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Thursday, September 23, 2010

8.24 Male "Menopause" - Hormone Replacement?

Physician's Notebooks 8 - http://physiciansnotebook.blogspot.com - See Homepage


24. Hormones and Older Men - Update 11 Aug. 2018 (Note: this very popular chapter should be read, preceded by an initial or re-reading of the just previous chapter)
Men see a more gradual decline than women in sex hormone with aging. My blood Follicular Stimulating Hormone and Luteinizing Hormone (respectively, FSH and LH, the latter aka Interstitial Cell Stimulating Hormone, or ICSH) are hormones of the anterior pituitary gland that stimulate the testes in men or the ovaries in women to make their sex hormones Estradiole (E2) and TEstosterone (TE) as well as being involved in sperm and egg production and release. 
   My sex hormone blood tests from ages 47 to 83 follow here. (The 3 numbers after my age are TE in nanogram/dL (often reported per mL, which is 0.01 dL), and respectively, FSH & LH in milli-IU/ml)  Note: My blood tests were done 9 AM in overnight fasting, rested, healthy state from venous arm blood sample. Note in the below listing, the ± when it comes after the TE number is standard deviation, meaning that 95% of the test numbers in that year are 2 times  + or -  (plus or minus) the average of 3 or more sample tests.

Age 47 – 1062, 5.4 & 7.3; age 48 – 846, 5.0 & 6.0; age 49 – 535, 6.0 & 7.2; age 50 – 630, 4.8 & 12.0; age 52 – 970, 6 & 25.0; age 53 – 615±5, 3.8± 0.5 & 8.35± 0.05; age 54 – 1100, 5.1 & 11.7; age 55 - 731±23, 6.6 & LH not done; age 58 – 672, 2.9 & 2.4; age 59 – 564, 3.0 & 3.3; age 61 – 570, 3.0 & 3.0; age 65 – 356, 2.7 & 3.0; age 66 – 387, 2.6 & 2.0; age 67 – 612, 2.4 & 2.5; age 68 – 375, 2.61 & 2.0; age 69 – 378, 2.14 & 2.10; age 70 – 758, 3.6 (FSH only from here); age 71 – 491, 3.2; age 72 – 479, 3.5; age 73 – 448 (No FSH); age 74 – 527, 2.67; age 75 and 4 mos, 400 and 1.4; age 75 and 9 mos 138 (vitamin B12 and folic acid deficiency) and 2.25; age 77 (B12 and folic acid mega supplements from here) - 550±71 (TE only from here); age 78 - 566±102; age 79 - 521±106; age 80 - 560±63; age 81 in year 2014 - two tests only gave 564 and 615. In year 2015 (767 and 640)
Averages of TE±Standard Deviation pg/ml by age decade: age 40s decade, 814±264(3 tests); age 50s decade, 755±202; age 60s decade, 446±113; age 70s decade, 527±101; age 80 to 82, 703 ave. (Note the improvement from the age 60s low due to taking megadoses vitamin B12 and folic acid from age 75 on.    

I last got a woman pregnant in 1984 at age 51. In 1985 my sperm count was recorded very low; in 2011 at age 78, it was zero.

In the 33 yrs, from age 47 to now age 85, my average TE has dropped from a high of 1100 nano/dL (single test, age 54) to low average 446 during age 60s, while FSH and LH has not risen, even with a TE as low as 138 at age 75 when I had vitamin B12 and folic acid deficiencies proven by blood tests and anemia. The data suggest a man can drop TE to 1/8th of his highest test without ticking off the brain and pituitary glands' negative feedback.(My latest FSH after months in hospital was 0.1) I wait to see the elevation of FSH & LH that will tell me my body sensing system detects the drop in TE of my aging system (I am still waiting at 85) At that point, I will consider starting testosterone replacement treatment. (See later for my most recent TE injection experiment now in progress)
  Now, focus on the remarkable drop in serum testosterone (TE) to an apparent low – 138 ng/dL - in my blood sample in 2008, 23 Oct. at age 75. It coincided with the development of an anemia (hematocrit 33% verging on large size RBC, or macrocytic anemia with MCV 98) and also a worsening osteoporosis. I wondered if it was the start of my male menopause. But my anemia turned out to be due to a combined deficiency of folic acid and vitamin B12 proven by blood tests and, once I treated it and restored normal B12 and folic levels, my TE rose to 450 (and still remains in the 400 to 700 range in blood tests to last age 82) and I began to get better erections (but still weak). So you older men, rather than starting TE injections, first check your blood test B12 and folic acid if your erections fail. (By June 2012 still on megadoses of folic acid and vitamin B12 my TE increased to 753, a high level not seen since my late age decade 50s)

Testosterone injections have risk, relating to overdose: Most importantly stimulating prostate cancer and worsening its development and spread; also hyper sexual stimulation, high cholesterol and increased blood clotting which is dangerous in the circulatory system. 
The depo-TEstosterone experiment.  After spending 11 weeks in hospital from late March to late June because of fractured pelvis from accidental fall and also hip-joint replacement surgery, I was finally discharged from hospital 24 June 2018 and decided to start getting Depo-TE shots on an experimental basis. At that time I could walk but with very little stamina, having to rest at frequent intervals. And I had an anemia (Hct 33%) from previous blood loss.  At the time of getting my first Depo-TE, I got a blood test which showed the usual blood TE between 4 to 7 nano/mL (400 to 700 nano/dL) and my Hct 33% which explained my loss of stamina.  But I also had thigh muscles weakness from collapsed L-S vertebrae not related to the accident or the surgery but just the result of old age wear & tear and osteoporosis.  
I got 250 mg Depo-Te intramuscular (IM) in shoulder, 19 July and 1 hour later my blood test showed blood TE 10 nano/mL.  During the following 2 weeks I noted gradual improvement in my stamina, I no longer needed to rest during long walks. And the feeling of chest compression, probably from the anemia, on long walks left me.  Then on 02 August, I doubled my dose, getting 500 mg Depo-TE in shoulder and 1 hour later, my blood TE showed 19 nano/mL.  Now it is 10 days later and I am feeling quite good with best physical stamina and Hct 36%.  I plan to continue 500 mg Depo-Te every 2 weeks.  
One side effect I did not like is local affect on ulnar nerve from the shot in shoulder causing numbness in 3rd to 5th fingers.  So from now I will give myself IM injection into rectus abdominis muscle of abdomen.  I have also noticed mild increase in libido with more frequent though still weak erections.  Also very good appetite.
It is possible that the good effects are just normal recovery from my hospitalization period due to good nutrition and vitamins.  But the Depo-Te has certainly not got in the way of the good results so I continue it at level of 500 mg IM in abdomen muscle every 2 weeks.

The sex hormone blood levels from samples I obtained from a 104-year-old man showed undetectably low TE and E2 from very old age complete testes failure. His FSH & LH blood tests, 136 & 202 units were more than 20 times higher than normal levels in young men, and even into early old age. (See my FSH & LH tests above; in July 2018, my FSH 0.08 units, very, very low) The results with the centenarian suggest the brain does respond to low enough TE and E2 even into very advanced old age.

  The hormonal treatment of older men with aging testicular failure is highly experimental and in a healthy old man should not be needed before age 80. I was 82 in 2015 and my tests still showed good TE that give me weak erections without Viagra (But with enthusiastic young partner the erections are good enough for satisfactory coitus)  and very good orgasms by masturbation so I did not need testosterone injections or Viagra
END OF CHAPTER. To read next now, click 8.(25-26) Gynecologic Surgery and Uterine/Vaginal...



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