Relation Of Sleep Apnia And Low Testosterone

[bhobba]

A friend has severe sleep apnea and uses a Cpap machine to manage it. He also has a testosterone level of 5. He has been as low as 3. He has some testosterone replacement left but is running out so went to his GP to get some more. He refused to give him any until they find the cause of the low testosterone. I thought sleep apnia caused it - it was obvious. Now he is desperate. His GP said he had a mate Dr So and So, just recently suspended for 3 years for prescribing testosterone so will not prescribe it.

I advised him to come up where I am. It's a much bigger city and can easily get a though going over by a good endocrinologist and sleep specialist - we have tons of them. I looked it up and 5 is pretty low - but 3 is really low. When it was that low he wanted to commit suicide - he felt so lousy. What worries him is they won't give him testosterone until its sorted out what's causing it. He is normally very rational, having a degree in biochemistry but this is really worrying him. I assured him both a competent endocrinologist and sleep doctor will not allow his testosterone to get so low he is suicidal, but is in a bad way. He will be coming up where I am soon and stay with his mother. I don't think there is anything to do other than getting him into the specialists ASAP - I know my GP's are very good at that - they get you in very quick if its needed. They got me in next day to an ophthalmologist when I had a suspected corneal ulcer - I did BTW. But what worry's me is why the hell his current doctors let him get so bad. 5 is pretty low and he is fastidious about seeing doctors for regular check-ups. Has the pendulum swung too far in using testosterone that GP's are now too afraid to prescribe it? And while where he lives is a relatively small town surely he shouldn't have to move up where I am for specialists to handle it? Or is GP's prescribing testosterone so much of an issue that's what it has come to?

Thanks
Bill

 

[BillTre]

WRT health care choices:

My parents lived in a rather rural area of the UP of Michigan. My sister (who spent a lot of time up there) thought they had pretty limited choices WRT health care issues and that the doctors were not so sharp or maybe not so aware of what might be available. On the other hand she has an emotional make-up.
I went to an old specialist once (he was at the bikini nuke tests with the navy!). I did not think he was all that in touch with modern methods. Younger docs will more likely be aware of current techniques.

Other issues could involve health plan/insurance and what kind of medical system your friend is associated, with if any. This may limit his choices.

 

[bhobba]

My parents lived in a rather rural area of the UP of Michigan. My sister (who spent a lot of time up there) thought they had pretty limited choices WRT health care issues and that the doctors were not so sharp or maybe not so aware of what might be available. On the other hand she has an emotional make-up. I went to an old specialist once (he was at the bikini nuke tests with the navy!). I did not think he was all that in touch with modern methods. Younger docs will more likely be aware of current techniques. Other issues could involve health plan/insurance and what kind of medical system your friend is associated, with if any. This may limit his choices.

I am in Australia - its a bit different here, but similar in many ways.

I think he is best coming where I am. We have specialists galore, and he has 100% heath cover the same as me, the top cover you can get. He has decided to come in a couple of weeks. I personally would like to see him come right now - with supplementation a testosterone of 5 is really low - it needs investigation by good specialists.

He has a degree in biochemistry, he knows this is serious, but I think the low testosterone is clouding his thinking. He has enough supplementation until he gets here so won't turn suicidal otherwise I would be really insistent he comes now.

Thanks
Bill

 

[Fervent Freyja]

Yes, there is a very big problem with testosterone supplements being prescribed far too often without thorough testing being done beforehand. There are three reasons that I know of for this: 1. It is performance enhancing and has a high potential for misuse. It improves energy levels, relieves depression, irritability, and many cognitive issues- it is known to produce an overall sense of well-being. So, the problem was that young men with only moderately low levels were going to their primary and getting a prescription without a thorough examination and testing for the cause of the low levels. Average and moderately low T levels can be somewhat improved without medications, but too many wanted to short-cut those methods to become superman. Doctors have been too lax in prescribing them in the past and it turned out that far too many men are on it without real great reason. They have been taking numerous actions to crack down on the problem. Your friends situation is a reflection of that. 2. This has high abuse by athletes, similar to the problem with other performance enhancing steroids. 3. Off-label use as male birth control. Testosterone replacement, at high levels, renders patients sterile. In about 90% of cases, the brain sends signals to the testes to stop T production which lowers sperm production to almost zero.

Right now, the doctor is being cautious. While your friends levels are currently low, it could be caused by tapering off/decreasing T replacement. Checking levels while on it doesn't show what they would be at naturally without the replacement, and, since your friend is a new patient, they are likely trying to confirm that the diagnosis had been initially valid. The doctor needs to check his levels once they build back up and plateau. That will take a while. My advice is to help him get off it as soon as possible so that testing can be completed. Make all the appointments with the endocrinologist close together. He will likely have a couple of appointments just for the blood work involved. There are numerous possible reasons he has low T, finding that can take months. Hypothalamus and pituitary defects, tumors, cancer, and brain damage all need to be ruled out, an undiagnosed genetic syndrome could be a cause. Another sleep study will probably be ordered. Poor sleep quality is found to affect levels, but sleep apnea is not likely the cause of it, this study states:

Although it is commonly asserted that OSA is a direct cause of the decrease in pituitary gonadal function, exposure of C57BL/6 mice to either 8 or 24 weeks of chronic intermittent hypoxia had no effect on plasma testosterone levels at either time point, [19] but the evidence in humans is mixed.

It could be that both the low levels and sleep apnea are both only secondary symptoms to a more serious condition. Your friend might be a little alarmed by the abrupt discontinuation of treatment, but you need to remind him that this new doctor is following a protocol that the prior one should already have. It's a good thing that he has your support. He will experience very uncomfortable existence after discontinuation. The only advice I can give you is to make sure he is catching up on his sleep, eating well, and keep him active. Keep watch on his mental state. You are right to worry that removing the testosterone could amplify already preexisting suicidal feelings and thoughts. You should make the suicidal behaviors/thoughts known during the first appointment, there are many medications that can make him feel less suicidal. That and being emotionally supportive will go a long way.

 

[bhobba]

Thanks for explaining what's happening.

He is coming up after Easter and will get a though going over by a Endocrinologist and sleep specialist.

I am sure they will do the right thing and ensure it doesn't get so low he is suicidal which is what worries him.

I am thinking seeing a good psychiatrist might help. He saw a VERY good psychiatrist that picked it up in the first place. I saw the same psychiatrist for reasons no need to go into here. Immediately he suspected sleep apnia and low testosterone where all the other doctors, including a psychiatrist he saw where he usually lives, said depression. He referred him to a endocrinologist and sleep doctor and was spot on.

Thanks
Bill