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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 29 Aug. 2021.
Note: one of the most frequently clicked on chapters (c.116,000) in last several years!)
   Sex hormone use to promote healthy longevity is an important question. It is being done in women after menopause with the female hormone estradiole (E2) but that remains controversial because of upping risks.  In men the use of the male hormone TEstosterone (TE) injections has been advocated but not much experience is available. Here is my report of TE injections after age 80. (Male hormone steroids are being massively misused by body builders and to enhance self image. I strongly do not advise them for that.)
   Men see a more gradual decline than women in sex hormone with aging. The blood Follicular Stimulating Hormone and Luteinizing Hormone (respectively, FSH and LH) are hormones of the anterior pituitary gland that stimulate the testes in men or the ovaries in women to make their sex hormone, Estradiole (E2) and TEstosterone (TE). They are also involved in sperm and egg production and release. These hormones, respectively, in men or women seem to delay the aging process.  They may not prolong life but it is hoped they will make the years after age 80 more vigorous and young-like.
   I became interested in this subject in my age 40s and started blood testing. My sex hormone blood tests from ages 47 to 83 follow here. (The 3 numbers after my age are TE in nanogram/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 within 2 times  + or -  (plus or minus) the average of 3 or more sample tests.

Age 47 – TE 1062, FSH 5.4 & LH 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 (TE and 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). Since 2015, my age from 83 blood test TE 300 to 500 when not getting TE injections.
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.   

In 1985 my sperm count was recorded very low; in 2011 at age 78, it was zero.

In the 39 yrs, from age 47 to now age 87, 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, age 85, after months in hospital was 0.1.) I have been waiting to see the elevation of FSH & LH that will tell me my body sensing system detects the drop in TE of my aging system. 
TEstosterone injections (against bad aging Brain changes) 250 mg Depo Testosterone intramuscular injection  every 2 to 4 weeks have risks relating to overdose: Most important are: the  stimulating prostate growth, obstruction and cancer; also hyper sexual stimulation, and high cholesterol and increased blood coagulation index which may be dangerous in the circulatory system. 

The Depo-TEstosterone Experiment.  After being in hospital from March to late June 2018 because of fractured pelvis from an accident and then for hip-joint replacement surgery, I was discharged 24 June 2018 and decided to start Depo-TE (Testosterone) 250 mg every 2-week injections. At that time I had just regained walking ability but with very little stamina, having to rest at frequent intervals. And I had an anemia (Hct 33%) from previous blood loss.  Just before the first Depo-TE injection, I got a blood test which showed my blood TE, 700 ng/dL (Quite good for age 85 and in absence of supplementary Depo-Testosterone). 
I got my first 250 mg Depo-Te intramuscular (IM) in shoulder, 19 July 2018 and 1 hour later my blood test showed blood TE 1000 ng/dL (10 ng/mL).  During the following 2 weeks I improved my stamina, I no longer needed to rest during long walks. And the feeling of chest compression from the anemia left me. 
 I got the 250 mg on 19 July, and, deciding to up the dose, I got two 500 mg single inj. each on 2 Aug. and 16 Aug., and, by then, I was feeling quite good with best physical stamina, and my blood test hematocrit, on 02 Aug., 41.3%, showed a marked increase from the previous low of 33%.  
 I notice mild increase in libido with more frequent though still weak erections.  Also good appetite with gain of 2 kg.  My LDL cholesterol rose from 60 to 88 and I restarted pravastatin to keep LDL low.  A blood test on 13 September, just before my TE injection, showed LDL cholesterol 44 and TG 46.
It is possible that the good effects I noted are just normal recovery from my hospitalization period due to good nutrition and vitamins.  But the Depo-TE certainly did not get in the way of the good results.
Further, on 13 Sept. was my injection and just before it (2 weeks since last TE injection) I had my blood drawn for sampling TE and it showed TE 1160 ng/dL (2 weeks after 2nd 500 mg Depo-TE injection), showing that at 500 mg TE Q 2-week dose, the blood TE maintains between 1000 and 2000 ng/dL.

From 20 December 2018 to end of February 2019, I went without Depo-TE injections. I did not notice any signs of the lack of the TE 2-week injections.
 In late February 2019, I resumed the Q 2 week 250 mg injections preceded by blood test for Te. I continued these 2-week-interval injections to July 2019, almost exactly 1 year after I started the injections.
I was not regularly checking my daily blood pressure until July 2019. Then I got the equivalent of 24-hour BP and began daily BP checking.   I was shocked to find I had developed hypertension, systolic 170-180/ diastolic 90 to 105. Blood tests revealed a hyperaldosteronism which certainly was the cause of my new hypertension. My medical consultant noted the the blood tests strongly suggested that the TE injections had caused the hyperaldosteronism and secondary hypertension. I stopped the TE injections, my last of the series being 26 Aug. 2019 and by 1 week after missing my last TE injection, my BPs had returned to a more normal 140/75.
   After a hiatus of several months without the TE injections I have resumed the injections (starting 14 May 2020) but now 250 mg on a once-a-month basis. I decided to continue albeit at a less frequent dose schedule because I feel it offers protection against old-age dementia and adds to my energy level. I will continue to report the results. (Good to date!) 
   As of this latest update, I am feeling good with no complications. I still have weak erections although I can masturbate to orgasm easily, have erotic dreams occasionally and could perform well with an enthusiastic partner.  I continue to get 250 mg IM injections of Depo-TE in the hope they will prevent or delay senile dementia (Alzheimer’s, et al) My BP and RHR have normalized on a regimen of beta-blocker, ACE-I and thiazides diuretic daily.

 If you are going to use TE in this way, you must accept the risks (For risk-takers only) and at least monitor your blood test TE, and watch your BP, and do not exceed 250 mg Depo TE on a once every 4-week basis.  I shall continue that and report at updates.

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 experimental, and in a healthy old man should not be needed before age 80. I was 85 in 2018 and my tests still showed good TE that gave me weak erections without Viagra (But with enthusiastic young partner the erections were good enough for satisfactory coitus.)  and very good orgasms by masturbation. But this recent experiment with Depo-TE suggests TE injections higher than 250 mg at a time or more frequent than once every 4 weeks may cause severe hypertension due to hyperaldosteronism.  
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