala (22 hours later)
Brief Answer:
Follow up

Detailed Answer:
I do understand your point.

No over-the-counter medication or supplement is suitable for this purpose.

Taking prescription testosterone helps ED when there is a genuine low testosterone state to begin with.

Have you discussed medications like Viagra or Cialis with your doctor to see if you are a candidate for those?

Furthermore, there are 'metabolic' conditions that need to be controlled for best erectile function. I am referring to blood pressure, glucose and cholesterol.

And finally there are some medications that hamper erectile function. It appears you are not those such as beta blockers for example.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Is it safe to undergo testosterone replacement therapy when diagnosed with sleep apnea?

Brief Answer: Sleep study / Testosterone Detailed Answer: Your doctor is following standard practice guidelines because testosterone should not be prescribed in severe untreated sleep apnea, as treatment with testosterone can worsen it. Although the evidence for this is not very strong and in fact on the contrary, treating sleep apnea well can result in improvements in testosterone levels to normal. But I follow your point that it may seem like too much is being done. However, we live in a litiginous society and best practices are typically encouraged. That being said, I would like to highlight the testosterone matter at your age. There is age related decline in blood testosterone levels. Whether this is significant and worth treating is best handled by an endocrinologist who will need to the opportunity to examine you in person. There are complex and subtle details to be kept in mind while assessing testosterone. For example. the blood levels must be checked in the morning time before 9 am preferably, for CBC CMP Total Testosterone SHBG FSH LH Prolactin Ferritin TSH HbA1c 25 hydroxy Vitamin D PSA Lipids Some of these tests are done on sequential manner based upon results of previous tests but for convenience sake I have lifted them all together above. If testosterone is low it must be confirmed on a second occasion to be indeed low before further extensive evaluations are undertaken. A genital examination including that of the testicles and penis is also relevant.